Drug-resistant TB is caused by TB bacteria that are resistant to at least one first-line anti-TB drug. Multidrug-resistant TB (MDR TB) is resistant to more than one anti-TB drug and at least isoniazid (INH) and rifampin (RIF).

Treating and curing drug-resistant TB is complicated. Inappropriate management can have life-threatening results. Drug-resistant TB should be managed by or in close consultation with an expert in the disease.

The most important way to prevent the spread of drug-resistant TB is to take all TB drugs exactly as prescribed by the health care provider. No doses should be missed and treatment

should not be stopped early. People receiving treatment for TB disease should tell their health care provider if they are having trouble taking the drugs.

Health care providers can help prevent drug-resistant TB by quickly diagnosing cases, following recommended treatment guidelines, monitoring patients’ response to treatment, and making sure therapy is completed.

Drug-resistant TB can occur when the drugs used to treat TB are misused or mismanaged. Examples of misuse or mismanagement include

• People do not complete a full course of TB treatment
• Health care providers prescribe the wrong treatment (the wrong dose or length of time)
• Drugs for proper treatment are not available
• Drugs are of poor quality

Drug-resistant TB is more common in people who

• Do not take their TB drugs regularly
• Do not take all of their TB drugs
• Develop TB disease again, after being treated for TB disease in the past
• Come from areas of the world where drug-resistant TB is common
• Have spent time with someone known to have drug-resistant TB disease

MDR-TB is a drug-resistant TB occurs when bacteria become resistant to the drugs used to treat TB. This means that the drug can no longer kill the TB bacteria.

Drug-resistant TB (DR TB) is spread the same way that drug-susceptible TB is spread. TB is spread through the air from one person to another. The TB bacteria are put into the air when a person with TB disease of the lungs or throat coughs, sneezes, speaks, or sings. People nearby may breathe in these bacteria and become infected.

IPT services are widely available in public and private facilities throughout Tanzania, luckily the services are provided free of charge to all beneficiaries

• Erratic supply of INH, this interrupt the IPT cascade hence completion rate become low
• Un trained staffs fear to provide INH
• Few clients reported side effects on INH requiring pyridoxine (not easily available)
• Clients and community misconceptions about IPT (Drug resistance, side effects)
• Poor documentation on IPT parameters in national tools i.e Presumptive TB Registers & CTC 2 cards
• High staff turn-over -Shortage of trained staff
• MMS against IPT (Stable clients to unstable criterial difficult on actual practices)
• Poor quality of TB screening by health care
• Difficulties to verify active TB especially in poor setting facilities (peripheral and difficulties to reach facilities)

PLHIV are at high risk of developing active TB at any time in their life time due to compromised immunity, Isoniazid is one of the most effective bactericidal, anti-TB drugs available at present. While it protects against progression of latent TB infection to active disease i.e. reactivation, it also prevents TB reinfection post the exposure to an open case of TB.  

In Tanzania people who at high risk for TB can get and benefit to IPT schedule, this population includes:

• HIV exposed and unexposed infants of contact with TB mothers
• All children young than five in contact with smear positive TB patient
• Hospitalize and outpatients HIV positive patients who have no symptoms of TB
• HIV positive household who are in contact with TB patients
• HIV positive health workers
• HIV positive prisoners
• Other HIV positive individual in congregate setting e.g Mineworkers

Isonaizid Preventive Therapy is the administration of INH to individuals with latent TB infection in order to prevent progression to active TB Disease.

• The two diseases are a deadly combination; they are far more destructive together than either disease alone
• In developing countries many people infected with HIV contract TB as the first sign of AIDS
• At least one-third of the 38.6 million HIV-positive people in the world are also infected with TB and are at greatly increased risk of developing TB disease (the active and contagious form of TB)
• TB is the leading cause of illness and death among people living with HIV in Africa and a major cause of death in HIV-positive people living elsewhere. In some settings, TB kills up to half of all AIDS patients

HIV and tuberculosis (TB) are so closely connected that their relationship is often described as a co-epidemic. In the last 15 years the number of new TB cases has more than doubled in countries where the number of HIV infections is also high.

People living with HIV are more likely than others to become sick with tuberculosis (TB). This is because HIV weakens the immune system, which makes it harder for the body to fight TB germs.

If you have HIV, it is important to know if you have TB infection because HIV weakens the immune system. When a person’s immune system is weak, latent TB infection can quickly progress to TB disease. If you have HIV, it is very important to get a TB test.

If you have latent TB infection or TB disease, and you do not know your HIV status, you should get an HIV test. This will help your physician know how to treat both your TB and HIV infections.

Good News!

The good news is that TB disease can be treated and cured. The first step is to find out if you are infected with the TB germs. You can do this by getting a TB diagnosis test.  You can get this TB from any public or private health facilities free of charge; hurry up!!! if you have any sign suggestive of TB

TB prevention consists of several main parts.

1. Stopping the transmission of TB from one adult to another

This is done through firstly, identifying people with active TB, and then curing them through the provision of drug treatment. With proper TB treatment someone with TB will very quickly not be infectious and so can no longer spread TB to others.

1. Other TB prevention activities

There are several other TB prevention activities. This includes preventing people with latent TB from developing active, and infectious, TB disease. TB infection control including the use of respirators and masks, which means preventing the transmission of TB in such settings as hospitals & prisons. The pasteurization of milk also helps to prevent humans from getting bovine TB. There is a vaccine for TB, but it makes only a small contribution to TB prevention. It does little to interrupt the transmission of TB among adults.

• Educating people about TB is also an important part of TB prevention, as well as ensuring that people who need treatment receive it as soon as possible.

Actions to be taken

In order to reduce exposure in households where someone has infectious TB, the following actions should be taken whenever possible:

• Houses should be adequately ventilated;
• Anyone who coughs should be educated on cough etiquette and respiratory hygiene, and should follow such practice at all times;
• While smear positive, TB patients should:
  • Spend as much time as possible outdoors;
  • If possible, sleep alone in a separate, adequately ventilated room;
  • Spend as little time as possible on public transport;
  • Spend as little time as possible in places where large numbers of people gather together.

TB bacteria are spread through the air from one person to another. The TB bacteria are put into the air when a person with TB disease of the lungs or throat coughs, speaks, or sings. People nearby may breathe in these bacteria and become infected.

TB is NOT spread by:

• shaking someone’s hand
• sharing food or drink
• touching bed linens or toilet seats
• sharing toothbrushes
• kissing

When a person breathes in TB bacteria, the bacteria can settle in the lungs and begin to grow. From there, they can move through the blood to other parts of the body, such as the kidney, spine, and brain.

TB disease in the lungs or throat can be infectious. This means that the bacteria can be spread to other people. TB in other parts of the body, such as the kidney or spine, is usually not infectious.

People with TB disease are most likely to spread it to people they spend time with every day. This includes family members, friends, and coworkers or schoolmates.

Symptoms of TB disease depend on where in the body the TB bacteria are growing. TB bacteria usually grow in the lungs (pulmonary TB). TB disease in the lungs may cause symptoms such as

• Cough that lasts 2 weeks or longer
• Frequency of fevers
• Coughing up blood or sputum (phlegm from deep inside the lungs)
• Excessive night sweats
• Noticeable weight loss

Other symptoms of TB disease are

• weakness or fatigue
• chest pain
• no appetite
• chills

Symptoms of TB disease in other parts of the body depend on the area affected.

Tuberculosis (TB) is a disease caused by bacteria that are spread from person to person through the air. TB usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys, or the spine. In most cases, TB is treatable and curable; however, people with TB can die if they do not get proper treatment.