Defeat TB

Overview

The USAID Defeat TB Project supports the Uganda Ministry of Health and the National TB and Leprosy Program (NTLP) to increase tuberculosis (TB) case detection and notification and improve treatment outcomes by strengthening the health systems delivering care with the aim of ending the TB epidemic in Uganda.

The project works with partner, the AIDS Support Organization (TASO), and civil society organizations (CSOs), to support community systems strengthening. Partner, the Infectious Diseases Institute (IDI), supports operations research and other technical capacity-building interventions. The project provides direct technical assistance (TA) to the NTLP in the focus districts of Kampala, Wakiso, and Mukono, and drug-resistant TB (DR-TB) treatment initiation facilities (Mulago National Referral Hospital and Arua, Soroti, Hoima, Masaka, Mubende, and Fort Portal Regional Referral Hospitals). Defeat TB collaborates with USAID-funded regional mechanisms to provide TA for DR-TB management at Kitgum, Iganga, and Matany General Hospitals and at Mbarara, Kabale, Lira, Gulu, Mbale, and Moroto Regional Referral Hospitals.

 

 

The Challenge

Although Uganda has made strides to combat TB, the disease is still a major public health problem. For years, identification of people with TB had predominantly been a passive, facility-based process undertaken by frontline health workers, particularly clinical officers and nurses. The incidence rate was estimated to be 234/100,000 with 89,000 people becoming infected with TB each year (Uganda TB Prevalence Study, 2014-2016). Further, there were an expected 1,736 rifampicin-resistant (RR)/multi-drug resistant TB (MDR-TB) cases of which only 30% (516) were detected. TB treatment success was reported at 72% for the 2017 cohort of drug-susceptible TB patients and 64% for the 2016 RR-TB/MDR-TB cohort. These indicators underscore the need for increased efforts to find missing people with TB, offer the necessary services to diagnose the disease, and provide patients with appropriate treatment support. The TB burden in Uganda is compounded by the high TB/HIV coinfection rate among people with TB (40%) and the high HIV prevalence in the general population (7.0%).

 

Objectives

To achieve the project’s overall goal of increasing TB case detection and treatment success rates to 90% for all forms of TB, the project aims to:

  • Increase screening and detection of all forms of TB in infants, children, adolescents, and adults at facility and community levels
  • Initiate and complete treatment for all patients diagnosed with all forms of TB
  • Ensure strong community systems to support the continuum of TB prevention, screening, diagnosis, care, and treatment
  • Enhance leadership and technical capacity of the TB program at national and subnational levels to effectively manage implementation of TB control activities

 

Achievements

  • With support from TASO and nine CSOs, up to 3,136 (26%) of the incident TB cases notified were from community referrals from contact tracing and targeted TB screening outreach. At the national level, TB case detection increased from 59% (47,822 incident cases) from the baseline year to 67% (53,562 incident cases) in performance year one and 80% (64,625 incident cases) in performance year two, which was the highest notification to the NTLP in at least the last five years.
  • The number of MDR-TB cases detected increased from 236 during the baseline period to 382 in performance year one to and 461 in performance year two.
  • The project supported the Ministry of Health and implementing partners to scale up TB preventive therapy (TPT) among people living with HIV. During a 100-day TPT surge campaign conducted between July and September 2019, 336,732 ART patients were enrolled on TPT. The campaign performance surpassed the target of 304,391 (111%). Cumulatively, from October 1, 2018 to September 22, 2019, 519,406 patients have been initiated on TPT, achieving 97% of the combined annual target of 530,524.
  • Operations Research: The final national TB Operations and Implementation Research Agenda was launched in March 2019 and the final Uganda TB Lateral Flow Urine Lipoarabinomannan Assay Country Implementation Plan for diagnosis of active TB in HIV-infected adults was developed and integrated into the advanced HIV disease management plan rolled out in June 2019.
  • Sharing knowledge gained: During its first two years, Defeat TB made 46 presentations at conferences to inform TB policy and practice at global and national levels, including at the Union World Conference on Lung Health, the International Society for Quality in Health Care, the National Quality Improvement Conference in Uganda, and the Uganda National Health Promotion Conference.
  • Using coaching and peer learning to improve TB processes in Uganda: The project uses evidence-based approaches to increase TB case notification and case detection and strengthen the health system to improve treatment outcomes. Defeat TB supports health facilities in Kampala, Wakiso, Mukono, and 34 other districts to find people with TB through continuous quality improvement approaches. The project coaches and mentors health facility teams to systematically reduce care system bottlenecks to improve TB screening, linkages to testing, treatment, and documentation. The case detection rate (CDR) in Kampala, Wakiso, and Mukono Districts increased from 54% to 74% while the national CDR improved from 57% to 78% between the project’s start and its third year.
  • Scaling up of community TB services through CSOs: Through small, performance-based grants, Defeat TB has worked with up to 10 CSOs each in Kampala, Wakiso, and Mukono Districts. These partnerships have accounted for up to 30% of total TB cases detected and an increase in the treatment success rate from 75% to 85%. Based on these successes, the National TB and Leprosy Control Program (NTLP) and USAID asked the project to scale up TB activities with other CSOs. Defeat TB worked with the NTLP to develop a national CSO engagement road map and is working with CSOs and regional partners to scale up nationwide efforts for ending TB in Uganda.

 

Resources

Reports
Briefs
Success Stories
Tools

 

Duration
2017 to 2022
Funders 
US Agency for International Development (USAID)
Partners 
The AIDS Support Organization (TASO)
Infectious Diseases Institute (IDI)
Regions/ Countries