TB AT A GLANCE 

Tuberculosis (TB) is the most common opportunistic infection affecting especially those with HIV, further compounded by drug resistant TB. South Africa contributes around 80% of the global burden of TB cases and ranks fifth out of 22 high burden TB countries, with 692 cases per 100,000.  More than 70% of people with TB are found to be co-infected with HIV with KwaZulu-Natal accounting for 31% of all TB reported cases in the country.

Spread of TB 

The spread of TB in KZN is due to a combination of factors, including:

• The province has a high co infection rate of TB and HIV, currently at 65%.
• HIV infection increases the risk of contracting TB and contributes substantially in further fuelling the TB epidemic.
• HIV increases the risk of developing active TB for those infected with HIV from 10% in one’s life time to 10% per year.

What is multidrug-resistant tuberculosis and how do we control it? 

A: The bacteria that cause TB can develop resistance to the antimicrobial drugs used to cure the disease. Multidrug-resistant tuberculosis (MDR-TB) is TB that does not respond to the two most powerful anti-TB drugs. 

The reasons why multidrug resistance continues to spread is mismanagement of TB treatment and person-to-person transmission. Most people with tuberculosis are cured by a strictly followed, six-month drug regimen provided to patients with support and supervision. Inappropriate or incorrect use of antimicrobial drugs, or use of ineffective formulations of drugs (e.g., use of single drugs, poor quality medicines or bad storage conditions), and premature treatment interruption can cause drug resistance, which can then be transmitted, especially in crowded settings such as prisons and hospitals.

In some countries, it is becoming increasingly difficult to treat MDR-TB. Treatment options are limited and expensive, recommended medicines are not always available, and patients experience many adverse effects from the drugs. In some cases even more severe drug-resistant tuberculosis may develop. Extensively drug-resistant TB, XDR-TB, is a form of multidrug-resistant tuberculosis with additional resistance to more anti-TB drugs that therefore responds to even fewer available medicines. It has been reported in 100 countries worldwide.

Drug resistance can be detected using special laboratory tests which test the bacteria for sensitivity to the drugs or detect resistance patterns. These tests can be molecular in type (e.g., Xpert MTB/RIF) or else culture-based. Molecular techniques can provide results within hours and have been successfully implemented even in low resource settings.