Freda (L) a TB Focal Person at Lubaga Hospital, Kampala District, Central Uganda, conducts a health education session with a client on how to complete their TB treatment. Defeat TB supports patient education combined with other quality improvement interventions to improve TB patient retention on treatment and thus a reduced treatment interruption or loss to follow up. Photo credit: Nicholas Kirirabwa

Defeat TB

The Challenge

Tuberculosis (TB) is a major public health problem in Uganda. Technical assistance is needed to find missing cases of TB, increase TB treatment success rates, and strengthen TB prevention to make progress toward ending the TB epidemic in Uganda.

Overview and Objectives

The USAID Defeat TB Activity (Defeat TB) is a five-year project with a central goal of increasing TB case detection and treatment success to 90% of all cases to end the TB epidemic in Uganda. The project works in collaboration with the Uganda Ministry of Health and the National TB and Leprosy Program (NTLP) to achieve this goal by strengthening the health systems for TB service delivery.

To achieve this goal, Defeat TB works 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; and
  • Prepare local partners to take over the project’s work to ensure long-term sustainability.

Defeat TB worked with the NTLP and civil society organizations to support the community systems strengthening component while project partner the Infectious Diseases Institute supported operations research and other technical capacity-building interventions.

Through the 5-year, USAID Defeat TB Activity, USAID and URC have strengthened the health system response to all forms of TB and achieved improved TB prevention, diagnosis, and treatment outcomes towards the global end TB targets.

The project worked in the three focus districts of Kampala, Wakiso, and Mukono and directly supported seven 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 also collaborated with USAID-funded regional mechanisms to provide technical assistance for DR-TB management at Kitgum, Iganga, and Matany General Hospitals and at Mbarara, Kabale, Lira, Gulu, Mbale, and Moroto Regional Referral Hospitals.

The project used key complementary approaches, including: Health system strengthening, leveraging multi-stakeholder partnerships, strengthening capacity for improving service delivery through application of continuous quality improvement methods, using differentiated service delivery models in urban and rural settings, and using innovative, low-cost technologies.

Achievements

In 2016, the estimated TB incidence rate in Uganda was 234 per 100,000 people, with 89,000 TB infections annually, according to the 2016 Uganda National TB and Leprosy Survey. By 2022, the rate had declined to 197/100,000, according to the 2022 survey. Defeat TB interventions nationally and in the three focus districts – the latter of which account for 20% of the country’s TB cases – contributed significantly to these gains.

Selected other Defeat TB achievements included:

Finding missing TB cases and improving TB treatment outcomes: In its first five years, Defeat TB helped increase the national TB quarterly case detection rate from 63% to 87.9% and the rate in the focus districts of Kampala, Wakiso, and Mukono from 61% to 72%. The project also improved the national TB treatment success rate from 69.3% to 85.3% and the three focus districts’ rate from 77.7% to 86%. Similarly, the national MDR-TB treatment success increased from 56.7% to 79.6% and from 46.4% to 79.2% at the seven directly supported DR-TB treatment sites.

Improved leadership, technical capacity, and coordination: The project supported the development of the patient centered, five-year TB national strategic plan and annual operational plans, plus the development and adaptation of World Health Organization guidelines for TB interventions. Through budget advocacy activities, Defeat TB contributed to a 239% increase in domestic TB funding. And the project facilitated and played a secretariat role for NTLP’s stakeholder engagements that included the national coordination committee, annual conferences, and quarterly implementing partner coordination meetings.

TB operations research, knowledge management, and improving national TB policy: Defeat TB facilitated development of the National TB research agenda and launched monthly operations research forum meetings to inform policy and promote research relevant to TB programming in Uganda. The project developed and scaled up change packages using continuous quality improvement approaches for actively finding missing TB patients, improving treatment success rates, accelerating preventative therapy initiation, improving patient retention, and authoring community TB activity implementation manuals and guides. The project shared several manuscripts and abstracts in national and international conferences.

Monitoring, evaluation, and learning: The project supported the transition from paper records to the Ministry of Health’s DHIS2 system, supported revision of health management information system tools, HMIS SOP development, data quality assessment, improvement activities, and data utilization through use of TB dashboards. Defeat TB also developed community TB activity reporting system, TB info &TB MIS, maintained the systems, supported the development, and rollout of the e-case based surveillance system.

Localization and sustainability: At USAID’s request in Defeat TB’s fourth year, the project identified and trained local partners and transitioned its work to them. Several Defeat TB staff have begun working for the partners, which include the Infectious Diseases Institute (IDI) and the AIDS Support Organization (TASO). These and other partners played key roles in the successes of the project.

Duration
2017–2022

Countries
Uganda

Regions
Africa

Expertise
Community Health, Digital Health, Health Service Delivery, Infectious Diseases, Quality Health Systems, and Tuberculosis

Funders
USAID

Partners
Infectious Diseases Institute (IDI) and The AIDS Support Organization (TASO)