Improving Detection of Multidrug-Resistant Tuberculosis in Uganda

 {Photo credit:  Diana Sharone Tumuhairwe} MDR-TB patients receiving continuous health education at Lira hospital.Photo credit: Diana Sharone Tumuhairwe

Although the incidence of tuberculosis (TB) in Uganda is declining, multidrug resistant TB (MDR-TB), a strain of TB that cannot be treated with the two most powerful first-line medicines, is a growing concern. This is especially true in Uganda’s Lira district, a commercial hub in the Northern region.

Until 2009 in the Northern region of Uganda, only the district hospital in Kitgum, near the border with South Sudan, had the capacity to treat the region’s MDR-TB patients and it struggled to sufficiently screen and identify new patients. Furthermore, the hospital did not have sufficient laboratory equipment to identify MDR-TB and had difficulty transporting sputum samples to the central laboratory in Kampala for analysis. 

MDR-TB and extensively drug-resistant TB (XDR-TB), which is resistant to almost all anti-TB medicines, threaten to reverse the global progress made in TB care and control. Drug resistance occurs when drug-susceptible TB patients do not receive the correct treatment regimens or do not complete the full course of treatment. Nearly 10 percent of the world’s TB patients have MDR-TB and nine percent of these patients also have XDR-TB.

“I started feeling this coughing in 2012, so I went to the health center and got tested,” said Grace*, a young woman in Kole, which neighbors Lira. “It was positive for TB. They started giving me drugs. After two months they tested and I was negative. They told me to continue with the drugs for five more months, but I stopped."

In February 2014, TRACK-TB, funded by the United States Agency for International Development (USAID) and led by Management Sciences for Health (MSH), began implementing MDR-TB management and control activities in Lira.  

At Lira Regional Referral Hospital, TRACK TB trained staff to ensure their ability to identify, screen, and treat MDR-TB patients. Beyond clinical skills, the project worked with hospital staff to reduce stigma associated with the disease and created a system to send sputum samples to the laboratory in Kampala for analysis.

As a result of the TRACK TB training, the hospital’s staff have obtained sputum samples from each patient in the TB register suspected of having MDR-TB and sent the samples to the laboratory for testing. TRACK TB helps ensure adherence to treatment by providing food to patients and facilitating daily transportation for treatment. The project even collaborates with other implementing partners to ensure that all MDR-TB patients have access to transportation support and avoid treatment interruptions.

Unfortunately, Grace is one of Uganda’s MDR-TB patients. “I thought I was ok. I started coughing again. Then I went to the hospital and they … took my sputum and it was MDR. It was two years of treatment, injections for six months, and drugs for two years.”

She has been adhering to her treatment, both for her own benefit and that of her friends. “I’m telling my friends they should go and test for TB … so that TB should not increase in the village,” she said. “We have to protect our friends.”

* Name changed to protect privacy.