TB CARE I - Uganda Final Report

The project was initially a 15-month project but was later extended to 21 months. The specific objectives of the project were to enhance leadership and technical capacity of NTLP to effectively guide and manage implementation of TB control activities at national and district levels, support implementation of DOTS in Kampala urban area, provide technical assistance for the coordination and implementation of comprehensive TB/HIV and DOTS interventions, and strengthen NTLP capacity to initiate a quality MDR-TB program. The project was implemented in collaboration with the NTLP and Kampala Capital City Authority (KCCA) as the main partners. Project implementation commenced in January 2012 and closed at the end of November 2013. The key project results are highlighted under the following areas: Universal Access, Programmatic Management of Drug-Resistant TB (PMDT), collaborative TB/HIV activities, and Health Systems Strengthening (HSS). In the area of Universal Access, the project supported NTLP to conduct a baseline assessment of TB control in Kampala, which revealed gaps in recording and reporting, weak support supervision of health facilities, erratic supply of TB drugs, and poor patient adherence to treatment. To address these gaps, the project implemented various interventions, including organizing meetings with health managers, supporting training for additional health care staff, providing facilitation for support supervision of health facilities, and monitoring TB drug stocks at health facilities. As a result, the TB treatment success rate (TSR) for Kampala increased to 70% in 2012 from the baseline of 49% in 2011 and was sustained at nearly the same level in 2013. In the area of PMDT, the project supported NTLP to strengthen capacity to initiate and implement a quality MDR-TB program. The project interventions addressed the inadequate technical capacity to manage MDR-TB at health facility level, capacity for coordination at NTLP central level, and admission needs for MDR-TB at Mulago Hospital. As a result, Mulago national referral Hospital has a fully remodeled and equipped 39-bed capacity MDR-TB isolation ward, and the number of MDR-TB patients enrolled on treatment has increased. In the area of TB/HIV, the project supported NTLP, the AIDS Control Program (ACP), and partners to more effectively implement the 3 I's (Intensified TB case finding, Isoniazid Preventive Therapy (IPT), and TB Infection control) for people living with HIV (PLHIV) and to improve antiretroviral therapy (ART) uptake for HIV-positive TB patients. The project supported the reactivation of the National Coordination Committee (NCC) and conducted TB/HIV joint support supervision in selected districts. As a result, ART uptake for HIV-positive TB patients increased from 32% in 2011 to 57.2% in the second quarter of 2013. In the area of HSS, the project supported interventions to address NTLP central level gaps to enhance planning and technical support supervision. The project procured local technical assistance and supported stakeholder meetings to finalize the 2012/2013-2014/2015 TB National Strategic Plan and develop the 2012/13 Annual implementation plan. The project also provided support to facilitate Uganda Stop TB Partnership (USTP) quarterly meetings and assisted NTLP to conduct two rounds of bi-annual TB support supervision in eight of the nine NTLP zones. Overall, the TB CARE I major contribution to the NTLP is reflected in the TB treatment success rate, which increased from 71% in 2011 to 77% in 2012. The project has also played a critical role in supporting MDR-TB patient enrollment, with all MDR-TB patients in 2012 and 63% of patients to date in 2013 being treated through TB CARE I-supported sites.