South Africa: From Test Tubes to Treatment - Two TB Researchers On Getting the Ancient Disease Themselves

Being a researcher who studies tuberculosis in the lab is one thing, having the TB bug in your lungs is quite another. Spotlight sat down with two of a relatively small number of people who have experienced both.

One morning in April, Constance Schreuder, a senior medical technologist at a large research group at the University of Cape Town, was called into the campus's occupational health office. "I was thinking, did I do something wrong?" she recalls.

When she got to the office, she says the doctor immediately opened the window behind him. She wondered "what is going on now?".

The doctor told her that she has tested positive for the very illness she's been studying at the South African Tuberculosis Vaccine Initiative (SATVI) for over two decades.

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Part of Schreuder's job involves working with post-mortem samples and tissues, as well as clinical trial samples sent from different TB research sites.

"We always protect ourselves by wearing the correct PPE [personal protective equipment]. So, we're always safety first," she says. "I was actually exposed [to TB] in the office where I sit. After all the years that I've been working in the lab."

TB, caused by Mycobacterium tuberculosis, is typically spread when someone with the bacterium in their lungs coughs it up and those droplets are inhaled by others. The droplets are just the right size to hang suspended in the air, allowing TB to survive in a room for several hours.

Schreuder was confused by the diagnosis because she didn't, and still does not, feel ill at all. She had been tested two months prior as a precaution after a PhD student in the lab had been diagnosed with TB and gotten very sick.

Her initial test results looked good. She had produced a sputum sample, a thick phlegm from the lungs, which was sent to the lab for molecular testing (using the GeneXpert platform). The test came back negative for TB DNA. She had also had a chest X-ray done, which showed no signs of TB in her lungs.

It was another test result that raised the alarm. In addition to the GeneXpert test, her sputum sample had been sent to be cultured. This involves putting the sample into a special tube, called a Mycobacteria Growth Indicator Tube (MGIT), and attempting to grow the bacteria if any is present. If TB bacteria has grown after around 50 days, then it means the TB bug was present in the sample. In Schreuder's case, the TB bacteria did grow, although the bacterial count was low, a result in-keeping with her lack of symptoms.

Although she was sceptical of the result and wondered about a potential laboratory error, Schreuder's thoughts immediately went to her close contacts - her 81-year-old mom who she sees on weekends, her pregnant daughter who lives nearby, and her son who lives with her. What did this mean for them, she wondered.

No one else from the office who had been tested showed any sign of TB disease, although Schreuder says that not everyone's sputum sample had been cultured due to the cost of the test.

Only about one in ten people who are exposed to the bacterium will become sick with TB. In most people, the immune system contains and eventually starves the bacterium to death. In others, however, the bug survives inside the body and eventually causes illness, weeks, months, or even years later.

A silent form of TB

Schreuder very likely has what is called asymptomatic TB. This is a state where the bug is active in someone's body, but it is not, or not yet, resulting in symptoms. There are many unknowns about this state, how much it actually contributes to TB transmission and how best to test for and treat it.

While there is much uncertainty about the prevalence of asymptomatic TB, some rough numbers exist. South Africa's first National TB prevalence survey found that just over half of the participants with TB that was confirmed through molecular testing, did not report having any TB symptoms.

Schreuder says that she knew about TB symptoms but was under the impression that people had to show at least some symptoms if they were ill.

She says she was issued with a sick note, was told by the doctor at the occupational health office to go to a public healthcare sector clinic to get treatment, and that she was booked off for the next 14 days. People who are ill with TB generally become non-infectious after having taken TB treatment for around two weeks.

South Africa's TB treatment guidelines does not recommend different treatment courses based on whether or not someone has symptoms. That means that Schreuder has to take the full six-month course of TB treatment.

'I thought it was something very serious'

Schreuder's experience is one side of the coin, the other side is a story from the same lab, one that may seem more familiar.

Tatenda Bvudzijena, an energetic young student, says he came to do his PhD at the SATVI lab because of the world class research that he felt he could learn a lot from. He shares an office space with several staff members at SATVI, including Schreuder. It was his TB diagnosis that had prompted the staff to get tested.

Bvudzijena describes himself as hard-working, so it was very unusual when he started feeling too tired to complete laboratory work near the end of 2025. He was finishing up the second year of his PhD at the time. He says he tried taking some vitamin B, but it didn't help. Then he started to develop some of the typical symptoms of TB, persistent cough and weight-loss. The cough didn't go away after he treated it with over-the-counter medicines.

"I had those coughing symptoms, then they disappear for a while, then it comes back again. It's oscillating...coming back, stopping, coming back again," he says.

Bvudzijena says a private sector doctor told him he might have asthma, but none of the medication he was prescribed - anti-inflammatories, cough syrup, antibiotics, and asthma pills - worked.

Meanwhile, he kept getting sicker.

"That's when I was like, 'no, this is not helping'. By that time, I had chest pains and I was losing a lot of weight," Bvudzijena says. "I just remember back then I used to wear like a size 32 jeans...then I was wearing size 28...I was less than 55kg, but I used to be like 70kg," he recalls.

He says he was starting to panic since the pain in his chest felt sharp. Gesturing to an area underneath his ribs on his left, he says: "I thought it was something very serious." He adds: "At first I thought, maybe I could be having lung cancer, because I used to vape."

Then, one Monday morning in February, Bvudzijena went to see another private sector doctor. This time he was immediately sent to get a TB test and a chest X-ray. "Your chest X-ray is showing symptoms suggestive of TB", the doctor told him two days later.

Bvudzijena says he was both scared and relieved. He was relieved because TB can be cured and he did not have something incurable but also scared because seeing his own chest X-rays, he realised he was quite sick with TB.

Bvudzijena has to take the same six months course of treatment as Schreuder.

What taking TB treatment is like

In South Africa, "typical" or drug susceptible pulmonary (of the lungs) TB in adults is treated with a six-month treatment course - consisting of four drugs for two months and then two drugs for the next four months.

TB is mostly treated in the public healthcare sector, so even if someone has medical aid or access to private sector healthcare, they might still go to public sector facilities to get treatment.

TB treatment and diagnosis is covered under the minimum prescribed benefits for medical aid members. According to a notice by the Council for Medical Schemes, TB treatment can be made available to members of medical aid schemes through public sector clinics, but they should be given the option of getting their treatment through the private sector. Whether they can get treatment in the private sector is likely to depend on whether they can find a private sector doctor comfortable with treating TB and a pharmacy that stocks TB medicines.

Still showing no symptoms of TB when she started treatment, Schreuder says she was surprised to learn from the package insert that came with the medicine that the pills must be taken on an empty stomach. The initial two months is five tablets per day (dosage depends on a person's weight), she explains grimacing.

She has had some side effects. At first, it was only constipation and her urine turning orange, a side effect of rifampicin, one of the four antibiotics used to treat drug-susceptible TB. But by the second month of taking the medication, she also started experiencing muscle and joint pains as well as burning feet.

Schreuder will start on the less intensive four remaining months of the course soon, when the regimen drops from four down to two antibiotics. But she worries about what the drugs might be doing to her body.

With TB already taking its toll on Bvudzijena, he says he started treatment knowing that he had to be serious about taking it as prescribed.

"I was in that situation whereby you know you're very sick and based on the chest X-rays I was seeing, this [TB disease] was intensive. So like I had to take meds, I had to," he says, tapping his finger on the table for emphasis.

He says he was surprised by the size of the tablets, eyes wide as he describes them. "They're big! I've never seen something like that. It was my first time seeing a pill for TB," he says.

For Bvudzijena, the side effects have been relatively mild, a runny stomach and a skin rash, as well as joint pain when he started the two-drug phase of treatment.

He says he started feeling better soon after starting treatment, got his appetite back, and his TB symptoms disappeared completely.

Two clinics, two different treatment experiences

But before they could start taking their treatment, Bvudzijena and Schreuder had to get access to the drugs, which was easier said than done.

Bvudzijena, upon getting his chest X-ray, says he was told nothing other than he needed to go to Groote Schuur Hospital. So he went, only to find that because Groote Schuur Hospital's waiting rooms employ a triage system - where patients who are in the most critical condition are seen first - he'd likely have to wait several hours.

So, he left and later went to a doctor at another private hospital and got referred to see a specialist at that hospital. He says the specialist would have only been able to see him a week later. At his wits end, he went to campus health, who put him in touch with a nurse at a nearby public sector clinic.

Once at that clinic, he says he was well taken care of, got given a little green card, identifying him as a TB patient. This card is his ticket to travelling through the clinic quickly and not having "to wait in a long queue wearing a mask".

"My only problem was from being diagnosed to getting help," he says.

Schreuder, after being booked off, had Googled the nearest public sector clinic that offers TB treatment. The next day, on a rainy Friday, she drove from her home in Cape Town's Northern Suburbs to a clinic in the Durbanville area. She wore a clean mask she had found in a bag, a remnant of the COVID-19 pandemic.

"I actually was there 06:30 in the morning because I wanted to just get it over with and start with this medication because they say if you drink it for 14 days, then you're not infectious anymore," she says.

At the clinic, she says she was taken to a separate room to wait by herself, as it turns out for five hours. Eventually she says she was helped by a nurse, who filled out her paperwork and took another sputum sample.

Another hour later, she says she left with six packs of TB medication, enough for the first month of treatment. But she had to stop at a private sector pharmacy on the way home because the clinic was out of vitamin B6, which she had been told to take to help with the potential side effect of "pins and needles in your hands and feet".

Her frustrations with the system would mount. At a subsequent clinic visit Schreuder discovered that her phone number hadn't been captured, meaning she hadn't received the test results from her second sputum test. When she asked for her TB medicines to be dispensed to her ahead of time since she was already at the clinic, she says she was told the medicines were out of stock.

When she arrived for her next appointment at 12:00 on a Friday in May, she says the clinic seemed empty. When she eventually found a nurse, she claims the nurse told her she was only working until 12:00, and that the rest of the staff had left to attend a party for someone who had resigned, and that Schreuder must come back on Monday. A frustrated Schreuder says she didn't accept this and eventually the nurse agreed to give her the medication.

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"What's worrying for me," says Schreuder, "is, I said to her, 'I work in this clinical trial lab where we want to find a cure for TB. But are we going to reach a TB free world if it [the health system] works like this?'."

What needs to change?

Both Bvudzijena and Schreuder say it needs to be made easier for people with TB to start and collect TB treatment. They suggest that private sector pharmacies could be a convenient alternative to public sector clinics. Bvudzijena adds that stable patients could also collect their medication from selected community pharmacies or other collection points closer to home, reducing unnecessary travel and long waiting times.

He also touched on the need for better, clearer information for people who have just been diagnosed with TB about where they need to go, what documents they might need and how to start treatment.

"When you've just been told you have TB, you're already worried," he says. "The last thing you need is to be sent from one place to another without knowing where to get help." He adds that there needs to be better coordination between private healthcare providers and public clinics.

Both touched on the stigma associated with a TB diagnosis. Schreuder says she received support from family members but otherwise it felt like people were simply checking that she had been cleared to go back to work. Bvudzijena says overall the reaction to his diagnosis was mixed. Some people like his roommates and friends were supportive, but not everyone was so understanding. "It was tough," he says.

TB IS STEALING LIVES IN SA | Ahead of World TB Day, Spotlight brings together perspectives from some of South Africa's leading TB activists, doctors, researchers, and policy advisors. Dive in: tinyurl.com/336rjxdw

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Change in perspective

Bvudzijena says that getting sick with TB changed his perspective on the research he's involved with.

"What I realise now, after having TB, is that this research is about so much more than science. My work is focused on improving TB diagnosis so people can be diagnosed earlier, while many of my colleagues are working on better treatments and vaccines. After going through TB myself, I know how much that work can mean to someone who's sick. It's really going to change people's lives," he says.

To Schreuder, the experience has also been eye-opening but in a different way. She recounts some of the stories she heard while waiting at the clinic, a woman who has arrived at 05:30 but hours later still hadn't been helped because her file was missing. A man who is afraid he'll lose his job if he waits any longer. Patients sent to wait outside on cold benches and concrete floors, some looking very ill. Data from community-led monitoring group Ritshidze suggests that long waiting times is a common problem.

"I can fight my own battles, but what about all those that are too afraid to say something?" Schreuder asks.

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