TB’s preventative treatment regimen: a health worker shares her experience
When TB Preventative Therapy (TPT) was first adopted in South Africa in 2002, the idea was that it would only be offered to people who were at the highest risk of getting TB disease after being exposed. These were mainly children under the age of five and people living with HIV, regardless of their age.
At the time, preventative therapy entailed a cocktail of anti-tuberculosis medicines, given with the intention of preventing the person from getting TB. The treatment period was between one to six months and resulted in significant side effects which affected how people adhered to the regimens and whether or not they completed their treatment.
But in 2021 that all changed when a new treatment regimen was introduced with only three tablets which needed to be taken for a shorter period.
As a result, the National Department of Health’s National Guidelines on the Treatment of Tuberculosis Infection has now emphasised the need for a more comprehensive approach, extending TPT to anyone exposed to TB and other high-risk populations.
The belief is that the treatment regimen will present the latent infection from progressing into active TB disease.
In South Africa, where the incidence of TB is among the highest in the world, preventive treatment is seen as an essential tool to reduce transmission and prevent the development of active TB. Studies conducted with high-risk groups such as young children, adolescents, household contacts of TB patients, people living with HIV, gold miners and healthcare workers in South Africa, show that Latent TB Infection (LTBI) rates ranging from 26% to 89%. This is higher than the global prevalence of LTBI which is estimated at around 24.8%.
For most people the concept of taking medication when you’re not ill is foreign.
Dr. Tabitha Mathose, a healthcare professional and specialist Family Physician at the Cape Winelands district in the Western Cape, shares her experience of being on TB Preventative Therapy with TBAC.
She admits that taking pills for prevention when you’re not feeling sick is difficult. “My personal experience with TPT showed me how difficult it is to take pills for prevention when you’re not sick,” she says. The prescribed regimen involved taking 2 pills once a week for three months, a routine she often struggled to keep. “I would end up taking the pills on a different day,” she recalls.
This challenge is a common barrier to TPT adherence and underscores the need for solutions that can make the regimen easier to follow, especially when patients feel healthy. Adherence remains a significant challenge in combating the spread of TB in the country.
According to studies conducted by the Human Research Science Council, nearly half of patients on TB treatment struggle with adherence, which is directly linked to poorer outcomes, contributing to disease spread and the emergence of drug resistance TB (DR-TB).
When asked about how she adhered to the treatment regimen, Mathose explains that she kept the pills on her bedside table as a visual reminder, but the most significant factor was having a “TPT buddy”, a colleague who was also undergoing the treatment. “We kept each other accountable,” Mathose says. This mutual support proved to be key in ensuring both completed the full course, demonstrating how having a support system can help patients stay on track with their treatment.
She emphasises the importance of a social support, especially for patients on long-term treatment. “It’s very important to have someone to keep you on track,” she explains. This support can make a huge difference in ensuring treatment completion and fostering a sense of community in a potentially isolating process.
Beyond the need for support, Mathose faced challenges with the size of the pills and the inconvenience of having to remember to take the folder to the pharmacy. “Taking a lot of them at the same time wasn’t appealing,” she says. Moreover, accessing medication was sometimes difficult, but her role in a hospital allowed the pharmacy to deliver the pills to her office, making it easier. This experience made her realise the barriers many patients face in accessing TB medication, particularly those with limited access to healthcare facilities or cannot afford time off work.
These challenges have influenced Mathose’s approach to patient care. “TPT is a way for the healthcare system to get TB under control as it prevents high-risk populations from contracting TB,” she notes. From her perspective, TPT is essential not only for preventing TB in people but for controlling its spread in high-risk populations.
Another challenge Mathose highlights is the stigma surrounding TB. “Many people, including healthcare professionals, don’t know much about TPT, how it works or the side effects,” she says. This lack of awareness contributes to the stigma surrounding TB and prevents many people from seeking treatment. By sharing her personal experience with TPT, she hopes to break down these barriers and encourage others to embrace preventative therapy.
“Anyone can get TB, and it’s important for the public to understand that it knows no gender, race, or socioeconomic status,” she says.