TB remains the leading infectious disease killer in the world. The World Health Organization (WHO, 2020) reported that in 2019, 10 million people fell ill with TB and 1,4 million died. In South Africa, TB is the leading overall cause of mortality with a reported 58 000 deaths in 2019, despite it being a preventable and curable disease.

Latent TB
When a person with TB disease coughs, sneezes or talks, the TB bacteria are expelled in the air. The bacteria can stay in the air for a few hours, depending on the ventilation in the room. An uninfected person can inhale the TB bacteria and get infected with TB. This person may not present with TB symptoms as the bacteria can be dormant in the body. This is called latent TB (Aurum Institute, online). Yet, latent TB can progress to TB disease in one in ten people (WHO, online). Once someone is diagnosed with TB disease and starts TB treatment, the risk for transmission to others decreases dramatically.
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Pulmonary TB
The most common form of TB is pulmonary TB or TB of the lungs.

Extrapulmonary TB
TB can affect any part of the human body, from the brain to the toes. This type of TB is then called extrapulmonary TB (outside of the lungs).

TB treatment includes oral medication which is usually taken for six months, but it can depend on the type of TB a person has. The treatment can be difficult to take due to the number of pills. Some of the treatment side effects can be frustrating but not dangerous (for example making your urine and tears orange) but others can indicate a more dangerous problem. An example is vomiting and pain over the right side of the abdomen can be a sign of liver problems (National Tuberculosis Management Guidelines, 2014).

Recently, two new drugs, Bedaquiline and Delamanid, have been introduced by the South African Department of Health for use in all patients with DR-TB to replace the injectable drug (South African Government, 2018).

For information aimed at health workers about potential side effects of drug-resistant TB medication please visit this link: MDR-TB Pocket Guide, 2018

Many clinics and hospitals provide support groups for TB patients. Support groups provide an essential platform where TB patients and TB survivors can freely share about their TB experiences. Goodman Makanda, a TB advocate and TB survivor from Khayelitsha said, “My support group helped to keep me alive, it was where I was able to talk to someone who understood what I was going through”.

Remember you are not alone. Contact the toll free helpline accessible from South Africa at 0800 012 322.
You can also join our TB Proof community. Click here to find out more on how to join TB Proof.

There are new national guidelines  from the National Dept of Health related  to the situation of this  family.

All close contacts  (not only  young children) of a person diagnosed with TB need to do the following:

1. Be tested for TB themselves 

• This involves providing a sputum sample which is tested for TB in a lab. 
• Close contacts need to be tested whether or not they have any symptoms of TB. 
• The definition of a close contact:  it is a person who has had a ‘significant TB exposure’ – that is: shared the same enclosed space or shared living arrangement with the person with TB for one or more nights or for frequent or extended daytime periods during three months before the person started taking TB treatment. It could also be an employee or co-worker, someone who regularly shares transport.
• Children under 5 who are unable to produce sputum should be examined by a doctor to make sure they are well  and have no signs of TB –  they would check for any weight loss, enlarged  lymph nodes, or respiratory / chest    If there are any concerns or uncertainty about possible TB, a chest XRay can be done, but is not mandatory. 

2. If any close contacts r are diagnosed with TB, they  need to take a full course of TB treatment.
3. If close contacts test negative for TB,  or a child has no signs on examination of TB disease,  then they should take TB preventive treatment (TPT).  

• This would include all the members of the household who have regular  / prolonged contact with the caregiver. 
• There are different options for TPT, depending on the age of the person.
• One option (for adults) is to take a once a week  course of TPT medicines for 3 months = a total of 12 doses.  This is called the 3HP regimen of TPT.
• A child could take a daily TPT medicines (called 3RH) for 3 months.  This medication is used very commonly and does not generally have any serious  side effects – children are much more tolerant of TB medication than adults. 

TB testing and TPT is available for free at all state / government clinics. 

BACKGROUND  INFORMATION REGARDING  THE  NEW  TB POLICIES

The South African National TB prevalence survey showed that 57.8 % of people included  who were diagnosed with TB (based on sputum tests or chest X-Rays), had no TB symptoms. So, many people have asymptomatic TB, and the only way we will find them is to do more TB testing – this is called  systematic screening.

1. Test and Treat: systematic screening for TB

The  TB Testing and Screening Standard Operating Procedure  ( www.nicd.ac.za/wp-content/uploads/2023/10/TB-SCREENING-AND-TESTING-SOP-2022.pdf)  released by the National Department of Health in 2022, provides information on the Targeted Universal TB Testing (TUTT) policy and how it should be implemented.

TUTT stands for Targeted Universal TB Testing. It recommends  that high risk individuals are tested for TB,  whether or not they  have symptoms of TB.  High risk groups include  close contacts of people diagnosed with TB,  people living with HIV and people  who had TB in the previous  two years. Testing does not depend on symptoms. The goal  of this policy is to find missing people with TB and make sure they get  fully treated .

2. TB Preventative Treatment (TPT): National guidelines on the “Treatment of TB Infection” Policy

The 2023  national TB policy called the “National guidelines on the Treatment of TB Infection”,  (https://sahivsoc.org/Files/Health_Latent%20TB%20Infection_2023_web.pdf) commonly referred to as the “TPT policy” recommends that people who are at higher risk of getting TB should be offered TB preventive medication to prevent TB, after TB disease is ruled out. 

What is new in this policy is that the eligibility criteria TPT have been expanded (to include  close contacts of people diagnosed with TB), and also that there are shorter TPT regimens. Instead of taking medication daily for 6 months (6H which is INH = Isoniazid)  there are  now 2 shorter  new TPT options:

1. 3HR (Isoniazid + Rifampicin): taken daily for 3 months. There is as a combination pill for adults, and syrup formulations for children.
2. 3HP (Isoniazid + Rifapentine) taken once a week for 3 months. A total of 12 doses.

These new policies are part of global efforts to end the TB epidemic.  Knowledge of  TB is empowering. Tell others what you know about TB.  We can all make a difference in the quest to end TB.