treatment Makasine wa Treatment Action Campaign Pudungwana 2008 Thibelo, Ho fumana bolwetse le Kalafo TB le HIV

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1 EQUAL treatment Makasine wa Treatment Action Campaign Pudungwana 2008 Thibelo, Ho fumana bolwetse le Kalafo TB le HIV 1

2 Editor: Jo-Anna Gorton Sub-Editor: Nathan Geffen Front Cover Photo by Sofia Tasolari Writing contributers: Andrew Warlick, Lesley Odendal, Hannan Braun, Katie Flannery, Lutti Ewers, Paula Akugizibwe, Johanna Ncala, Teryn Allen, Javid Syed, Nosisa Mthlathi, Nokhwezi Hoboyi, Claire Wingfield, Fatima Hassan, Scott Dunlop, Vatiswa Kamkam, Jessica Kiddle, Micheal Mackenzie, Thandeka Vinjwa and Adam Malapa. TSE KA HARE Phatlalatso ya 26 - Pudungwana 2008 Photos: Nick Fletcher, Sofia Tasolari, Damien Shuman, Kristian Dubrawski, Michael Maurel, TAC Policy Communications and Research Department Special thanks to Sharon Ekambaram, Professor Ben Marais, Polly Claydon, Eric Goemare, Graeme Meintjies, Francois Venter, Sister Phumi, the staff of the Khayelitsha Ubuntu Clinic, Helen Cox, Thami Ndlovu (Infection Control Practitioner for MSF) and Busisiwe Beko (MSF DR TB counsellor). Distribution: Faniswa Filani Layout: Designs4development, info@d4d.co.za Printing: CTP Book Printers TAC is committed to providing people with HIV, their families and caregivers accurate information about life-saving medicines and treatment. However, TAC and its leaders are independent of the pharmaceutical industry and have no financial interests with it. Equal Treatment is published by the Treatment Action Campaign. Postal Address: PO Box 2069, Cape Town Physical Address: Westminister House, 122 Longmarket Street, 3rd Floor, Cape Town Phone: 0861 END HIV Fax: Website: Provincial and District TAC offices Western Cape Province: Khayelitsha District: Gauteng Province: Ekurhuleni District: Limpopo Province: Elim District: Mpumalanga Province: Eastern Cape Province: Lusikisiki District: Queenstown District: Kwazulu-Natal Province: Pietermaritzburg District: Ilembe 2 District: page 2 page 10 page 22 page 31 Ho fumana bolwetse Hlahlobo ya ho bona TB e kenyelletsa hlahlobo ya mmele ho bona matshwao le diteko tsa ho bona baktheria ya TB. Re lokela ho ba le phihlelo ya disebediswa tse ntlafetseng tsa ho etsa diteko tsa TB, haholoholo tseo tse tla bona TB ho ba tshwaeditsweng ke HIV le TB ka bobedi. Kalafo TB e ka phekolwa. Karolo ena e lekodisisa kalafo ya ho qala ya TB, dikamahano tsa meriana, ditlamorao, jwala le TB ekasitana le kalafo bakeng sa bana le ka nako ya boimana. TB e Hanyetsanang le Meriana (TB e hanyetsanang le meriana) TB e hanyetsanang le kalafo ya ho qala ya TB ke bothata bo ntseng bo hola mona Afrika Borwa. Karolo ena e kenyelletsa diathikele tse mabapi le saense ya TB e hanyetsanang le meriana, mekgwa e fapaneng ya tlhokomelo ya batho ba nang le MDR le maano ao Afrika Borwa e a nkileng mabapi le kalafo ya batho ba nang le TB e hanyetsanang le meriana. Ditaba tsa TAC Lehloyo la batho ba tswang dinaheng tsa ka ntle mona Afrika Borwa Ka Motsheanong 2008 ho ile ha tloha merusu kgahlanong le baahi ba matjhabeng. TAC e ile ya thusa ho etella pele karabelo kgahlanong le ditlhaselo.

3 Bohlophisi TB ke bolwetse bo phekolwang. Empa selemo le selemo batho ba bangata haholo ba kula mme ba shwa ke baka la TB. Ba bangata ba batho bana ba tshwaetswa ke HIV le TB ka bobedi. Bothata bona ba ha jwale ba TB bo bakwa ke dilemo tse ngata tsa tshebetso e fokolang ya mananeo a TB mmoho le sephetho sa sewa sa HIV se behang dimiliyone tsa batho kotsing e hodimo haholo ya ho kenwa ke TB. TB e fokodisa kgatelopele yohle e entsweng twantshong ya AIDS. Batho bao e ka bang ba ka be ba phela hantle ba ntse ba na le HIV ba shwa ka baka la TB. TB ha se feela sesosa se ka pelepele sa se bolayang batho ka AIDS mona Afrika empa hape ke sesosa se seng se ka pelepele se bolayang batho le mona Afrika Borwa. Hona ho tshabeha hampe haholo. TB e ka phekolwa ha batho ba ka fuwa tlhokomelo ya bophelo e nepahetseng. Ntho e sehloho ke hore mananeo a rona a TB a hlolehile ho lokisa diphoso tse bakileng mathata ana qalong. Ke 1% feela ya batho ba phelang ba na le HIV lefatsheng lohle ba hlahlobilweng bakeng sa TB. Metheo ya taolo ya TB eo e leng taolo ya tshwaetso, ho fumanwa ha bolwetse bona bo sa qala, tshehetso ya bakudi le tshalomorao ya ho netefatsa hore ho phethwa ha kalafo e ba ntho ya sebele ho ena le ka moo re tsebang kajeno. Hodima moo baahi ha ho eso rerisanwe le bona hantle kapa ba fuwa tshehetso twantshong ya TB. Hona ho baka ho se utlwisise le sekgobo kgahlanong batho ba nang le TB. Mmuso wa rona o lokela ho etsa ho hongata ho feta mona. Re na le tokelo ya ho tseka hona mmoho le maikarabelo a ho etsa bonnete ba hore re ba le seabo ka mafolofolo taolong le kalafong ya TB baahing ba habo rona. Phatlalatso ena ya Equal Treatment e tla lekola ditsela tse fapaneng tseo re ka di sebedisang ho thusa ho thibela TB. Re na le tsela e telele eo re lokelang ho e tsamaya empa ka thuto e mabapi le kalafo bohle re ka ba le seabo se mafolofolo jwalo ka batshehetsi ba molemo, batho ba kenyang mananeo tshebetsong le balebedi ba mananeo a tlhokomelo le taolo ya TB baahing ba habo rona. Johanna Ncala, TAC Treatment Literacy Paula Akugizibwe, Aids and Rights Alliance for Southern Africa 1

4 TB Afr Ho fumana bolwetse 2 Setshwantsho: Sofia Tasolari TB e amanang le HIV ke yona e bakang ho hlokahala ha batho ka bongata mona Afrika Borwa. Palo ya batho ba hlokahalang e bakwang ke TB e batlile e menahana hararo pakeng tsa 1997 le TB e sitisana le kgatelopele eo re seng re e entse twantshong ya HIV. TAC haesale e ntse e sebetsa ho thusa ho laola le ho alafa TB. Jwale re ntse re matlafatsa maiteko a rona le ho feta pele. Re lokela ho etsa bonnete ba hore mmuso, mokga wa poraefete le setjhaba ekasitana le batho ba itlama ho thibela TB. Ka thuto ya kalafo bohle re ka ba batshehetsi ba molemo mme ra sebeletsa ho qala le ho lebela mananeo a TB diterekeng tsa rona. Re lokela hape le ho ba le letsholo mabapi le ditaba tsena tsa bohlokwa: Ho etsa bonnete ba hore tlhokomelo ya HIV le TB ho fanwa ka tsona ka bobedi ditliliniking le dipetlele. Ho hlokeha boetapele ba dipolotiki maemong ohle ho etsa hore hona ho phethahale. Taolo e akaretsang ya tshwaetso: Ho ba le taolo e sebetsang hantle haholo ya tshwaetso malapeng a rona, dibakeng tseo re sebetsang ho tsona, transporotong le dibakeng tsa tlhokomelo ya bophelo ho ka fokotsa ho hasana ha TB. Re lokela ho ruta baahi ba habo rona ka taolo ya tshwaetso (sheba leqephe la ho IC). Tswelopele ya ho fana ka kalafo ya dilwantshamahloko tsa di-antiretroviral: Kalafo ya di-arv bakeng sa bao ba di hlokang e fokotsa kotsi ya ho kenwa ke TB e mahlahahlaha ka 50% (halofo).

5 ika e ka Borwa Kalafo e thibelang bakeng sa batho bohle ba nang le HIV: Diphuputso tse entsweng lefatsheng lohle di bontshitse ha batho ba nang le HIV ba nkang kalafo ya thibelo ba kgonang ho fokotsa haholo kotsi ya bona ya ho kenwa ke TB e mahlahahlaha (sheba leqephe la 20 bakeng sa ho tseba haholwanyane ka IPT). Batho ba bangata ba etswa diteko nako e sa le teng bakeng sa TB: Batho ba phelang ba na le HIV ba lokela ho etsa diteko tsa TB kgafetsa. Batho ba fumanwang ba na le TB ba tshwanetswe ho fuwa dikeletso tsa hore ba fumane diteko tsa HIV. Re lokela ho sebeletsa ho lemoha matshwao a TB mme re kgone ho fihlela diteko tse nang le dikarolo tse fapaneng hape tse ntlafetseng tsa TB. Tshehetso le tshireletso ya bao ba behwang ba le bang ka baka la TB: Batho ba beuweng ba le bang ka baka la TB e hanyetsanang le meriana dithuso tsa bona tsa setjhaba di a hlakolwa. Re lokela ho ba le letsholo la hore mmuso o phetha boikarabelo ba ona ba semolaotheo mme o fane ka tshehetso e eketsehileng ho ba malapa a anngweng ke TB e hanyetsanang le meriana (sheba leqephe la 25 bakeng sa ho eketsehileng ka ditokelo tsa botho le TB). Tshehetso le tshalomorao ya batho ba leng kalafong ya TB. Mamello e fokolang ya kalafo ya TB e beha batho le baahi kotsing ya ho hlaha Tb e hanyetsanang le meriana. Mehlodi: STATS SA, TAC IPT Brief 2008 Mama Maposela o hlokomela bana lekeisheneng la Gugulethu mane Western Cape. Bongata ba bana pejana ba ne ba dula diterateng. Ba bangata ba bona ba na le TB. Ka tshehetso ya Desmond Tutu TB Centre, Mama o ntse a tswela pele ho fana ka tlhokomelo le tshehetso bakeng sa bana ba leng kalafong ya TB. Ho fumana bolwetse Setshwantsho: Damien Schumann 3

6 Saen Setshwantsho: Sofia Tasolari Jwalo feela ka HIV re lokela ho ba le kutlwisiso e ntlafetseng ya saense ya TB. Re lokela ho utlwisisa hore na TB ke eng le hore re tshwanetse ho etsa diteko tsa TB neng. Re lokela hape le ho utlwisisa ka moo kalafo ya TB e sebetsang ka teng e le hore re tle re kgone ho thusa ho bopa le ho lebela mananeo a TB hara baahi ba habo rona. Baktheria ya TB e ka bonwa feela tlasa microscope Na TB ke eng? TB e bakwa ke baktheria e bitswang Mycobacterium Tuberculosis. Baktheria ke dikokwanahloko tse nyenyane tse ka bonwang feela ka tlasa microscope. Baktheria fumanwa mmeleng ya rona hape le metsing, dimeleng, mobung le diphoofolong. TB haesale e ntse e le teng dilemong tse ngata haholo. TB e ka dula mmeleng dilemo tse ngata ntle le ho o kudisa. Hona ho etsahala ka baka la hobane boitshireletso ba mmele wa hao bo kgona ho lwantsha baktheria le ho e thibela hore e se ikatise. Ha ho na le TB mmeleng wa hao empa wena o kgona ho e thibela hore e se ikatise hoo ho bitswa TB e Ipatileng. Ha motho a na le boitshireletso bo fokolang ba mmele, jwalo ka motho ya tshwaeditsweng ke HIV, moo ha a sa kgona ho lwantsha baktheria ya TB. Ha hona ho etsahala mme baktheria e kgona ho ikatisa hoo ho bitswa TB e Mahlahahlaha. TB e feta ho tswa mothong e mong ho ya ho e mong hape ka moya. TB e Mahlahahlaha hangata e hlaha matshwafong. Yona e bitswa Pulmonary TB. Ha motho ya nang le Pulmonary TB a kgohlola, a thimola kapa a bina, baktheria ya TB e tswela moyeng ka dikarolwana tse ka bonwang ka microscope tse bitswang di-droplet nuclei. Di-droplets tsena, tse nang le baktheria ya TB ka hara tsona, di ka dula moyeng nako e telele. Hona ke nnete haholo haebe tikoloho e tletse haholo. Ha motho a hema moya o tletseng di-droplets tsena baktheria e ka kena matshwafong a hae. 4 Kotsi ya hao ya ho hema baktheria ya TB e eketseha ha o nka nako o na le motho ya nang le TB kap o le dibakeng tse tletseng batho ho feta tekano. Tsela e ntle ya ho thibela TB hore e se hasane ke ho ba le taolo e sebetsang hantle ya tshwaetso

7 se ya TB jwalo ka ho boloka difenstere di butswe kapa ho kwala molomo wa hao ha o kgohlola. HIV le Extra-pulmonary TB Ha batho ba nang le boitshireletso bo fokolang ba mmele TB e ka hasana ho tloha matshwafong ho ya dikarolong tse ding tsa mmele. Hona ho bitswa Extra-pulmonary TB mme ho tletse haholo bathong ba nang le HIV. Ha o na le TB dikarolong tse ding tsa mmele matshwao a tla fapana le a batho ba nang le TB fela matshwafong a bona. Diteko tsa hao tsa TB hape di ka ba le diphetho tse fapaneng. Ho bohlokwa hore batho ba nang le HIV ba bolle tliliniki ya TB hore ba na le HIV hore ba tle ba tsebe ho sheba matshwao a extra-pulmonary TB. Ha ke na le TB, na hoo ho bolela hore ke na le HIV? Tjhe. Motho e mong le mong a ka kenwa ke TB. Batho ba nang le HIV ba kotsing e kgolo ya ho kenwa ke TB hobane boitshireletso ba mmele ya bona bo a fokola. Ho qala ka di-arv ha o di hloka ho ka fokotsa haholo kotsi ya ho kenwa Ho tshwaetswa ke bobedi Lefuba/HIV HIV e fokodisa boitshireletso ba mmele wa motho. Hona ho beha motho kotsing ya ho kenwa ke TB e mahlahahlaha. Batho ba nang le HIV ba kotsing e kgolo ya ho kenwa ke TB e mahlahahlaha ho ena le bao ba se nang vaerase ena. ke TB e mahlahahlaha. Ha o na le HIV o lokelwa ho hlahlojwa bakeng sa TB dikgwedi tse ding le tse ding tse 6. Batho ba nang le TB empa ba sa tsebe boemo ba bona ba HIV ba lokelwa ho fuwa dikeletso tsa ho etsa diteko tsa HIV. Na TB e ka fetoha ho ba HIV? Tjhe. TB le HIV ke dikokwanahloko tse fapaneng. TB ke baktheria ha HIV yona e le vaerase. Ho ke keha kgonahala ho hang hore TB e fetohe ho ba HIV. Na ho na le pheko bakeng sa TB? Ee. Ka kalafo motho a ka phekolwa TB (bakeng sa ho tseba haholwanyane sheba leqephe la 10-14). TB e feta ho tswa mothong e mong ho ya ho e mong hape ka moya. Ha motho ya nang le TB e mahlahahlaha a kgohlola, baktheria ya TB e tswela moyeng Baktheria ya TB TB e hengwa ke motho e mong Ho fumana bolwetse 5

8 Ho etsa diteko tsa TB Ha se batho ba bangata ba etswang diteko e be ba hlahlojwa e be ho fumanwa hore o na le TB. Hona ke nnete haholo bathong ba phelang ba na HIV. Ho lekanyetswa hore ke 2% feela ya batho ba phelang ba na le HIV ba etsang diteko kgafetsa bakeng sa TB mona Afrika Borwa. Batho ba ka etsa diteko tsa TB ka ho sheba matshwao a bona le ho etsa diteko hape le diteko tsa baktheria ya TB. Ho hlahlojwa e be ho fumanwa hore o na le TB ho bolela hore motho a ka qala kalafo e be wa phekolwa. Ha diteko di supa hore o na le TB, ditho tsa lelapa la hao le bohle ba haufi le wena ba lokela ho etsa diteko tsa TB Ditshupo le Matshwao a TB Matshwao a tlwaelehileng haholo a TB ke ho ota le ho kgohlola bakeng sa dibeke tse pedi. Hangata batho ha ba lemohe hore ba na le TB hobane matshwao a ka nka dibeke kapa dikgwedi pele a bonahala. Ha o na le afe kapa afe a matshwao a hlalositsweng mona ka tlase o lokela ho etsa diteko tsa TB. Ha o tshwaeditswe ka bobedi ke HIV le TB mosebeletsi wa hao wa bophelo o lokela ho sheba matshwao a extra-pulmonary mmoho le pulmonary TB. Haebe ha ho na diteko tsa baktheria, ditataiso tsa World Health Organisation (WHO) di re ngaka e ka hlahloba motho ya nang le extra-pulmonary TB ka ho ya matshwao a hae e le hore ba tle a qale ka kalafo hanghang. Matshwao a Tlwaelehileng a Pulmonary le Extra-Pulmonary TB Ho ota Ho kgohlola bakeng sa dibeke tse pedi Feberu Hlooho e opang Ho fumana bolwetse Mahlaba sefubeng / Bothata ba ho hema Mahlaba Molaleng kapa masapong a mokokotlo Mpeng: Ho ruruha kapa Mahlaba 6

9 Diteko tsa baktheria ya TB Ho bokella Sekgohlela Ha o ya tliliniking bakeng sa diteko tsa TB apoyentemente ya hao le mosebeletsi wa bophelo e lokela ho kenyelletsa diteko tsa baktheria ka hodima hlahlobo ya mmele bakeng sa matshwao a hao. Ha o na le HIV, ho bohlokwa hore o tsebise mosebeletsi wa hao wa tsa bophelo ka hona. Hona ha se ka baka la hobane matshwao a hao a TB a fapane empa hape hobane ho tshwaetswa ka bobedi ke HIV/TB ho ka ama diphetho tsa diteko tsa hao tsa baktheria. Diteko tsa Smearmicroscopy X-ray ya sefuba Diteko tsa Sehlopha sa baktheria ya TB Ditshwantsho: Sofia Tasolari Ho bokella Sekgohlola Ho hlokeha sekgohlola bakeng sa teko ka nngwe ya TB. Sekgohlola ke mokedikedi o motenya o tswang matshwafong a hao. Se fapane le mathe, ao e leng metsi a tswang hanong la hao. Ho fumana sampole e ntle ya sekgohlola ho ka eketsa monyetla wa ho fumana hlahlobo e nepahetseng ya TB. Bakeng sa ho bokella sekgohlola mosebeletsi wa bophelo o tla o neha setshelo sa sekgohlola e leng moo o tla kgohlolla teng. Ho kgohlola sekgohlola e ka ba ntho e bohloko hape e boima. Hula moya ka mokgwa o tebileng haholo e be o kgohlola ka matla le ka mokgwa o tebileng ka ho ya ka moo o ka kgonang. Ha o na le bothata ditliliniki tse ding di ka o neha nebulisation. Hona ho kenyelletsa ho kenya mask e tla romela di-droplets tse nyenyane tsa metsi matshwafong a hao e be o a kgohlola. Ho bohlokwa hore teko ya sekgohlola e etswe phaposing e nang le difenstere tse ngata tse butsweng kapa phallo ya moya. Hona ho etswa ke hore ho kgohlola sekgohlola ho ka ntshetsa baktheria ya TB moyeng ha o na le TB. Ho etsa diteko ka ntle hape ho ka sebetsa. Mefuta e fapaneng ya diteko tsa TB Smear Microscopy Smear test ke teko e tsebahalang haholo tsa TB. Yona e sibolotswe dilemong tsa bo-1880 mme e kenyelletsa ho hlwaya TB ho tswa sekgohloleng sa hao tlasa microscope. E sebediswa haholo hobane e le bonolo mme e ka etsuwa kae kapa kae. Ka bomadimabe diteko tsa smear hangata ha di a nepahala. Diphuputso tse ding di bontshitse hore teko ya smear e hloleha ho fumana TB e mahlahahlaha bathong ba nang le HIV nakong e batlileng e etsa 50%. Ho eketsa monyetla wa hore diteko tsa hao di o nehe sephetho se nepahetseng tliliniki e lokela ho nka bonyane disampole tse pedi tsa sekgohlola ho wena. Bona ba ka o kopa hore o etse teko e le nngwe tliliniking le e nngwe lapeng. Teko ya lapeng e lokelwa ho etswa hoseng pele ho borakefese. Dikarolwana tsa dijo di ka tswakana le diphetho tsa teko ka hoo ho bohlokwa hore o ntshe sekgohlola pele o ja eng kapa eng. Ha o kgutlisetsa setshelo tliliniking bona ba ka o kopa hore o etse teko e nngwe hape. Diteko tsohle tsa hao tsa smear di tla sebediswa ho bona hore na o na le TB. X-ray ya sefuba X-ray ya sefuba ke setshwantsho sa bokahare ba sefuba sa hao se bontshang matshwafo a hao. Ha motho a na le TB ho ka ba le matshwao a tshosang matshwafong. Matshwao ana a tla thusa ngaka kapa mooki ho bona ha o na le TB. Diteko tsa sehlopha sa baktheria ya TB Bakeng sa teko ena TB e hodiswa laboratoring ho tswa disampoleng tsa sekgohlola kapa tsa thishu. TB ha e hole ka potlako ka hoo teko ena e ka nka dibeke tse ka fihlang ho tse tsheletseng hore ho fumanwe diphetho. Ke teko e nepahetseng ya TB, haholoholo ho bao ba tshwaeditsweng ka bobedi ke TB le HIV. Ho fumana bolwetse 7

10 Setshwantsho: Sofia Tasolari Bothata ba ho hlahloba le ho fumana TB bathong ba phelang ba na le HIV Diteko tsa sehlopha sa baktheria ya TB mane Cape Town. Batho ba bangata Afrika e ka Borwa ha ba kgone ho fihlela diteko tsa sehlopha sa baktheria ya TB le ha tsona e le tse nepahetseng haholo tsa ho bona smear-negative TB. Batho ba phelang ba na le HIV ba na le menyetla mebedi ya ho ba le sekgohlola se bontshang smear-negative TB. Mona ke ha diphetho tsa diteko tsa smear di kgutla di sa bontshe hore o na le TB le o na le TB e mahlahahlaha. Hona ho ka etsahala hobane TB e hasane dikarolong tse ding tsa mmele wa hao kapa hobane boitshireletso ba mmele wa hao bo se matla ka ho lekana bakeng sa ho lwantsha baktheria o sebedisa sekgohlola. Ha o na le matshwao a TB empa diteko tsa hao tsa smear di supa hore ha o na yona o lokelwa ho etswa diteko tse ding hape. Tsona di kenyelletsa diteko tsa sehlopha sa baktheria ya TB. Diteko tsa sehlopha sa baktheria ya TB di ntle haholo bakeng sa ho bona ka nepo empa di fumaneha haholo feela dibakeng tse bohareng mme le diphetho tsa tsona di nka dibeke tse 6 ho tswa. Hobane TB e ka hatela pele ka potlako haholo bathong ba nang le HIV o lokelwa ho qalwa ka kalafo ha o ntse o emetse diphetho tsa diteko tsa sehlopha sa baktheria ya TB ya hao. Dibakeng tseo ho tsona ho se nang diteko tsa sehlopha sa baktheria basebetsi ba tsa bophelo ba lokela ho hlahloba smear-negative TB ba sebedisa matshwao, diteko tsa madi le ho lekanya dikarabelo tsa kalafo ya TB. Andrew Mosane, Morupelli wa Treatment Literacy, o bua le ba Equal Treatment ka ho hlahlojwa hore ho bonwe haeba o na TB. Ho fumana bolwetse 8 Ke ile ka ya tliliniki ka ho kgohlola hona ho boima. Ka ho ba le thuto e itseng e mabapi le kalafo, ke ile ka kopa ho hlahlojwa TB mme ka tletleba ka ho fufulelwa bosiu. Ke ile ka etsa diteko tsa smear empa diphetho tsohle di ne di re smear-negative. Ke ile ka pheella ho etsa diteko tsa sehlopha sa baktheri ya TB hobane ke a tseba hore bakeng sa batho ba phelang ba na le HIV ho ba boima haholo ho fumana hlahlobo e nepahetseng o sebedisa diteko tsa smear, le ha o na le TB e mahlahahlaha. Bakeng sa diteko tsa ka tsa sehlopha sa baktheria ya TB ke ne ke ba le bothata ba ho ntsha sekgohlela. Ke ile ka romelwa sepetlele bakeng sa nebulisation. Ka nako ya nebulisation ke ile ka kgona ho ntsha sekgohlela. Ka nko eo, tliliniki e ile ya qala ho mpha kalafo ho fihlela diphetho tsa ka tsa diteko tsa sehlopha sa baktheria ya TB di loka. Diphetho tsena di kgutlile di supa hore ke na le TB. Ke ile ka nka kalafo ya TB dikgwedi tse 6. Ho ne ho le boima ho nka ka bobedi kalafo ya TB le di-antiretroviral (di-arv). Ditlamorao e ne e le tse tshabehang. Ke ile ka qeta kalafo ya ka ho ntse ho le jwalo mme ha ke sa batla ho ba le TB hape. Ke phetse hantle jwale mme ke sebeletsa TAC mona Gauteng. Andrew Mosane a le letsholong bakeng sa ditokelo tsa batho ba nang le HIV

11 Developing Better TB Tests In order to speed up the time it takes people to get a corrent TB diagnosis we need access to better TB tests. We also need to advocate for the development of new TB tests. In this article Javid Syed of New York s Treatment Action Group discusses improvements in TB testing technology that can save lives in the absence of a perfect TB test. The technologies discussed are only available in some pilot sites across South Africa and not in the public sector. As discussed in this issue of Equal Treatment, there are problems with the most common TB tests we use. Smear tests are simple but fail to diagnose TB in up to 50% of people co-infected with HIV and TB. TB culture tests are very good at getting the correct diagnosis but they require a lot of infrastructure and results take weeks. The perfect TB test would be one that is fast, cheap, easy to use and also able to detect smear-negative and drug-resistant TB. We don t have this tool yet and with current levels of funding we won t have one soon. There are, however, new tests that are an improvement over what we have now. We need access to these tools in our districts. 1. Fluorescent microscopes TB can be stained to make it glow brightly. This can improve how well the bacteria is seen under the microscope. This method is expensive and requires reliable electricity. Researchers are now developing a battery operated microscope. This method is only commercially available in South Africa. 2. The BACTEC MGIT (Mycobacteria Growth Indicator Tube) The MGIT is a TB culture testing machine. It can test for normal and drug-resistant TB. Studies show that the MGIT machine is correct in its diagnosis of positive TB samples almost 100% of the time. Results take two weeks. Unfortunately MGITs require reliable power and need skilled technicians and environmental controls to get correct results and keep workers safe. MGITs could be used on a regional level in partnership with safe and reliable transport and information systems. 3. MODS (Mycroscopically Observed Drug Susceptibility Test) This is a very similar system to the MGIT except the product is not restricted by patent. It is currently being standardised and tested for use in South Africa. 4. Hain MDR TB Plus This test is used to detect drug-resistant TB. This is a test that identifies isoniazid and rifampicin resistance from sputum and TB cultures. Results take only a couple of hours and it is currently being tested in South Africa. It is more accurate and speedy than culture tests for drug-resistant TB but only works in big central reference laboratories. Sources: Siddiqi K, Lambert ML et all Lancet Lambert ML et al Lancet infect Dis. WHO summary report 2007 Mello FC et all J Clin Microbiol Steingart et al Lancet infect Dis. KRHenry M, Ng V et al Lancet Infect Dis. Barnard M et al Am J Respir Crit Care Med. Photos: Sofia Tasolari Positive TB Culture TB being prepared for a culture test Fluorescent microscopy testing 9

12 Kalafo ya Ha o fumanwe o na le TB e mahlahahlaha o ka qala ka kalafo e tla o phekola. Karolo ena ya Equal Treatment e hlalosa hore ke kalafo efe eo o tla e nka le ka moo o ka e nkang ka nepo ka teng. Kalafo ya TB ha e nkuwa ka nepo e ka bolaya baktheria yohle e mahlahahlaha ya TB mmeleng wa hao. Hore na o nka kalafo efe ho tla itshetleha hodima diphetho tsa diteko tsa hao tsa TB, hore na TB e hola hokae mmeleng wa hao, na tshwaetso ya hao e mpe ha kae mmoho le histori ya hao ya TB. Batho ba phelang ba na le HIV ba fumana kalafo e tshwanang le ya bao ba se nang vaerase. Kalafo ya TB e tlwaelehileng e nka dikgwedi tse 6-8. O tla nka efe kapa efe e mene ya meriana e mehlano. Yona ke isoniazid, rifampicin, ethambutol, pyrazinamide le streptomycin. Streptomycin e sebediswa feela bakeng sa kalafo botjha. Sheba setshwantsho se mona ka tlase bakeng sa ho fumana dintlha tse eketsehileng. Enjekshene ya streptomycin e ya haella? Streptomycin e sebediswa hape jwalo ka meriana ya kalafo. Ha tliliniking ya heno ba re ha ba na streptomycin o ntse o lokelwa ho fuwa meriana e meng e mene ya TB. Ha o latela kalafo ya hao matshwao a hao a tla ba betere dibekeng tse pedi. Ka mora dibeke tse ka bang tharo hangata ha o sa kgona ho hasana TB empa ke mohopolo o motle ho ba le taolo e ntle ya tshwaetso. First line TB treatment (6-8 months) Who People with pulmonary or extra-pulmonary TB who have not been treated before First 2 Months 4 medicines: isoniazid, rifampicin, pyrazinamide, ethambutol (taken together as Rifafour) Treatment Next 4-6 Months 2 medicines: isoniazid and rifampicin (taken together as Rifinah) TB Re-treatment Who Treatment People who have previously taken TB treatment including people whose treatment was interrupted or is not working. First 2 months 5 medicines: isoniazid, rifampicin, pyrazinamide, ethambutol and streptomycin injections. Next 1 month 4 medicines: isoniazid, rifamcipin, pyrazinamide, ethambutol Next 5 months 3 medicines: isoniazid, rifampicin, and ethambutol

13 TB Ho latela Kalafo ya TB Le ha o ka qala ho ikutlwa o le betere ka mora dibeke tse mmalwa tsa kalafo ho tla nne ho be le baktheria ya TB mmeleng wa hao. Ha o ka emisa ka kalafo kapa o sa nke kalafo ya hao ya TB ka nepo baktheria e tla hola hape e be e etsa hore o kule. Hona hape ho ka baka baktheria e hanyetsanang le meriana eo ho leng boima haholo ho e alafa (sheba leqephe la 24 bakeng sa ho tseba haholwanyane ka TB e hanyetsanang le meriana). Ho lebela diteko tsa smear-positive TB Ha o hlahlobilwe ka ho sebedisa teko ya smear ho tla sebediswa mofuta o tshwanang wa teko wa smear ho lebela kalafo ya hao. O lokelwa ho etswa teko ya smear ka mora dikgwedi tse pedi tsa ho qala tsa kalafo le ka mora ho ba kalafo e fele. Haebe ka mora dikgwedi tse pedi tsa ho qala o ba le sephetho sa teko se reng o smear-positive o lokela ho dula ho yona kalafo eo bakeng sa kgwedi e nngwe hape. Ka mora kgwedi ena o lokelwa ho etsa diteko hape. Ha diphetho tsa teko ena di ntse di re o smear-positive hona ho bolela hore kalafo ya hao e hlolehile. O lokelwa ho kengwa kalafong e fapaneng e be o etswa diteko tsa TB e hanyetsanang le meriana. Ho lebela diteko tsa smear-negative le extra-pulmonary TB Ha e le teng, diteko tsa sehlopha sa baktheria ya TB ke tsona tsela e ntle haholo ya ho lebela TB ho batho ba nang le smear-negative kapa extrapulmonary TB. Ha diteko tsa sehlopha sa baktheria di le siyo batho hangata ba lebelwa ka mokgwa wa bongaka. Boima ba mmele wa hao, diteko tsa madi le matshwao a tla sebediswa ho lekanya ka moo kalafo e sebetsang ka teng. Ho qeta kalafo ya ka ya TB Morupelli wa Treatment Literacy (ho ruta ka kalafo), Oscar Mabela o bua le ya ngollang Equal Treatment, Adam Malapa, ka ho hlahlojwa o fumanwe o na le bolwetse, e be o alashwa bakeng sa TB. Lebitso la ka ke Oscar Mabela mme ke dilemo tse 29 boholo.ke dula mane Tickeyline, Provinseng ya Limpopo ya Afrika Borwa. Haesale ke ntse ke phela ka bolokolohi le batho ba nang le HIV ho tloha ka Ke qadile ho nwa di-arv ho tloha ka Ka Loetse 2007 mme ka tswa matshwao a ileng a etsa hore ke belaele hore e ka nna ba ke na le TB. Ke ne ke na le lehlaba sefubeng mme ke hema ha bohloko. Ke ile ka iswa sepetlele hobane ke ne ke hema ha bohloko. Ke ile ka etsa diteko tsa smear. Sephetho s seng se ile sa re ke smear-positive ha se seng se le smear-negative. Sepetlele sa ka ba ile ba tiisetsa hore ke na le TB ka ho etsa x-ray e ileng ya bontsha tshenyo eo TB e bakang matshwafong a ka. Ka potlako feela ka mora hoba ho fumanwe hore ke na le TB ka Loetse ke ile ka qala ho nka kalafo ya TB. Ke phethile kalafo ya ka ka Tlhakubele Ho ne ho le boima ho nka dipidisi tse ngata hakale empa jwalo ka morupelli wa Kalafo ke ne ke tseba bohlokwa ba ho latela bolwetse. Ke ne ke kgona hape le ho thusa ba bang ba neng ba na le mathata a ho nwa meriana ya bona ya TB. Kalafo Jwale ke phetse hantle mme ke ntse ke tswela pele ka di-arv tsa ka. 11

14 Ho phephetsa DOTS Directly Observed Therapy Shortcourse (DOTS) ke mokgwa o ananetsweng o sebediswang ke Mokgatlo wa Lefatshe wa Bophelo bo Botle bakeng sa kalafo ya TB. Afrika Borwa e sebedisa mmotlolo ona bakeng sa tlhokomelo ya TB.. Sebopeho se seholo sa lenaneo lena ke sa hore batho ba lebelwe ha ba ntse ba nka kalafo ya bona. Hona ho bolela hore batho ba leng kalafong ba lokela ho tsamaya ba ye ho molebedi wa DOTS kapa tliliniking matsatsi a mahlano bekeng. Le ha lenaneo le sebetsa dibakeng tse ding lona ha le sebetse hantle haholo mona Afrika Borwa. DOTS e bile mmotlolo bakeng sa dilemo tse 20 empa bothata ba rona ba TB bo ntse bo mpefala. Re lokela ho nahana hape ka moo re ka hlokomelang batho ba alashwang bakeng sa TB. Re lokela ho nka dithuto tseo re ithutileng tsona ho tswa tlhokomelong ya HIV e be re di sebedisetsa ho rala kalafo e ntlafetseng ya TB le mananeo a tlhokomelo. Hona ho kenyelletsa ho ruta ka kalafo, tshehetso ya ho latela ditataiso, thuto ya baahi le tlhokomelo e arohantsweng. Kalafo 12 Setshwantsho: Nick Fletcher Novungile o dilemo tse 25 boholo. Boima ba hae bo etsa 26 kg mme o nka kalafo ya TB kgetlo la boraro. Hantlentle ha a sa na mosifa o setseng mme haesale a robetse nako e ka bang ka hodimo ho selemo. Le ha ho le jwalo, le ha boemo ba bophelo ba hae bo le jwalo, yena o lebelletswe hore a ye tliliniking matsatsi a mahlano bekeng ho ya fumana enjekshene ya hae ya streptomycin jwalo karolo ya kalafo botjha. Hore a fihle moo, mme wa hae o mo rwala ka wheelbarrow. Jwalo ka ha a na le bana ba bang ba leshome, mme wa hae ha a kgone hore a mo ise moo sebakeng se bohole ba dikilometara tse 3 ka mehla. Novungile o kotsing ya ho fetwa ke kalafo ya hae. Mmotlolo wa DOTS ha o sebetse bakeng sa batho ba jwalo ka Novungile.

15 Kalafo ya di-arv le kalafo ya TB Ke ntho e tlwaelehileng ho nka kalafo ya di-arv le ya TB ka nako e le nngwe. Ha o ka fuwa meriana e nepahetseng ya TB le HIV e be o lebelwa ka nepo, kalafo tseo tse pedi di ka sebetsa hantle haholo mmoho. Ha o se o le kalafong ya di-arv Ha o se o le kalafong ya di-arv ha ho tla fumanwa hore o na le TB moriana wa hao wa ARV o ka tshwanela ho tjhentjha. Ka baka lena, ho bohlokwa hore mosebeletsi wa hao wa tsa bophelo a tsebe hore ke di-arv dife tseo o di sebedisang. Ke mohopolo o motle ho tla le di-arv tsa hao tliliniking ha o qala ka kalafo ya TB. Ha o ntse o nka di-arv mmoho le kalafo ya TB o lokelwa ho behwa leihlo ka hloko ke ba tliliniking bakeng sa ditlamorao ekasitana le dikamahano tsa meriana. Kalafo tse ngata tsa TB di kenyelletsa rifampicin. Rifampicin e ka fokotsa bokgoni ba ho sebetsa ba nevirapine. Haebe moriana wa hao wa ARV o kenyelletsa nevirapine o kgothaletswa ho fetohela ho efavirenz. Rifampicin e ka fokotsa hape le bokgoni ba ho sebetsa ba di-arv tse jwalo ka diprotease inhibitor kaletra le NRTI abacavir. Ha o na le HIV le TB empa o sa sebedise di-arv Ha o tshwaeditswe ka bobedi ke TB le HIV empa o se kalafong ya di-arv, tliliniki ha ya tshwanela ho o qala ka kalafo ya bobedi HIV le TB ka nako e le nngwe. Kalafo ya TB ka mehla e lokela ho tla pele. Ha o qala ka kalafo ya di-arv hoo ho tla itshetleha ho palo ya CD4 ya hao. Ditataiso tsa ha jwale tsa Afrika Borwa di re ha palo ya CD4 ya hao e le ka tlase ho 200 o lokela ho qala ka di-arv dibekeng tse pedi ka mora ho qala ka kalafo ya TB. Diphuputso tsa moraorao tjena mona Afrika Borwa di bontshitse hore mang kapa mang ya nang le palo ya CD4 e ka tlase ho 500 o lokela ho qala ka di-arv nakong e seng ka hodimo ho dikgwedi tse 2 ka mora ho qala ka kalafo ya TB. Kalafo ya TB le Dithibela Pelehi tse Nowang Rifampicin e ka fokotsa ho sebetsa hantle ha dithibela pelehi tse nowang. Ha o qala ka kalafo ya TB mosebeletsi wa hao wa tsa bophelo o lokela ho tjhentjha dipidisi tsa hao. Immune Reconstitution Inflammatory Syndrome (IRIS) Ka mora ho qala ka di-arv batho ba bang ba ba le Immune Reconstitution Inflammatory Syndrome (IRIS). Hona ke ha o qala ho bontsha matshwao a ho kula kapa o ikutlwa o le boemong bo bobe le ho feta ka mora ho qala ka di-arv. Ha ho bolele hore di-arv tsa hao ha di sebetse. E mpa e le hore mmele wa hao o se o le matla hoo o kgonang ho lwantsha tshwaetso e neng e se e ntse e le mmeleng wa hao. TB ke e nngwe ya tshwaetso tsena tseo mmele wa hao o qalang ho di lwantsha hang ho ba o qale ka kalafo ya ARV. Mona matshwao a qala ho bonahala ka mora ho ba o qale ka kalafo ya ARV. H ao ka ba le matshwao a TB dibekeng tse pedi ho isa ho tse tsheletseng ka mora ho qala ka di -ARV, o lokela ho bolella mosebeletsi wa hao wa tsa bophelo ho etsa diteko ho bona hore na ha o na TB. Ha ho ka fumanwa hore o na le TB e mahlahahlaha o lokela ho qala ka kalafo ya TB. Kalafo 13

16 Ditlamorao tsa kalafo ya TB Meriana ya TB e na le ditlamorao tse ngata. Ho ba le ditlamorao ho ka etsa hore ho be boima ho latela kalafo. Re tshwanetse ho kgona ho bona hona e be re tlalehela ditliniki ha re bona hore di ba mpe le ho feta. Ditlamorao tse ding di ka fokotswa ka meriana e meng. Ho bohlokwa hore o se ke wa emisa ho nwa meriana ya hao ya TB ntle le ha mosebeletsi wa tsa bophelo a ho bolella hore o etse jwalo. O ka fumana ditlamorao tsena ho tswa kalafong ya TB: Isoniazid: Peripheral neuropathy,* mokgathala, mahlaba manonyeletsong, hepatitis,** lekgopho letlalong, feberu Rifampicin: Ho se be le takatso ya dijo, ho feroha, mahlaba ka mpeng, ho hlohlona, hepatitis** Pyrazinamide: Mahlaba manonyeletsong, hepatitis** Ethambutol: Peripheral neuropathy,* mahlaba manonyeletsong, ho lahlehelwa ke pono ka mokgwa o tswelang pele,*** lekgopho letlalong Streptomycin: Lekgopho, feberu, ho tsekela, ho sitiseha ha boemo, ho lahlehelwa ke kutlo *Peripheral neuropathy ke ho shwa bohatsu le/kapa mahlaba dinyaong le tlase maotong a hao. O lokelwa ho fuwa pyridoxine (vitamin B6) le/kapa amitryptiline maemong a mabe haholo bakeng sa ho laola mahlaba. **Hepatitis ke ha sebete sa hao se senyehile. Meriana e mengata ya TB a bakela sebete sa hao bothata mme hoo ho senye sebete. Tshenyeho ena e ka ba e mpe haholo ha meriana ya TB e nkuwa mmoho le meriana e meng e jwalo ka co-trimoxazole le di-arv tse ding. ***Bao ba nkang ethambutol ba lokelwa ho hlahlojwa mahlo kgafetsa. Ethambutol ha ya tshwanelwa ho fuwa bana ka ha e ka etsa hore ba foufale. Meriana e metjha ya TB? Kalafo Ho na le tlhokeho ya hore ho etswe diphuputso tse eketsehileng tsa kalafo tse ntjha tse tla sebetsa hantle haholo tsa TB. Ha jwale ho na le meriana e metjha e mehlano ya TB mokgahlelong wa ho qala wa dipatlisiso bathong. Hona ke ntlafatso dilemong tse 40 tse fetileng empa ho sa ntsane ho ena le tse mmalwa feela tse ka bang le bokgoni. Meriana e betere ya TB e ka fokotsa nako ya kalafo, e ka fokotsa ditlamorao, e ka fokotsa bothata ba dipidisi, e be le monyetla o monyenyane wa ho tswakana le di-arv, ho ntlafatsa kalafo ya TB e ipatileng, e kgone ho sebetsa hantle kgahlanong le TB e hanyetsanang le meriana kapa e kgone ho alafa betere TB baneng. Moriana wa ho qala wa TB ha wa lebellwa hore o tla be o se o lokile ho fihlela ka Re lokela ho ba le letsholo bakeng sa diphuputso tse eketsehileng tse tla fumana ditsela tse bonolo hape tse sebetsang hantle haholo tsa ho alafa TB. 14

17 TB le Jwala Ho nwa jwala haholo ke bothata bo boholo baahing ba bangata ba heso. Ha ho tla ho TB, diphuputso di bontshitse hore ho nwa dibiri tse tharo kapa ka hodimo ho moo ka letsatsi ho eketsa kotsi ya ho kenwa ke TB e mahlahahlaha ho menahane hararo. Hona ho bakwa ke sephetho sa jwala boitshireletsong ba mmele wa hao le sebeteng le ka baka la boitshwaro bo amanang le ho nwa haholo. Paleng ena, Josephine Mthembu o bolella mofuputsi wa TAC, Nokhwezi Hoboyi ka ho hlahlojwa hore na o na le TB le sephetho sa ho nwa ka nako eo a neng a le kalafong ya TB. My name is Josephine Mthembu. I am 44 years old and live in Extension 28 Vosloorus, Gauteng. In 2007 I had pains in my chest and I was coughing for about one month. Sometimes I also coughed up blood and I was losing weight. I went to the clinic and was given medicines for a chest infection. Two weeks went by but I did not get better. Instead I was losing strength and felt tired. I went back to the clinic and the nurse told me I had symptoms of TB. She gave me a sputum container at the clinic and one to fill at home the next morning. When I went back to the clinic for my results they told me that my results were smear-negative. Because I had the symptoms of TB the nurse decided to send my sputum for a TB culture test. I had to wait six weeks to get my test results. During this time I became worse. I coughed up blood and had sores in my mouth and throat. I went back to the clinic and I was given some medication to treat the sores while I was waiting for my test results. The nurse asked me to do an HIV test but I told her that I would come back for the test. I never did though because I am scared. After six weeks my culture test came back positive. I was started on TB treatment. I took my tablets every day for six months. It was difficult because I had bad side effects that were made worse because I drank a lot of alcohol. I already drank about six quarts a day before I started TB treatment. I still drank this much during my TB treatment. I had severe pain in my abdomen and problems with my liver. It was also hard for me to get to the clinic every day when I drank although most of the time I managed to make it. I still drink each day and now I am having symptoms of TB again. I have done a sputum test that is going to be cultured so I am waiting six weeks for the results. I am always tired and my chest is very painful. I am still trying to find the courage to get an HIV test. Source: Barclay, L BMC Pub. Health Kalafo 15

18 TB le Boimana Ha o ho ba le ngwana etsa bonnete ba hore etsa diteko tsa TB. Ha o na le TB mme o nka kalafo ke mohopolo o motle ho qeta kalafo ya hao yohle pele o ba moimana. Kalafo 16 Ditliliniki tsa pele ho peleho di lokela ho etsa diteko tsa TB le HIV ka bobedi Ha o le moimana, o na le HIV mme o na le TB ho na le kotsi ya hore o fetisetse tshwaetso tseo ka bobedi leseeng la hao. Ditliliniki tsohle di lokela ho fana ka diteko tsa TB le HIV basading ba baimana. Le ha kalafo e ka rarahana, ho nka kalafo e nepahetseng ho ka etsa hore o phele hantle mme le ngwana wa hao a se kenwe ke HIV le/kapa TB. Ho hlahlo le ho alafa TB ha o le moimana Ha o le moimana o lokela ho etsa diteko tsa bobedi TB e ipatileng le TB e mahlahahlaha. Tuberculin Skin Testing (TST) e tla etsa diteko tsa TB e ipatileng mme e nkuwa e bolokehile. Mefuta e meng ya diteko bakeng sa TB e mahlahahlaha e jwalo ka diteko tsa smear le tsona di bolokehile bakeng sa ngwana wa hao. (Bakeng sa ho tseba haholwanyane ka diteko sheba leqephe la 6-10). Ha o na le HIV mme o se na TB e ipatileng kapa e mahlahahlaha O lokela ho romelwa lenaneong la Thibelo ya Tshwaetso ya ho tswa ho Mme ho ya Leseeng. Ha o na le TB e ipatileng Kalafo e thibelang e tla fokotsa kotsi ya ho kenwa ke TB e mahlahahlaha. Bakeng sa kalafo ena, o lokelwa ho fuwa Isoniazid (INH) letsatsi le letsatsi kapa habedi ka beke bakeng sa dikgwedi tse 9. Basadi ba nkang INH ba lokela ho nka hape le moriana o mong hape ka hodimo o bitswang pyridoxine (vitamin B6) supplementation. Ha o na le TB e mahlahahlaha Kalafo e ratwang haholo ya ho qala ke isoniazid, rifampicin le ethambutol letsatsi le letsatsi bakeng sa dikgwedi tse 2 ho latele isoniazid le rifampicin letsatsi le letsatsi kapa habedi ka beke bakeng sa dikgwedi tse 7. Ena ke kalafo ya dikgwedi tse 9. Streptomycin ha e kgothaletswe baimaneng ka ha e ka etsa hore bana ba se ke ba utlwa ditsebeng saruri. Hangata, pyrazinamide le yona ha e kgothaletswe hobane sephetho sa yona baneng ha se eso tsejwe. Meriana e meng ya kalafo ya bobedi ya TB ha e kgothaletswe ka nako ya boimana. Ha o hloka kalafo ya mokgahlelo wa bobedi ya TB o lokela ho bona specialist (setsebi). Na ho bolokehile hore ke nyantshe ngwana wa ka ha ke ntse ke nka meriana ya TB? Ha o na le HIV o kgothaletswa hore o sebedise lebese kapa tsona dijo tsa bana haebe hoo ho bolokehile hape ho fumaneha. Ha o na le TB o ka e fetisetsa ngwaneng wa hao ka ho nyantsha ka hoo ho sebedisa dijo tsa bana le hona ho a kgothaletswa. Ha o na le TB ho kgothaletswa hore ngwana wa hao a fuwe kalafo e thibelang ya TB. Kalafo e thibelang hape e tla fokotsa le kotsi ya hore o fetisetse Tb ngwaneng wa hao. Na nka sebedisa meriana ya HIV le TB mmoho? Moriana wa TB e leng rifampicin, e leng karolo ya kalafo ya mokgahlelo wa ho qala, o sitisana le tsela eo di-arv tse ding di sebetsang ka teng. Ho bohlokwa hore o bolelle mosebeletsi wa hao wa tsa bophelo hore o sebedisa di-arv pele o qala ka kalafo ya TB. Mehlodi: TB in our Lives, WHO, SA Health Info. Division of Tuberculosis Elimination (DTBE)

19 TB Baneng TB baneng ke bothata bo boholo. Re lokela ho ntlafatsa diteko le kalafo ya bana le ho etsa bonnete ba hore bana ba leng kotsing e hodimo ba fumana kalafo e thibelang. Ke ka baka lang bana ba banyenyane ba leng kotsing e kgolo ya ho kenwa ke TB? Bana ba banyenyane ba kotsing e kgolo ya ho kenwa ke TB hobane boitshireletso ba mmele ya bona ha bo eso hole hantle. Tshwaetso ya HIV le phepo e mpe di etsa hore ba se sireletsehe le ho feta. Bana hangata ba kenwa ke mefuta e mebe haholo ya TB. Hona ho kenyelletsa le TB ya boko (TB meningitis) le TB ya mading (miliary TB). Bana ba nang le mefuta ena e hatetseng pele ya TB ba hloka tlhokomelo e ikgethang mme ba ka senyeha boko saruri. Ntho e molemo eo re ka e etsang ke ho leka ho thibela bana ho kenwa ke TB qalong. Ha ho na motho lapeng leno ya hlahlobilweng mme a fumanwa hore o na le TB, bana bohle ba dilemo tse ka tlase ho tse 5 le bao ba sa sireletsehang ho TB (ba jwalo ka bao ba nang le HIV kapa ba fumanang phepo e mpe) ba lokela ho etswa diteko tsa TB. Bao diteko di reng ba negative, ke hore ha ba na TB, ba tshwanelwa ho fuwa kalafo e thibelang. Ho ba le taolo e nepahetseng ya tshwaetso lapeng ho ka fokotsa kotsi ya hore bana ba kenwe ke TB. Na bana ba hlahlojwa jwang ho bona bolwetse? TB baneng e ka ba boima ho e bona. Ha ho bonolo hore bana ba ntshe sekgohlola, mme le diteko tsa smear hangata di ba negative (ha di bontshe bolwetse) hape ho ba boima ho bala ho leng ho x-ray. Hlahlobo e ka etswa ka ho botsa ka TB lapeng le ho sebedisa diteko tsa sehlopha sa baktheria moo di leng teng. Kalafo e lokela ho qala ha o ntse o emetse diphetho ha ho na le matshwao. Setshwantsho: Damien Schumann. Na bana ba alashwa jwang bakeng sa TB? Bana ba alshwa ka mokgwa o tshwanang le batho ba baholo ntle le hore ditekanyo tsa bona di a fokotswa mme ethambutol yona e ya qojwa moo ho kgonehang. Bana ba nang le TB meningitis ba hloka kalafo e kenelletseng hape e ikgethang. Ho thweng ka TB prophylaxis? TB e ka thibelwa ka ho fana ka kalafo e thibelang. Moriana ona (isoniazid, INH) o lokelwa ho fuwa bana ba nang le HIV, bao ba leng ka tlase ho dilemo tse hlano le bao ba phelang dibakeng tse ka bang kotsi haholo. INH e nkuwa bakeng sa dikgwedi tse 6. BCG (Bacillus Calmette-Guerin): Ona ke moento o fanang ka tshireletso e itseng kgahlanong le mefuta e mebe haholo ya TB. Tshireletso ha ya phethahala ka botlalo mme bana ba sa leng banyenyane ba ntse ba sa sireletseha. BCG ho fanwa ka yon ka tlwaelo ka nako ya peleho mme ho tshwanetswe hore ho tswelwe pele ka yona, le ha e sa kgothaletswe baneng ba nang le HIV. Mehlodi: TB in Our lives, TB SANTP 2008 draft guidelines, Dr. Ben Marais Kalafo 17

20 Taolo ya T Motho e mong le e mong o kotsing ya ho kenwa ke TB. Ba bangata ba rona re kotsing le ho feta hobane re le batho ba phelang ba na le HIV. Re lokela ho fetola mehopolo ya batho ba habo rona mabapi le taolo ya tshwaetso. Batho ha ba tshwanelwa ho behwa sekgobo hobane ba na le TB. Jwalo ka ha re kenya dikhondomo nako le nako ha re ba le thobalano, bohle re lokela ho nka mehato ya ho itshireletsa kgahlanong le TB. mme re sireletse le ba bang. Ena le mehlala ya mehato eo re ka e nkang ho thibela ho hasana ha TB. Kwahela molomo wa hao ha o kgohlola: ka setswe sa hao; ka thishu; kenya mask. Taolo ya Tshwaetso Lapeng Phoustara Moya o foreshe: Dumella moya o foreshe hore o kene ka lapeng la hao ka ho bula difenstere le mamati motsheare. Kwahela molomo wa hao ha o kgohlola. Ha ho na le motho ya nang le TB ke mohopolo o motle hore motho eo a robale phaposing ya hae a le mong ha ho kgonahala. 18

21 shwaetso Ditekesi Ditekesi di a tlala. Ho bula difenstere ho ka fokotsa monyetla wa ho hasana ha TB. Ditlhophiso tsa Tlhokomelo ya Bophelo Dibaka tsa ho leta tse tletseng ho feta tekano le diwoto tsa dipetlele ekasitana le ditliliniki ke dibaka tse ka bang kotsi haholo bakeng sa ho hasana TB. Basebeletsi ba Bophelo Ba tshwanetswe ho rupellwa ho lemoha hantle le ho hlahloba batho ba nang le matshwao a TB. Ba lokelwa ho fuwa di-mask tsa N95. Di-mask tse tlwaelehileng tsa bongaka di ke ke tsa sireletsa kgahlanong le baktheria ya TB. Ba lokelwa ho fuwa isoniazid prophylaxis. Ditliliniki le Dipetlele Phallo e Nepahetseng ya Moya. Diphaposi tsa ho leta le ditliliniki di tshwanetse ho ba le phallo e ntle ya moya le haebe hona ho hloka hore ho dihuwe mabota. Diphaposi tsa ho leta di tshwanetse ho ba le moya o foreshe le mahlasedi a letsatsi kapa fene ka phaposing e se nang difenstere tse bulehang. Open the windows in taxis. A health worker wearing an N-95 respirator. Clinic windows should be open. A health worker wearing an N-95 respirator. The Ubuntu Clinic in Khayelitsha has fans and good air flow. 19

22 Kalafo ya ho thibela TB Bathong ba Phelang ba na le HIV Kalafo e thibelang ke tshebediso ya moriana wa TB wa isoniazid (INH) ho thibela TB e ipatileng hore e se be TB e mahlahahlaha. Ka Mmesa 2008 Mokgatlo wa Lefatshe wa Bophelo bo Botle (World Health Organisation - WHO) o ile wa kgothaletsa hore INH e fuwe batho bohle ba phelang ba na le HIV moo tshwaetso ya TB e ipatileng e leng ka hodimo ho 30%. Mona Afrika Borwa sekgahla sa tshwaetso ya rona ya TB e ipatileng se ka hodimo ho 90% dibakeng tse ding. TAC e dumela hore INH e hlokeha ka potlako bakeng sa batho ba nang le HIV le bakeng sa basebeletsi ba tsa bophelo ba sebetsang dibakeng tse nang le TB e hodimo. Re lokela ho latela ditherisano tsa ha jwale tsa ka moo re ka fanang ka INH ka mokgwa o ntlafetseng. Thibelo 20 Na isoniazid preventive therapy (IPT) ke eng? IPT ke tekanyo e le nngwe ya isoniazid (INH) e nowang letsatsi le letsatsi bakeng sa dikgwedi tse 9. Yona e thibela kgatelopele ya TB e ipatileng ho ya ho TB e mahlahahlaha. INH ke moriana o sebediswang mokgahlelong wa ho qala wa kalafo ya TB empa diphuputso di bontshitse hore ha batho ba nang le HIV ba nang le TB e ipatileng ba nka INH, e ka fokotsa kotsi ya ho kenwa ke bolwetse ba TB e mahlahahlaha ka halofo. Batho ba phelang ba na le HIV (di-pwa) ba phekotsweng TB pejana ba ka fuwa hape le INH. Diphuputso tsa moraorao di sisinya hore melemo ya ho nka INH e tla nka dikgwedi tse ka bang 48 le ha sa ntsane ho hlokeha hore ho etswe diphuputso tse ding ka hona. Ha jwale ho kengwa tshebetsong ha INH lefatsheng lohle e bile ntho e yang butle ka 0.1% feela ya di-pwa e fumanang moriana ona. Ho kengwa tshebetsong butle ho baka ke kgaello ya maikemisetso a sepolotiki a ho rarolla taba ena ka potlako ka ho ya ka moo ho hlokehang. Hape e bontsha ho se hlake ka tsela e ntle ya ho qala lenaneo lena la INH. Hwa bohlokwa ke hore IPT e hloka ho kopangwa le mananeo a HIV. Mananeo a HIV a boheha a na le boikarabelo bo boholo ba ho kenya tshebetsong IPT. Hona ho tla hloka hore ho fanwe ka ditshebeletso tsa HIV le TB mmoho. INH le di-arv tse ngata di ka nkuwa mmoho ka polokeho. Ha o nka di antiretroviral tsa d4t kapa ddi ho na le kotsi ya ho hlaha peripheral neuropathy (mahlaba maotong a hao). Hona ke ditlamorao tse mpe haholo le ha di ka fokotswa ka ho nka pyridoxine (vitamin B6). INH e lokelwa ho qojwa batho ba nang le bolwetse bo mahlahahlaha ba sebete kapa bao ba nwang jwala haholo ka baka la sephetho sa bona sebeteng sa hao. Diphephetso tse pedi tse kgolo bakeng sa rona mona Afrika Borwa e tla ba tsa ho nka ka hore TB e mahlahahlaha ke ntho e siyo mme re etse bonnete ba hore re latela ditaelo tsa IPT. Ho phatlalatsa hore TB e mahlahahlaha ke ntho e siyo: Ha motho a ka fuwa ka phoso kalafo e thibelang moo hantlentle a nang le TB e mahlahahlaha ho na le kotsi ya hore motho a ka ba le kganyetso ya INH. Lena ke lona lebaka le tlwaelehileng haholo le etsang hore batho ba hane ho kengwa tshebetsong ha IPT. Diphuputso di bontsha hore ha ho na kotsi e kgolo ha feela TB e mahlahahlaha e ka phatlalatswa hore ha e yo. Ho latela IPT: Diphuputso tse entsweng mona Afrika Borwa di bontshitse ha sekgobo, kgaello ya ditjhelete bakeng sa dijo le transporoto le ho hana ho nka kalafo ya TB ha ba se na matshwao, tsena tsohle di ama mokgwa oo batho ba lokelang ho latela IPT. Re hloka thuto ka kalafo mabapi le taba ena hore r e tle re ntshetse pele kutlwisiso le hore ho latelwe ditaelo le hore ho fanwe ka tshehetso ya ho latela ditaelo bakeng sa IPT. Mohlodi: TAC IPT Brief 2008

23 Dihlopha tse sa sireletsehang kgahlanong TB Ditjhankaneng TB basebetsing ba Merafong Ditjhankane ke tsona dibaka tseo TB e hasanang haholo ho tsona. Dintlha tsohle tse kgolo tse bakang kotsi di fumaneha moo, jwalo ka ho tlala ho feta tekano, tshebetso tse fokolang tsa ho kenya moya, phepo e fokolang le HIV. Ho hloleha ho ela hloko taba ena ho baka tlolo ya tokelo ya batshwaruwa ya ho fumana tlhokomelo ya bophelo ka mokgwa o lekaneng. Hape ho kgella tlase maiteko ohle a taolo ya TB, jwalo ka ha e hasana le hara baahi ha batshwaruwa bao ba lokollwa tjhankaneng le ka baeti le basebetsi ba tjhankaneng. Maemo a TB merafong a menahane ha leshome ho ena le boemo ba naha. Basebetsi ba merafong ba kotsing e kgolo ya ho kenwa ke TB hobane ba phela le ho sebetsa dibakeng tse teteaneng mme ho na le maemo a hodimo a HIV bathong ba merafong. Taba e nngwe e kgolo, ke ya hore basebetsi ba merafong (haholoholo merafong ya kgauta) ha ba sireletseha leroleng la silica. Ha o ka hema lerole lena nako e telele lona le ka ba le sephetho sa bolwetse ba matshwafo bo bitswang silicosis. Batho ba nang le silicosis ha ba sireletseha haholo ho TB. Lefapha la Bophelo bo Botle le Lefapha la Ditshebeletso tsa Tlhabollo ya Batshwaruwa a lokela ho sebetsa mmoho mabapi le maano a ho shebana le TB ditjhankaneng. Hona ho kenyelletsa ntlafatso ya taolo ya tshwaetso le diteko tsa TB ditjhankaneng. Ho bohlokwa hape ho etsa bonnete ba hore ho ba le dikamano tse matla pakeng tsa dibaka tsa bophelo bo botle tsa tjhankaneng le mokgwa tshebetso o felletseng wa bophelo bo botle e le hore batshwaruwa ba be le phihlelo e tshwanang ya kalafo le tlhokomelo ya TB.. Tsena tsohle di tla ba le moedi ha feela re sa fetole maemo a tjhankaneng a kgothaletsang ho hasana ha bolwetse. Re lokela ho ba le letsholo bakeng sa bonyane ba maemo a amohelehileng a ditokelo tsa botho a lokelwang ho kengwa tshebetsong ditjhankaneng tsohle. Le ha dikhampani tse ding tsa merafo di entse maiteko a ho kenya mananeo a matla a TB/HIV ho sa le hongata ho lokelwang ho etswa. Taolo ya tshwaetso le diteko tsa TB di lokela ho ntlafatswa mme mmuso o lokela ho lebela ka tsela e ntlafetseng mananeo a TB merafong. Dikhampani tsa merafo di lokela ho hlahisa mananeo a felletseng a thibelo le kalafo mme di lokela ho shebana le ditshitiso tseo basebetsi ba merafong ba teanang le tsona ha ba leka ho fumana ditlhapiso tsa mosebetsing bakeng sa ho tshwaetswa ke TB mosebetsing. Thibelo le TB 21