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USAID Defeat TB Quarterly Report (April 1–June 30, 2018)
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The USAID Defeat TB project is a five-year project (2017–2022) that aims to increase TB case detection and treatment success in Uganda to 90% of all cases to end the TB epidemic in Uganda. To achieve its goal, the project strengthens health systems at national, sub-national and health facility levels with a focus on TB diagnostics, logistics, data management systems, quality improvement and other health system strengthening approaches. Defeat TB provides technical assistance to the National TB and Leprosy Programme (NTLP) and direct service delivery (DSD) support to focus districts of Kampala, Wakiso and Mukono districts. The project supports the 17 DR-TB sites in Uganda. The project provides direct support to 7 sites located in CDC supported region and technical assistance to the other 10 sites in USAID supported region through implementing partners. This report provides an account of the project’s interventions, achievements, challenges and lessons learnt from implementation during the period April 1st to June 30th, 2018. Building on the achievements of PY1 Q2, the project maintained a focus on 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 2,932 incident TB cases compared to 2,625 detected in Q2 (hence an additional 307 cases). There was an increase in the number of cases detected from 1,801 to 1,918 (117 additional), 598 to 695 (97 additional) and 226 to 319 (93 additional) for Kampala, Wakiso and Mukono districts respectively. Within the national TB case finding QI collaborative comprised of 34 sites country wide, 1,875 incident TB cases were detected compared to 1,478 last quarter (an additional 397 cases).
A total of 128 DR-TB cases were detected compared to 118 in Q2 (an additional 10 cases). At the national level, 13,743 cases were detected compared to 13,316 from Q2 (427 additional cases). The three focus districts combined had an improvement in treatment success rate from 71% to 76% between Q2 and Q3, and from 73% to 79%; 64% to 68%, 62% to 64% for Kampala, Mukono and Wakiso Districts respectively. At the national level, TB treatment success increased from 69% to 73%. Improving treatment success will be a priority focus for the project next quarter through operationalization of the appointment systems, adherence support and patient tracking activities using the community structures.
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 46% to 117% in Mukono, 43% to 49% in Wakiso and 63% to 67% in Kampala, timeliness of HMIS 106A reporting (TB section) from 61% to 81%, 99% to 94% for Kampala and Wakiso respectively and maintained it at 100% for Mukono district.
The project continued to work with community linkage facilitators (CLFs) to coordinate patient adherence support and tracking of interrupters as well as conduct community education, mobilization and contact investigation activities through which 125 patients were detected and initiated on treatment. Other community volunteers were engaged to cover sites that had no CLFs and completed the process of identifying and engaging civil society organizations (CSOs) to conduct community level TB case finding and treatment support activities.
At the national level, Defeat TB provided technical assistance for the development of the annual operational plan, new district action plan (DAP) templates and targets, coordination of stakeholders to roll out DAPs, IPT implementation, planning for TB commodities, set up of national level dashboards in the MoH DHIS2 and TB info and engaged the national TB coordination committee to address system bottlenecks for TB control. The project facilitated the completion of the operations research (OR) agenda and structures and preparation of abstracts; 14 (9 for Defeat TB, and 5 from the NTLP supported by Defeat TB) of which were accepted for oral/poster presentation at the 49th Union World Conference on Lung Health.
The project achieved these results through learning and adapting interventions to improve TB case detection and treatment outcomes in Kampala, Wakiso, and Mukono, and nationally. This improvement is a result of collaboration with multiple stakeholders at the national, district and facility levels.