Adult Ugandans to access latent tuberculosis treatment

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Adult Ugandans can now access treatment for latent tuberculosis (TB) unlike in the past when it was only available to children. 

When a person has latent TB, it means the germs are present in the body but do not cause disease because they are being managed by the immune system. 

Previously, the treatment for latent TB in Uganda was only available to children and HIV-positive adults, but the target population has been widened. 

“In the past, the treatment for latent TB was being given to people living with HIV and children under the age of five who had been exposed to a known TB patient because they were at a higher risk of getting infected. 

Currently, the treatment has gone on to cover more people older than five years. As long as you have evidence that you were in contact with a TB patient and you have the germ in your body, you can get the TB preventive therapy,” Dr Mary Nabukenya, the director of the USAID TB flagship project in the Ministry of Health, told journalists at a media briefing in Bukoto, Kampala. 

Before one is started on treatment, they first undergo a test to see if they have the germ in the body or not. It after the presence of the germ is confirmed that one is started on the TB preventive therapy which consists of isoniazid and rifapentine. 

“We got a new drug with a new formulation (rifapentine plus isoniazid) that you take for 3 months as opposed to the past when it was for six months (isoniazid). We are always evolving to improve things. The preventive therapy is to help you so that the latent TB does not progress into TB disease,” she added. 

With 200 cases per 100,000, Uganda is one of the top 30 countries with the highest TB burden in the world and the Government has rolled out a raft of measures to scale down infections. 

In Ugandan public health centres, tuberculosis tests and treatment are done at no cost. 

“Currently, over 300 government health facilities have TB GeneXpert machines to test people for the disease. For health centre IIIs, we have Truenat TB test machines, which have a long battery life,” Dr Nabukenya says. 

“For every four TB cases, three are men. We have more TB among men mainly because of social behavioural factors. For example, after work men do not go straight to their homes,” Dr Susan Akello Adakun, says. 

The areas with the highest TB infections in Uganda are Karamoja and Kampala Metropolitan region which consists of Wakiso, Mukono and Kampala. 

Karamoja has the highest incidence of TB in Uganda with 3,500 new cases identified and treated every year. 

The high TB cases in Karamoja are attributed to malnutrition while those in Kampala are attributed to crowding. 

Barriers to preventive treatment in Uganda 

According to recent research from the International Union Against Tuberculosis and Lung Disease (The Union), a research organisation, the main reason for 91% of eligible people not starting TB preventive treatment was missed appointments and opportunities. 

This was 81% of people living with HIV already on antiretroviral therapy and 96% of people living with HIV newly on ART (less than one month). 

The research team identified the barriers to access as lengthy treatment initiation procedures, lack of staff time to screen patients for eligibility, concerns about adverse events, alcoholism, stigma and hesitancy among otherwise-healthy people living with HIV. 

The findings were based on data analysis and health facility monitoring from June to December 2022. 

The study established that 90% of people living with HIV who were already on ART had been initiated on TB preventive treatment by December 2022. Of those, 69% had completed treatment and 31% were still on TB preventive treatment. 

The study enrolled 306 people living with HIV newly on ART and 392 people living with HIV already on ART, aged 15 and over, across 12 health facilities. 

John Paul Dongo, the Director of The Union Uganda Office, said: “Despite improvements, barriers still hamper TPT implementation. Continuous patient education would help address stigma and apprehension about TPT. 

“An efficient medicine supply chain, wider roll-out of shorter regimens, streamlined patient flow, implementation of adherence monitoring and timely follow-up of patients are important to improve TPT completion.” 

The research project began in May 2022, with the training of healthcare workers on the management of TB infection, including recording and reporting of TB screening and TPT provision.  

In June 2022, the people living with HIV were enrolled to help evaluate the TPT provision. Followed up with the enrolled participants and data collection was then undertaken in December 2022.