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USAID Defeat TB Annual Report - Year 1
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USAID Defeat TB Activity is a five-year project (2017-2022) that aims at increasing TB case detection and treatment success in Uganda to 90% of all cases to end the TB epidemic in Uganda. The project realizes its achievements through strengthening health systems at national, sub-national and health facility levels with focus on TB diagnostics, logistics, data management systems, quality improvement and other health system strengthening approaches. Defeat TB provides technical assistance to the NTLP and direct service delivery (DSD) support to focus districts of Kampala, Wakiso and Mukono districts, 7 DR-TB sites in Uganda in CDC funded regions and TA for 10 DR-TB sites in close collaboration with Regional USAID implementation mechanisms. This report provides an account of the project’s interventions, achievements, challenges and lessons learnt from implementation during the period October 1st , 2017 to September 30th, 2018. During Year 1, the project focused on supporting high patient volume sites to optimize screening and TB case detection using CQI coaching and mentorship and peer learning approaches to improve performance along the facility level TB cascade, as well as contact investigation and targeted screening activities for populations at high risk for TB. All the focus districts doubled screening efforts and altogether detected 10,672 incident TB cases compared to 10,034 detected during the same period last year; Incident TB cases increased from 2,220 to 2,946 between Q1 and Q4 (hence an additional 726 cases). Increase was from 1,567 to 1,879 (312 additional), 439 to 733 (294 additional) and 214 to 334 (120 additional) for Kampala, Wakiso and Mukono districts respectively. Following the start of the national TB case finding improvement collaborative involving 34 sites countrywide, an additional 617 TB cases (from 1281 to 1898 between Q1 and Q4 respectively) were detected. Overall at national level, 53,562 incident TB cases were detected up from 47,822 detected last year;
Other health system improvements included improvements in accuracy and timeliness of orders for TB commodities following training of providers in TB commodity management and roll out of the TB Web based ordering system in Kampala and Wakiso, utilization of GeneXpert machines from 39% to 65% in Mukono, 40% to 60% in Wakiso and 42% to 76% in Kampala, timeliness of HMIS 106A reporting (TB section) from 62% to 89%, 62% to 89% and 96% to 100% for Kampala, Wakiso and Mukono districts respectively.
The project worked with TASO and 10 CSOs engaged to coordinate active case finding in communities, patient adherence support and tracking of interrupters as well as conduct community education, mobilization and contact investigation activities through which 993 patients were detected and 885 (89%) duly initiated on treatment.
At national level, Defeat TB provided technical assistance for the development and implementation of the annual operational plan, coordinated compilation of district action plans (82% - 92/112 and 64% - 72/112 of the districts submitted their DAPs for FY18 and FY19 respectively), IPT implementation, planning for TB commodities, developing national level dashboards in the MOH DHIS2 & TB info, engaging the National TB Coordination Committee (NCC) to address system bottlenecks for TB control, development of the OR agenda and preparation of abstracts; 10 of which were accepted for oral/poster presentation at the 49th Union World Conference on lung health.
Achievements outlined above were realized through collaboration with multiple stakeholders at national, district and facility levels to optimize interventions, jointly learn and adapt interventions during implementation of activities to realize greater improvements in TB case detection and treatment outcomes in Kampala, Wakiso and Mukono and in Uganda.