Tuberculosis in Uganda

A study evaluates Uganda’s national community tuberculosis (TB) intervention using a before-and-after design within the RE-AIM framework, focusing on reach, adoption, outputs, and effectiveness. The intervention involved two biannual campaigns in 2022, aimed at enhancing TB detection and treatment initiation through a community-based approach involving village health teams.

Campaign 1 reached about 2.9% of Uganda’s population, while Campaign 2 significantly scaled up to 11.6%. The screening led to identifying thousands of presumptive and confirmed TB cases, with the majority initiating treatment. The strategy also successfully implemented preventive therapy for high-risk contacts, with over 23,000 individuals reached in the second campaign alone.

Adoption of the intervention expanded markedly between the two campaigns. While the first involved 76% of districts and about 38% of diagnostic units, the second campaign achieved full national coverage, indicating strong governmental and partner support. The logistical execution—mobilizing village teams, use of mobile diagnostics, and integration of educational tools—enhanced local engagement.

Effectiveness was clearly demonstrated through increased TB case notification rates: Campaign 1 improved the rate by 24%, while Campaign 2 achieved a 59% increase compared to pre-intervention periods. These gains were corroborated by inter-district comparisons, showing better outcomes in intervention districts. Furthermore, the initiative integrated leprosy screening, adding another dimension to its community health impact.

The study’s quasi-experimental design is well-suited to evaluating national public health initiatives where randomized control trials are not feasible. By using a control period from the previous year and stratifying by region, the study controls for seasonal and reporting biases. However, it does acknowledge potential variability in health infrastructure and service uptake across regions.

In conclusion, Uganda’s community TB intervention has proven to be an effective, scalable, and impactful public health strategy. With sustained support and refinement, it holds potential for long-term improvements in TB control, especially in high-burden and hard-to-reach communities.

Sources:

1. Turyahabwe, S., Bamuloba, M., Mugenyi, L., Amanya, G., Byaruhanga, R., Imoko, J.F., Nakawooya, M., Walusimbi, S., Nidoi, J., Burua, A. and Sekadde, M., 2024. Community tuberculosis screening, testing and care, Uganda. Bulletin of the World Health Organization, 102(6), p.400.