MSH Project Improves Detection and Treatment of TB and Multidrug-resistant TB in Eastern Uganda

 {Photo credit: MSH staff}Mariam Nangobi receives treatment for multidrug-resistant TB (MDR TB) at an MSH-supported health facility in eastern Uganda.Photo credit: MSH staff

Mariam Nangobi was first diagnosed with tuberculosis (TB) in 2010 when she was 12 years old. After completing a full, eight-month course of treatment, she still tested positive for the disease. She was referred to a larger health facility where she stayed for two months, receiving daily injections.

Again, after treatment, she continued to test positive for TB and missed a year of school. Health workers eventually diagnosed her with multidrug-resistant TB (MDR TB) -- a strain of TB that cannot be treated with the two most powerful first-line medicines.

Finally, Mariam received treatment at a facility supported by Management Sciences for Health (MSH) and partners through the Strengthening TB and HIV & AIDS Responses in Eastern Uganda (STAR-E) project. Said Mariam:

I have been on treatment for one year and four months now and my life has improved greatly. I no longer fall sick and can now continue with my studies.

Funded by the US Agency for International Development (USAID) through the US President’s Emergency Plan for AIDS Relief (PEPFAR), STAR-E (2009-2016) supports the rapid scale-up of TB and HIV services in 12 districts and 154 of their health facilities in Eastern Uganda. Implemented by an MSH-led consortium of international and Ugandan partners, STAR-E supports managing MDR TB by rolling out national guidelines to health facilities, and providing mentorship, TB registers, standard operating procedures, and expanded TB screening (Figure 1), among other services.

Although the incidence of TB in Uganda is declining, the nation is among 22 identified by the World Health Organization as having one of the heaviest TB burdens in the world. Of those infected with HIV in Uganda, half also have TB. Some people with TB develop a drug-resistant form of the illness if they do not receive the correct treatment regimens or do not complete the full course. A patient who develops active disease with a drug-resistant TB strain can infect other people.

STAR-E has improved TB case detection and treatment in the Eastern Region. The case detection rate rose from 29 percent at the start of the project to 40 percent by 2015. The TB case treatment success rate improved from 50 to 87 percent, with key support from the 192 STAR-E-trained and -supported subcounty health workers monitoring client treatment and check-ups.

The project also strengthens facilities’ capacity to order and manage TB drugs, and procures laboratory equipment. STAR-E supports community-based screening and referrals by peer educators, nongovernmental and civil society organizations, and subcounty health workers to provide community-based directly observed treatment short-course.

Further, the project has institutionalized TB case finding at all entry points of health facilities, including outpatient departments, maternal and child health clinics, and young child clinics.  STAR-E has strengthened 149 laboratories to conduct TB and HIV lab tests, up from only one supported in 2009, and has had four labs accredited by international standards.

By simultaneously strengthening and linking community, facility, and laboratory services for TB case detection and management, including MDR TB, and testing and treatment for TB/HIV co-infection, STAR-E is decreasing the burden of TB in HIV patients and the burden of HIV in TB patients.

Andrew Mukuye  is a TB technical advisor for the STAR-E project in Uganda.