Uganda
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Uganda ranks 15th on the list of 22 high-burden tuberculosis (TB) countries in the world. In
2006, the country had more than 106,000 new TB cases, with an estimated incidence rate of
355 per 100,000 population. The DOTS (directly observed treatment, short course) case
detection and treatment success rates (44 and 73 percent, respectively) for new sputum
smear-positive (SS+) cases are still below World Health Organization’s (WHO) global targets
of 70 and 85 percent, respectively. These low rates are mainly due to insufficient case
reporting, nonadherence to TB treatment, poor access to health care services, and a limited
number of skilled staff and diagnostic facilities. In addition to these challenges, Uganda has the
highest default rate of any high-burden country. According to UNAIDS, the prevalence of
HIV/AIDS, at 5.4 percent, further exacerbates the problem of TB control. However, while
the TB incidence rate is still quite high, it fell by more than 4 percent between 2005 and
2006. TB mortality also declined, as has the prevalence of HIV/AIDS. Collaborative TBHIV/
AIDS activities are expanding slowly; in 2006, only one-quarter of TB patients were
tested for HIV. According to WHO, around 16 percent of new TB patients are HIV-positive.
Uganda’s combined National Tuberculosis and Leprosy Program (NTLP), initiated in
1990, achieved 100 percent DOTS population coverage by 2002. In 2001, the Ministry
of Health (MOH) formally adopted the community-based TB care (CBTBC) strategy to
address TB services. The approach includes a six-step process that districts implement
within their TB programs. Service delivery depends on a strategic approach that relies
on trained community volunteers implementing CBTBC. The success of this
intervention hinges on partnerships between the communities (including traditional
health practitioners) and formal health services. Currently, most of Uganda’s 79
districts have introduced CBTBC.
USAID Approach and Key Activities
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USAID/Uganda began its support to the NTLP in 2001 to develop and implement the TB control strategy including TB/HIV integration, expand community based DOTS (CB-DOTS) to all districts, strengthening district level TB planning, surveillance, timely reporting and supervision. The overall aim was to increase capacity at national and district levels to manage TB control programs effectively, and contribute to the national goal of increasing case detection and treatment success rates leading to reduced mortality in TB-HIV/AIDS co-infected patients by 50 percent. USAID funds for TB programs in Uganda reached $2,182,000 in fiscal year (FY) 2008. USAID supported TB control activities were implemented through the Uganda Program for Holistic Development (UPHOLD), Northern Uganda Malaria, HIV/AIDS and TB program, the Tuberculosis Control and Assistance Program (TB CAP) and Health Initiatives in the Private Sector (HIPS) in 56 of the 81 districts in Uganda. District level activities included
- Increasing the capacity of districts to manage TB and TB/HIV collaborative
activities
- Improve availability of TB diagnostics up to the district level;
- Scaling up DOTS in non-MOH sector
- Advocacy, communication, and social mobilization activities; and Increasing
community involvement and awareness of TB
- At the national level, FY 2008 resources supported National coordination of
partners through the Uganda STOP TB partnership
- Adaptation of DOTS to prevent and manage MDR-TB
- Expanding public-private partnerships, including TB and TB-HIV/AIDS
activities in the workplace
USAID Program Achievements
USAID provided capacity building to the AIDS Control Program, NTLP and the 56 districts to absorb funding from the Global Fund to Fight AIDS, Tuberculosis, and Malaria and to execute the key elements of the STOP TB Strategy over the long-term through strengthening health systems by providing training on management skills, TB and TB-HIV/AIDS. USAID program
achievements include the following:
- Achieved case detection and treatment success rates above the national average in U.S. Government supported districts, reaching 53 and 86 percent respectively, higher than the national averages
- Increased HIV/AIDS care and treatment for TB patients from 20 percent to 69 percent, increased the number of TBHIV/
AIDS patients on antibiotics to prevent opportunistic infections from 40 percent to 88 percent, and increased the
number of TB-HIV/AIDS patients on antiretrovirals from 5 percent to 29 percent in USAID supported areas; developed
and distributed TB-HIV/AIDS supervision tools for district and facility managers
- Supported Public-Private Mix DOTS (PPM DOTS) through training programs that expose and sensitize nongovernmental
health care providers to extend quality TB care beyond the national TB control program.
- Developed a refresher training course on CB-DOTS and oriented a team of nine national trainers; collaborated with the
Uganda Peoples Defense Forces to develop a modified CB-DOTS for the military
- Renovated and equipped 30 health centers and their laboratories in FY 2007; provided external quality control to
improve sputum smear microscopy in more than 100 laboratories from January to March 2008
- Trained nearly 200 health workers and volunteers to implement CB-DOTS and link TB-HIV/AIDS co-infected patients to
TB and HIV care and treatment services
- Streamlined the TB drug supply chain system and implemented a computerized data entry system for tracking TB drug
and supply procurement
- Developed and tested management information system tools for TB laboratories; updated the TB infection control (IC)
policy and assisted the NTLP in IC strategy development
- Training in management and leadership was provided to the Ministry of Health (MOH) AIDS Control Program (ACP)
and NTLP using the “Management and Organizational Sustainability Tool
Case Detection and Treatment Success Rates Under DOTS
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Note: DOTS treatment success rate for 2006 will be reported in the 2009 Global Report.
Source: Global Tuberculosis Control: Surveillance, planning, financing:WHO Report 2008. |
Partnerships
Partnerships are an important element in combating TB in Uganda. Under leadership of the National TB and Leprosy Program, the USG, Canada, the German Leprosy and TB Relief Association, International Union Against Tuberculosis and Lung Disease, WHO, Malaria Consortium, GFATM and others collaborate to increase TB interventions. The Global Fund has approved two
grants to Uganda: a Round 2 grant in 2004 for $4.7 million and a Round 6 grant in 2007 for $8.1 million.
February 2009
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