There is much more TB in Uganda than estimated

By Atim Salome

As Uganda plans to mark World TB day on Friday, March 24 under the theme "Unite to end TB and: slogan, find the missing patients with TB. There is a call to address the scourge.

The new survey results indicate that the overall TB prevalence is 253/100,000 (95% CI: 191 - 315). This is much higher than previously estimated.

The observed high prevalence across age groups suggests that TB transmission is still widespread despite implementation of the stop TB strategy, calling for innovative approaches in ending tuberculosis including a strong collaboration between the private and public TB response actors.

Furthermore a total of 87,000 new cases occur every year. Considering that Uganda notified 46,171 TB patients (WHO, 2015) survey results revealed that 40,829 patients were missed in 2014.

Why missed cases?

One of the major reasons contributing to missing of cases is poor health seeking behaviour of those reporting chronic cough. About 39% of symptomatic presumptive TB patients and 36.7% of symptomatic prevalent TB cases did not take any action for their symptoms. The reasons for not seeking care included ignored illness (31.1%), self-treated (31%), hindered by cost (16%), did not recognise illness (12%), long distance (5.4%), long waiting time (1.3%) and others (2.9%). Understanding and addressing patients' barriers to service access is crucial to maximize the demand for service utilisation. Furthermore use of poor TB diagnostic services contributes to missed TB cases. There is need to use up to date TB screening services; including use of new developments in diagnostics.

National actions and commitments fall short to those needed to end tuberculosis in Uganda.

Other challenges faced in TB management in the country include poor adherence to TB treatment, poor TB counselling services, poor implementation of TB infection control practices, negative cultural beliefs coupled with misconception, stigma and discrimination of TB patients and inadequate resources allocated for TB control contributing to stock outs of vital TB medicines, supplies and other commodities. While Uganda grapples with the fear of impending catastrophic costs meted by tuberculosis on her citizens and the country at large, there is inadequate funding to end the TB of the epidemic. In 2014 domestic funding to meet TB need was 4%, international support 14 % unfunded 81%.

Ending TB

Uganda needs to follow up closely on the commitment to end TB epidemic by 2030 by funding and implementing the targets in the Global Plan to End TB (2016-2020). Furthermore achieve the 90-(90)-90 TB targets of reaching 90% of all people who need TB treatment, including 90% of populations at high risk and achieving at least 90% treatment success. There is need for prompt actions to halt TB transmission in Uganda and ending TB is the way to go because the diseases is curable therefore the country should prioritise interventions to increase TB case finding in order to curtail the spread of the disease in the community.

This therefore calls for urgent supply of quality and adequate drug-resistant TB medicines, improved and or new interventions in TB infection control, policy changes in offering TB treatment following emergency of new drugs and new regimens, community education and social mobilization on TB, TB contact tracing and follow up. This will go hand in with ensuring that every TB patient has access to effective diagnosis, treatment and cure, stop transmission of TB, reduce the inequitable social and economic toll of TB, develop and implement new preventive, diagnostic and therapeutic tools and strategies to stop and end TB.

A multi- sectoral level approach to enhance TB case finding should be put in place, starting with increasing strategic investments for TB control and better utilization of available diagnostics. There is urgent need to expand TB screening and diagnostic services to the different levels, with emphasis on TB hotspots and high risk population (prisons, health workers, congregate settings, PLHIV, diabetics, slum dwellers and contacts of confirmed and infectious TB patients).

This therefore calls for urgent supply of quality and adequate drug-resistant TB medicines, improved and or new interventions in TB infection control, provision of up to date TB screening; including use of new developments in diagnostics. Policy changes in offering TB treatment following emergency of new drugs and new regimens, community education and social mobilization on TB, TB contact tracing and follow up. This will go hand in with ensuring that every TB patient has access to effective diagnosis, treatment and cure, stop transmission of TB, reduce the inequitable social and economic toll of TB, develop and implement new preventive, diagnostic and therapeutic tools and strategies to stop and end TB.

To end TB calls for concerted efforts by a range of partners including Civil Society Organisations, Faith based organizations, Local Government, Private clinics, Health workers, Civil society members, Community leaders, Policy makers and Community Involvement. We must all make TB a priority and work towards its elimination.

"TB needs to become a political and financial priority. We must understand the big threat that TB represents for all of us. We need to shift from controlling this disease towards ending it…."

The writer is the advocacy for Better Health (ABH) Project Officer, National Forum Of PLHA Networks In Uganda