A community health worker in Kampala, Uganda conducts home follow-up visits to TB patients. Photo credit: Defeat TB

Defeat TB

The Challenge

Tuberculosis (TB) is still a major public health problem in Uganda. In 2016, the estimated TB incidence rate was 253 per 100,000 population, with 89,000 people becoming infected with TB annually, according to the 2016 Uganda National TB and Leprosy Survey.

Technical assistance was needed to find missing cases of TB, increase TB treatment success rates, and strengthen TB prevention to end the TB epidemic in Uganda. For example, out of an estimated 1,736 multidrug-resistant (MDR) TB cases, only 516 were detected, according to the 2016 survey.

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 provides technical assistance to 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 is working 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; and
  • Enhance leadership and technical capacity of the TB program at national and subnational levels to effectively manage implementation of TB control activities

Defeat TB works with The AIDS Support Organization (TASO) and civil society organizations to support community systems strengthening. Project partner the Infectious Diseases Institute supports operations research and other technical capacity-building interventions.

The project provides direct technical assistance in the focus districts of Kampala, Wakiso, and Mukono, and selected 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 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.

Achievements

Key Defeat TB achievements to date include:

Finding missing TB cases and improving TB treatment outcomes and TB prevention: Defeat TB increased the quarterly case detection rate from 56% to 89% in the project’s first four years at the national level and 61% to 71% in the focus districts of Kampala, Wakiso, and Mukono. The project also improved the national TB treatment success rate from 69% to 86% and improved the rates in the districts of Kampala, Wakiso, and Mukono from 78% to 86% in the same time frame.

Improved leadership, technical capacity, and coordination: The project supported the development of the patient centered, 5-year national strategic plan and annual operational plans and the development/adaptation of WHO guidelines for TB interventions. Defeat TB also contributed to increased TB funding (120%) through advocacy activities, including stakeholder engagement, national coordination committee meetings, and annual conferences.

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. The project also 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.

Monitoring, evaluation, and learning: The project facilitated the transition from paper records to the Ministry of Health’s DHIS2 system, supported revision of health management information system (HMIS) tools, data quality assessment and improvement activities, and data utilization through use of dashboards. Defeat TB also developed a community TB activity reporting system and supported the development and roll out of the e-case based surveillance system.

Duration
2017–2022

Countries
Uganda

Regions
Africa

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

Funders
USAID

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