Download Annex 6b PreTx Leafl

WHAT IS TB?
TB is an infectious disease which is caused by tuberculosis bacteria, transmitted from people with active lung TB to
other people by airborne droplets. TB bacteria can also affect other parts of the body such as brain, bone, lymph nodes and
kidneys.
How is TB of the lungs spread?




TB is spread through the air by coughing, sneezing, talking loud, laughing or spitting.
When a person with TB of the lungs is coughing many TB bacteria will be spread through the air
These bacteria can remain in the air for many hours.
Tuberculosis is not transmitted through - hand shaking – sharing dishes or food – hugging – sharing tooth brush –
sharing cigarettes.
Common symptoms of TB - if they stay for more than two weeks








Coughing
Weakness
Appetite loss
Fever
Sweating at night
Spitting up blood
Pain in the chest
If TB affects other parts of the body (like brain or bone) there
may also be other symptoms
How is TB detected?
 Symptoms of TB
 Laboratory examination of sputum (smear, culture)
 X-ray
What is drug sensitive and drug resistant TB?
 Drug sensitive TB is not resistant to TB drugs and can
be treated by standard first-line drugs within 6-12
months. The treatment includes only tablets and there
are few side effects. Drug resistant TB bacteria are
resistant to one or more of the first line drugs. This
means that these drugs will not work effectively because they can no longer kill the TB bacteria. The treatment
takes longer, has more side effects and cures fewer people.
What is standard MDR TB Treatment
When the TB bacteria become resistant to rifampicin and isoniazid they are known as “MDR TB” bacteria. They are treated
using a combination of second-line TB drugs for 20-24 months. The combination of 5 or 6 drugs includes injections for at least
the first 8 months of treatment. Currently in Karakalpakstan, MDR TB treatment is provided in certain rayons by the joint
cooperation of MoH and MSF. Treatment is provided as direct observed therapy (DOT) 6 days a week.
What is Pilot Short Course MDR TB Treatment
Short course MDR TB treatment is going to be provided for the first time in three rayons in Karakalpakstan (Shumanay, Kegeily
and Nukus City) by MoH and MSF. A new combination of existing second-line TB drugs will be used in this shorter regimen. The
duration of treatment will be 9-11 months. The initial 4-6 months will use 6 drugs and one injection, while the last 5 months
will use 5 drugs and no injections. The shorter regimen does require treatment to be taken 7 days a week as direct observed
therapy.
Difference of standard and short course regimen
Short course regimen treatment
Standard course regimen treatment
-
9-11 months (Short period of treatment)
Less side-effects
Injections for 4-6 months
Treatment 7 days per week
Higher rate of cured patients in other
countries
Not used in Karakalpakstan before
-
20-24 months (Longer period)
More side-effects
Injections for at least 8 months
Treatment 6 days per week
Combination of drugs has been used for a
long time
Who CAN receive the Short course regimen treatment?
Patients with MDR-TB based on laboratory tests on sputum
Children less than 14 years with sign and symptoms of TB and close contacts of MDR TB
Residents of Shumanay, Kegeily rayons or in Nukus City or patients who are willing to stay in these two rayons throughout the
course of treatment
Who CANNOT receive the Short course regimen treatment?
Patients who are resistant to injections or second line drugs (ofloxacin)
Patients who were previously treated with second line drugs for longer than one month
Patients with known allergy to any of drug used in this regimen
WHAT SIDE EFFECTS CAN THE TB TREATMENT CAUSE?
Diarrhoea
Nausea and vomiting
Low mood
Stomach pain
Itchiness of skin/Rash
Headache
Bronze color skin
Pain in the joints
Dry / irritated eyes
Side effects
Side effects are unwanted effects that happen when you are taking your TB drugs. Possible side effects are shown in
the picture above. If a side effect occurs – it is important that you directly tell your nurse or doctor. Never stop taking your TB
drugs without talking to your nurse or doctor. Most side-effects disappear after a few days or weeks when your body becomes
used to the treatment. It is important to know that not all side effects will affect everybody and that a lot of patients tolerate
the TB drugs well. However, the side effects from the short course regimen are less severe when compared to standard MDR
TB treatment. Pregnancy needs to be prevented during treatment and an information sheet about pregnancy and
breastfeeding is available.
Directly observed treatment
DOT – is the TB treatment method that is recommended by World Health Organization. DOT means that patients take
all theirs TB drugs under the observation of a medical worker. The reason is to prevent the development of more resistance to
TB drugs. This will mean that you will need to go every day (7 days a week) during the whole treatment to your SVP or policlinic
to receive your treatment. There you will meet a nurse who will support you and also other patients on treatment.
WHY IS ADHERENCE TO TREATMENT IMPORTANT?
Adherence is defined as one’s motivation to their treatment plan, the correct intake of medications and the following of a
healthy lifestyle including a healthy diet and other activities.
What will happen if I do not take all of the TB drugs?







You may not be able to continue with the shorter treatment regimen. In this case, you will offered the standard MDR
TB treatment.
The TB treatment loses its strength, the drugs has no effect against the TB bacteria and health condition may worsen
Your chance of cure will be less
The TB bacteria become stronger and more dangerous because you get more resistant TB bacteria
You will have to follow a longer treatment and take more drugs.
You can transmit resistant TB to other people
It can lead to death
What helps to increase adherence?
 Together with the counselor/ASN you will try to solve any difficulties
 Cured patients and successful patients on treatment can be really helpful to talk to
 Positive coping with daily stressors and also the support of the family.
 Positive thinking, future goals, timely accurate side-effect management may influence positive outcome
How often do I need to collect sputum?
 Once a month to monitor the positive effects of treatment
Your doctor may prescribe some extra tests if necessary.
Each time you need to give two samples. One sample can be collected at home immediately after waking up and before the
breakfast. The other sample you have to give in the DOT corner under observation of a nurse. The sample should be not less
than half small spoonful of sputum and it should not be saliva. If the sample is too small, you may be asked to produce a third
sample.
INFECTION CONTROL





Take all your TB drugs. This is the most important thing since only the TB drugs will help you to not be infectious
anymore.
Always cover your mouth with a handkerchief or disposable tissue when you cough, sneeze or laugh.
Put your bed in a separate room from your family members. Try to meet your friends outside instead of inside a
house.
Have good ventilation in the room where you are staying. Always keep a window open, as this will make the TB
bacteria disappear. In winter opening a window for the whole day might be difficult, so then you can try to open it
now and then during the day.
Use a sputum container if you are coughing up a lot of sputum. This container is provided by your nurse and should be
closed after each time you spit in it.
Incorrect beliefs about TB?
-
TB cannot be cured
Camel’s milk can cure TB
Dog fat can cure TB
TB is transmitted by inheritance in families
TB is spread by sexual ways
Mothers with TB should not breastfeed
All who have TB are infectious
It is necessary to drink urine for treatment of TB
Vodka can help to fight TB
ASD (drug for veterinarian purpose) can cure TB
WHAT IS TB?
TB is an infectious disease which is caused by tuberculosis bacteria, transmitted from people with active lung TB to
other people by airborne droplets. TB bacteria can also affect other parts of the body such as brain, bone, lymph nodes and
kidneys.
How is TB of the lungs spread?




TB is spread through the air by coughing, sneezing, talking loud, laughing or spitting.
When a person with TB of the lungs is coughing many TB bacteria will be spread through the air
These bacteria can remain in the air for many hours.
Tuberculosis is not transmitted through - hand shaking – sharing dishes or food – hugging – sharing tooth brush –
sharing cigarettes.
Common symptoms of TB - if they stay for more than two weeks
 Coughing
 Weakness
 Appetite loss
 Fever
 Sweating at night
 Spitting up blood
 Pain in the chest
 If TB affects other parts of the body (like brain or bone) there
may also be other symptoms
How is TB detected?
 Symptoms of TB
 Laboratory examination of sputum (smear, culture)
 X-ray
What is drug sensitive and drug resistant TB?
 Drug sensitive TB is not resistant to TB drugs and can
be treated by standard first-line drugs within 6-12
months. The treatment includes only tablets and there
are few side effects. Drug resistant TB bacteria are
resistant to one or more of the first line drugs. This
means that these drugs will not work effectively
because they can no longer kill the TB bacteria. The treatment takes longer, has more side effects and cures
fewer people.
What is standard MDR TB Treatment
When the TB bacteria become resistant to rifampicin and isoniazid they are known as “MDR TB” bacteria. They are treated
using a combination of second-line TB drugs for 20-24 months. The combination of 5 or 6 drugs includes injections for at least
the first 8 months of treatment. Currently in Karakalpakstan, MDR TB treatment is provided in certain rayons by the joint
cooperation of MoH and MSF. Treatment is provided as direct observed therapy (DOT) 6 days a week.
What is Pilot Short Course MDR TB Treatment
Short course MDR TB treatment is going to be provided for the first time in three regions in Karakalpakstan (Shumanay, Kegeily
and Nukus City) by MoH and MSF. A new combination of existing second-line TB drugs will be used in this shorter regimen. The
duration of treatment will be 9-11 months. The initial 4-6 months will use 6 drugs and one injection, while the last 5 months
will use 5 drugs and no injections. The shorter regimen does require treatment to be taken 7 days a week as direct observed
therapy.
Difference of standard and short course regimen
Short course regimen treatment
Standard course regimen treatment
-
9-11 months (Short period of treatment)
Less side-effects
Injections for 4-6 months
Treatment 7 days per week
Higher rate of cured patients in other
countries
Not used in Karakalpakstan before
-
20-24 months (Longer period)
More side-effects
Injections for at least 8 months
Treatment 6 days per week
Combination of drugs has been used for a
long time
Who CAN receive the Short course regimen treatment?
Patients with MDR-TB based on laboratory tests on sputum
Children less than 14 years with sign and symptoms of TB and close contacts of MDR TB
Residents of Shumanay and Kegeily rayon or Nukus City or patients who are willing to stay in these three regionss throughout
the course of treatment
Who CANNOT receive the Short course regimen treatment?
Patients who are resistant to injections or second line drugs (ofloxacin)
Patients who were previously treated with second line drugs for longer than one month
Patients with known allergy to any of the drugs used in this regimen
WHAT SIDE EFFECTS CAN THE TB TREATMENT CAUSE?
Diarrhoea
Nausea and vomiting
Low mood
Itchiness of skin/Rash
Stomach pain
Headache
Bronze color skin
Pain in the joints
Dry / irritated eyes
Side effects
Side effects are unwanted effects that happen when you are taking your TB drugs. Possible side effects are shown in
the picture above. If a side effect occurs – it is important that you directly tell your nurse or doctor. Never stop taking your TB
drugs without talking to your nurse or doctor. Most side-effects disappear after a few days or weeks when your body becomes
used to the treatment. It is important to know that not all side effects will affect everybody and that a lot of patients tolerate
the TB drugs well. However, the side effects from the short course regimen are less severe when compared to standard MDR
TB treatment. Pregnancy needs to be prevented during treatment and an information sheet about pregnancy and
breastfeeding is available.
Directly observed treatment
DOT – is the TB treatment method that is recommended by World Health Organization. DOT means that patients take
all theirs TB drugs under the observation of a medical worker. The reason is to prevent the development of more resistance to
TB drugs. This will mean that you will need to go every day (7 days a week) during the whole treatment to your SVP or policlinic
to receive your treatment. There you will meet a nurse who will support you and also other patients on treatment.
WHY IS ADHERENCE TO TREATMENT IMPORTANT?
Adherence is defined as one’s motivation to their treatment plan, the correct intake of medications and the following of a
healthy lifestyle including a healthy diet and other activities.
What will happen if I do not take all of the TB drugs?

You may not be able to continue with the shorter treatment regimen. In this case, you will be offered the standard
MDR TB treatment.






The TB treatment loses its strength, the drugs has no effect against the TB bacteria and health condition may worsen
Your chance of cure will be less
The TB bacteria become stronger and more dangerous because you get more resistant TB bacteria
You will have to follow a longer treatment and take more drugs.
You can transmit resistant TB to other people
It can lead to death
What helps to increase adherence?
 Together with the counselor/ASN you will try to solve any difficulties
 Cured patients and successful patients on treatment can be really helpful to talk to
 Positive coping with daily stressors and also the support of the family.
 Positive thinking, future goals, timely accurate side-effect management may influence positive outcome
How often do I need to collect sputum?
 Once a month to monitor the positive effects of treatment
Your doctor may prescribe some extra tests if necessary.
Each time you need to give two samples. One sample can be collected at home immediately after waking up and before the
breakfast. The other sample you have to give in the DOT corner under observation of a nurse. The sample should be not less
than half small spoonful of sputum and it should not be saliva. If the sample is too small, you may be asked to produce a third
sample.
INFECTION CONTROL





Take all your TB drugs. This is the most important thing since only the TB drugs will help you to not be infectious
anymore.
Always cover your mouth with a handkerchief or disposable tissue when you cough, sneeze or laugh.
Put your bed in a separate room from your family members. Try to meet your friends outside instead of inside a
house.
Have good ventilation in the room where you are staying. Always keep a window open, as this will make the TB
bacteria disappear. In winter opening a window for the whole day might be difficult, so then you can try to open it
now and then during the day.
Use a sputum container if you are coughing up a lot of sputum. This container is provided by your nurse and should be
closed after each time you spit in it.
Incorrect beliefs about TB?
-
TB cannot be cured
Camel’s milk can cure TB
Dog fat can cure TB
TB is transmitted by inheritance in families
TB is spread by sexual ways
Mothers with TB should not breastfeed
All who have TB are infectious
It is necessary to drink urine for treatment of TB
Vodka can help to fight TB
ASD (drug for veterinarian purpose) can cure TB