The number of new Tuberculosis cases in Uganda is now at 94,000 per year, which means about 260 people are getting infected by the disease daily.

About 60% of people who are infected by Tuberculosis (TB) are men and nearly 16% are children, plus about 4% of those infected have drug-resistant TB.

However, identification of those who fall sick was at above 90% last year, “although it reached 100% in 2022,” says Dr Stavia Turyahabwe.

The Assistant Commissioner Health Services in-charge of Tuberculosis and Leprosy Control at Ministry of Health says the number is a result of increasing identification of people with TB.

“We did our prevention survey in 2014/ 2015. What it discovered was that there were many more people that were living with TB in communities than those that the health system was screening,” Turyahabwe says.

“We used to call that group of people, missing people with TB. Uganda was among 20 countries globally that were contributing to the missing people with TB.

As a result, tests have to be conducted every six months. In 2022, one was conducted in March another in September.

“We were able to identify everyone who had fallen ill with TB in that year. Although the number is more, we are at advantage of preventing TB in Uganda.

“We need to be able to identify everybody with TB each year over a period of time perhaps five years and then give them preventive treatment so that we stop people from advancing into disease, then, we will be able to see a decline in TB incidents in Uganda,” Turyahabwe says.

How prevention after tests has worked in Uganda

Tuberculosis (TB) remains one of the world's deadliest infectious killers and a growing challenge in Uganda with each day about 30 people losing their lives, says the World Health Organisation (WHO).  But preventive measures are being put in place.

“We have introduced preventive therapy. We started with a six months regiment-daily doze for someone who has been in contact with TB, Turyahabwe says.

“But now we have the option of three months. We have introduced another regiment that is easier to use, that you take once a week.

“The prevention is available once you have been exposed, stayed with someone who has TB, got checked and found not to have the disease. You can benefit from the prevention treatment that will help you not to advance into disease.

“You got the infection but the preventive drug will help keep the germ dormant so that it does not advance to disease,” Turyahabwe says.

“We are seeing good progress in this area but we still have a lot to do. The uptake of the preventive treatment is still low; we need people to improve the uptake of the TB preventive service.

“If you stayed with someone who has TB, got assessed and don’t have TB, you get supported with preventive treatment,” she emphasized.

People with HIV were the first priority to be provided with TB preventive treatment to reduce their chances of developing the disease.

“We know that once you have HIV your immunity is disorganized and chances of developing TB are much higher,” Turyahabwe says.

As a result, over 97% of those who have been in HIV care have received preventive TB treatment. Also introduced was one of the rapid diagnostics for TB among the people living with HIV.

The interventions have led to the reduction of TB and HIV co-infection in Uganda from over 60% in the last one or so decade, to now about 30% to 32% in some areas.

“So not everyone who has TB has HIV as the public thinks. Some people think when you have TB you also have HIV. Now it’s only about 30% who have both TB and HIV among the people that we find with TB, otherwise over 70% of the people we find with TB do not have HIV,” Turyahabwe says.

Prevention for children

For children, there is still vaccination at birth. Once the child is born immediately before leaving the hospital, they get vaccinated against TB and leprosy, that vaccination is available.

The only licensed TB vaccine given to infants in Uganda is the Bacille Calmette-Guérin (BCG) vaccine.

Turyahabwe says the other preventive measures are environmental related.

“For instance, when you are constructing a living space (a house) make sure it is well ventilated. Also when coughing or sneezing cover the mouth and nose so that other people are not exposed to TB.

The challenges

We still face the challenge of stigma, Turyahabwe says. “When someone is diagnosed with TB people want to run away from them as if at the time we made the diagnosis is the time they got the disease.

“That is fueled by lack of awareness and information because once the problem has been identified and the person is put on treatment, they are no longer a treat.”

Turyahabwe says the treatment reduces their possibility of spreading the germ to very low levels “and it does this very fast.”

“Once you take your first doze within two weeks your chances of transmitting TB to others are very low, she says.

Treatment for those with TB

Treatment is available and can be taken even the lowest level and even at home, Turyahabwe says.

“Once you are linked to the health facility and prescription is done, you can continue your treatment at home. Once it is done you get cured, the disease is curable and you become normal again.

“For the drug resistance we have treatment available mainly at hospital level but still we make this treatment available for people who have the disease to continue it at home, in their communities.

“So, the issue of long admission in wards is no longer a problem. You can have TB and still continue with your activities.”

Extensive care

We have services starting from village level. At least each village in Uganda has a VHT who has been oriented about TB and Leprosy, Turyahabwe says.

“We have testing facilities from Health Centre III Level to the highest level (Specialised national referral hospital).”

Also introduced are community screening and testing tools.

“We have five mobile clinics and 17 mobile digital x-ray machines which can go markets, schools, communities and do screening for TB, they can identify the disease before it is advanced at community-level.

“When funding is available from our partners, we do periodic community-level screening using those VHTs that we trained in each village, every six months in March and September but it is dependent on availability of resources.

“But it is an approach that is helping us make inroads in creating TB awareness at community level, because in the village at that time people are talking about TB and leprosy

“It also helps us identify some of the cases that may not have reached the health facility during the year,” she says.

Turyahabwe says more resources are needed to push forward TB interventions that have been put in place and to scale.

“Imagine a village has three four VHTs but only one is oriented. We want all other VHTs to also be on board so that when they are doing their routine work, they can be able to identify some of the people in their catchment who may have TB and bring them to the health system.

“We also want the testing facilities to cover at least most of the Health Centre IVs, we have the geneXpert and similar equipment’s that we use for testing TB but it is not available in all health center IVs.

“These testing machines we would need them at the health Centre IV levels that would improve accessibility to testing for the people who need them in the communities,” she says.

Also introduced is use of stool for diagnosis of TB in children.

“This has been a difficult area for health workers to make a diagnosis for TB because most children would not spit out the sputum especially the young ones.

So, the use of the stool is going to help us,” Turyahabwe says of measure taken to diagnose TB more easily in children.

Ending the TB epidemic by 2030 is among the health targets of the United Nations Sustainable Development Goals (SDGs). SDG Target 3.3 includes ending the TB epidemic by 2030.

On March 24, Uganda and the world commemorated World TB Day, the theme continued with the affirmation that, “Yes! We Can End TB!” a preventable and curable disease, yet it remains one of the most common and deadly infectious diseases worldwide.

Turyahabwe says with the interventions in place and more resources from government and partners to scale them up, Uganda can end TB by 2030