TB Treatment — What to Expect
South Africa has one of the highest TB rates in the world, but the disease is curable. Treatment is free, takes 6 months for drug-sensitive TB, and has a cure rate above 85% when completed. This guide covers the full treatment journey.
Getting diagnosed
If you have a cough lasting more than 2 weeks, night sweats, unexplained weight loss, or fever, go to your nearest clinic and ask for a TB test. The clinic will collect a sputum sample (you cough into a small container) and send it for GeneXpert testing. Results come back within 2 hours at clinics with on-site machines, or within 48 hours if sent to a lab.
GeneXpert is the standard first test in South Africa. It detects TB bacteria and simultaneously checks for rifampicin resistance (the most important drug). If the test is positive, the clinic may also order a chest X-ray and additional sputum cultures to guide treatment.
The treatment regimen
Standard drug-sensitive TB treatment lasts 6 months in two phases:
All medication is provided in a single combined pill (fixed-dose combination) — you take one pill per day, not four separate tablets. The pills are free.
DOTS — Directly Observed Treatment
South Africa uses the DOTS strategy: during the intensive phase, a health worker, community volunteer, or treatment supporter observes you taking each dose. This is not about distrust — it is the most proven way to ensure treatment completion worldwide.
Your DOTS supporter can be a clinic nurse, a community health worker who visits your home, a workplace health officer, or even a trusted family member trained by the clinic. The goal is to make daily treatment as easy as possible for you — if the current arrangement is not working, tell the nurse and they will find an alternative.
Side effects to watch for
Most people tolerate TB medication well, but some side effects are common in the first few weeks:
- Orange/red urine — this is normal and caused by rifampicin. It is harmless. It may also stain contact lenses and sweat.
- Nausea — take medication with a small amount of food if needed. Usually settles after the first 2 weeks.
- Joint pain — caused by pyrazinamide. Usually mild. Tell the nurse at your next visit.
- Tingling in hands/feet — caused by isoniazid. The clinic should give you pyridoxine (vitamin B6) to prevent this.
Go to the clinic immediately if you experience: yellow eyes or skin (liver toxicity), vision changes (ethambutol can affect eyesight), severe rash, or persistent vomiting. These are rare but need urgent attention.
Why finishing treatment matters
Most people feel better within 2-4 weeks of starting treatment. This is the most dangerous point — because you feel well, it is tempting to stop. But the TB bacteria are still alive, just weakened. Stopping early almost guarantees the TB will return, and it may return as drug-resistant TB, which is harder and longer to treat.
Complete the full 6 months. No exceptions. South Africa's TB crisis is driven primarily by incomplete treatment and the resulting drug resistance.
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