Uganda
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Uganda ranks 16 th on the list of 22 high-burden tuberculosis (TB) countries in the
world. In 2007, the country had almost 102,000 new TB cases, with an estimated
incidence rate of 330 cases per 100,000 population. The DOTS (the internationally
recommended strategy for TB control) case detection and treatment success rates (51
and 70 percent, respectively) for new sputum smear-positive (SS+) cases are still below
the World Health Organization’s (WHO’s) 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 5.7 percent between
2006 and 2007, and TB mortality has declined over the past four years. Collaborative
TB-HIV/AIDS activities are expanding slowly; in 2006, only one-quarter of TB patients
were tested for HIV. According to WHO, around 38.7 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 among the communities (including traditional
health practitioners) and formal health services. Currently, most of Uganda’s 89
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 integrating TB-HIV, expanding community-based DOTS
(C-DOTS) to all districts, and strengthening district- level TB planning, surveillance,
timely reporting, and supervision. The overall aim was to increase capacity at the
national and district levels to manage TB control programs effectively, and to
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 $2.2 million in fiscal year (FY) 2008.
USAID-supported TB control activities were implemented through the Uganda
Program for Holistic Development, Northern Uganda Malaria, HIV/AIDS and TB
program, the Tuberculosis Control and Assistance Program (TB CAP), and Health
Initiatives in the Private Sector in 56 of the 89 districts in Uganda. District-level
activities include the following:
- Increasing the capacity of districts to manage TB and TB-HIV collaborative
activities
- Improving the availability of TB diagnostics up to the district level
- Scaling up DOTS in non-MOH sector
- Implementing advocacy, communication, and social mobilization activities; and
increasing community involvement and awareness of TB
- At the national level, FY 2008 resources supported the national coordination
of partners through the Uganda Stop TB Partnership
- Adapting DOTS to prevent and manage multidrug-resistant TB
- Expanding public-private partnerships, including TB and TB-HIV/AIDS activities in the workplace
USAID Program Achievements
USAID provided capacity building to the National AIDS Control Program, the NTLP, and 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 (USG)- supported
districts, reaching 53 and 86 percent, respectively
- Increased HIV/AIDS care and treatment for TB patients from 20 to 69 percent, increased the number of TB-HIV/AIDS
patients on antibiotics to prevent opportunistic infections from 40 to 88 percent, and increased the number of TBHIV/
AIDS patients on antiretrovirals from 5 to 29 percent in USAID-supported areas; developed and distributed TBHIV/
AIDS supervision tools for district and facility managers
- Supported public-private mix 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 C-DOTS and oriented a team of nine national trainers; and collaborated with
the Uganda Peoples Defense Forces to develop a modified C-DOTS for the military
- Renovated and equipped 30 health centers and their laboratories in FY 2007; and 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 C-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
- Provided training in management and leadership to the MOH’s National AIDS Control Program and the 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 2007 will be reported in the WHO Report 2010.
Source: Global Tuberculosis Control WHO Report 2009 |
Partnerships
Partnerships are an important element in combating TB in Uganda. Under the leadership of the NTLP, the USG, Canada, the
German Leprosy and TB Relief Association, the International Union Against Tuberculosis and Lung Disease, WHO, Malaria
Consortium, the Global Fund, 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.
May 2009
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