Tuberculosis

Tuberculosis (TB) is an infectious disease that, unlike HIV and hepatitis, is caused not by viruses but bacteria. TB affects, in the first place, people with a weakened immune system. Some people who use drugs (PWUD) are especially vulnerable to TB, due to additional risk factors including other infectious diseases, smoking and drinking, poor nutrition, poverty, homelessness and imprisonment.

All people suspected to have TB should be referred to a medical exam as soon as possible. People who have close contact with TB patients should be motivated to undergo TB screening too. Diagnosis of TB in PWUD can be more difficult because of the high prevalence of HIV and other diseases among them. Lung TB, which is negative for analysis, is most common in people living with HIV, which in turn leads to late detection, poor treatment outcomes and early mortality. Late diagnosis is particularly common among PWUD or patients of OST program, since some opiates can suppress the cough reflex. Some PWUD avoiding TB diagnostics for fear of inpatient treatment that might deny them access to their drug of choice. This is a major factor in countries with low levels of access to OST and or repressive drug policy.

Co-infection of HIV and tuberculosis:

TB is one of the main causes of death among PWUD living with HIV. TB develops easier in people whose immune system is weakened by HIV, and HIV often develops faster in people with TB. For example, for people who are infected with TB, the risk of developing active disease throughout life is 5-10%. And for HIV-positive people, the risk of developing the active disease during within one year is 5-10%. It is important to conduct regular screening among HIV-infected people so that, with the help of an earlier start of ART, it is possible to prevent the transition from latent to active TB.

Treatment of tuberculosis:

Treatment of TB requires a long time (from 6-9 months to up to two years with drug-resistant TB), during which it is necessary to take TB drugs daily. Often they have very unpleasant side effects, especially when taking ART at the same time. But for a successful, complete cure of TB, the treatment regimen must be strictly observed on a daily basis. Without this, there will be no improvement and a very high risk of developing drug resistance.

Key facts about tuberculosis:

• Tuberculosis is one of the top 10 causes of death worldwide.
• Tb is the leading killer of people living with HIV.
• Tb is transmitted by air. When a person with a contagious tb in the lungs or larynx, coughs, sneezes, sings, laughs or talks, particles containing tb bacteria enter the air. Infectious particles can remain in the air for many hours. When other people inhale air with infectious particles, they can become infected with tb.
• Tb bacteria do not spread through household items (for example, clothes, books, toilet seats, etc.), food, drinks or through a handshake with a person living with tb.
• Tuberculosis can be «latent» and «active». A person infected with mycobacterium tb which is in its latent form has the infection in his or her body but it does not develop, and it is impossible to become infected from this person.
• Symptoms of active form of tb include: prolonged cough (2-3 weeks); weight loss; mild fever (about 37 degrees); loss of appetite; increased fatigue; and sweating at night.
• There are forms of drug-resistant tb. This means that drugs for tb treatment no longer function to kill tb bacteria.
• Resistance to anti-tuberculosis drugs is often caused by their incorrect, inappropriate
• Use, the use of ineffective drugs and the premature discontinuation of therapy. It is also possible to become infected with a form of tb which is already drug resistant.
• Drug resistant tb is spread in the same way as drug-susceptible tb. There is no definite evidence that drug-resistant tb is more infectious than drug-susceptible tb.

Before the training, collect information about the tb situation in the country and the knowledge level among the training participants. If the problem of tuberculosis among PWUD is important in the country, we recommend to dedicate one full day for this topic. You might use a TUBIDU training outline. TUBIDU materials are available in Bulgarian, Estonian, Latvian, Lithuanian, Romanian, Russian and English languages.