TB/HIV and Multi-drug Resistant TB

Giving health education on TB infection
Nurse in-charge at Mubende RRH conducts health education for TB patients.

Tuberculosis (TB) and HIV/AIDS remain major public health problems in Uganda. HIV is the leading risk factor for development of tuberculosis (TB), and TB is the leading cause of death among people with HIV/AIDS (PWHA).  The HIV prevalence in Uganda is estimated at 7.3%, and approximately 50-60% of TB patients are also co-infected with HIV. The Ministry of Health (MOH) places a lot of emphasis on delivering integrated TB/HIV services to effectively control the dual TB and HIV epidemics.

Support for both TB and TB/HIV integration started in 2010 at project inception. The project aimed to: enhance TB case detection and TB treatment adherence and optimize treatment success rates. Other aims included: reducing the burden of TB among HIV patients and similarly reducing the burden of HIV among TB patients.  In 2012, the project’s scope was broadened to include the implementation of multi-drug resistant TB (MDR-TB) care - currently at seven sites. Overall, USAID/SUSTAIN supports the delivery of both quality TB and MDR-TB services at 13 healthcare facilities in Uganda.

USAID/SUSTAIN Approach

In line with the support needs and gaps identified by the National TB and Leprosy Program, USAID/SUSTAIN uses key strategic approaches to strengthen the capacity of supported regional referral hospitals (RRH) for TB and MDR-TB management including:

  • Strengthening service provider knowledge and skills to enhance the management of TB and MDR-TB;
  • Strengthening TB drugs and commodities supply chain management systems and the provision of buffer stocks of consumables for TB testing;
  • Increasing surveillance for MDR-TB among presumptive cases, prevention of MDR-TB through quality directly observed therapy (DOT) and improved patient treatment monitoring systems;
  • Providing MDR-TB treatment enablers and continuum of care support;
  • Expanding monitoring and evaluation (M&E) systems for TB, TB/HIV and MDR-TB;
  • Improving physical infrastructure for MDR-TB patient isolation and optimum TB infection control practices and provision of personal protective equipment; and
  • Supporting TB sample referral and provision of specialized MDR-TB patient monitoring tests.

Achievements

Susceptible TB

  • A total of 41,327 new and relapsed TB cases were identified at project supported healthcare facilities between 2010 and June 2016. Of these, 38,170 TB clients have a documented HIV status. 
  • 11,156 HIV-positive new and relapsed cases were on antiretroviral therapy during TB treatment.
  • TB treatment success rate (for new sputum smear positive TB cases) improved from 68.6% in October 2014- September 2015 to 75% in October-March 2017 for cohorts under evaluation.
  • Up to 960 healthcare service providers were trained in managing susceptible TB by March 2017.

MDR-TB

  • Up to 158 healthcare service providers were trained in managing MDR-TB by March 2017.
  • A total of 294 patients were diagnosed with MDR-TB from April 2013 to June 2016. Of these, 274 were started on treatment.
  • Six MDR-TB isolation wards were refurbished in Mbale, Gulu, Kabale, Masaka, Fort Portal and Mubende, with infrastructure that meets the essential TB infection prevention and control (IPC ) standards – well ventilated, in-patient admission rooms, consulting rooms, reception and waiting areas.
  • The project has supported tracking and investigation of approximately 1,771 household contacts - diagnosed drug resistance among four of the contacts and initiated all on MDR-TB treatment.

Learn more in our Tuberculosis technical brief!