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TB Community Engagement chapter
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Introduction:

The TB/HIV Community has over the last 2 weeks participated in consultations on the TB/HIV

community response. Consultations were carried out in Central, Eastern and Central Western

regions. Participants included members of the TB community, PLHIV/AIDS; PLTB, Networks,

Service Providers, and community leaders.

Consultations coordinators:

  • USTB Partnership
  • Uganda National Association of AIDS Support Organizations (UNASO)
  • African Young Positives Network (AY+)
  • National Forum of People Living with HIV/AIDS Uganda.

 Objectives:

To create space for TB communities to participate in the development of the TB/HIV Priorities and inform

the GF writing process.

To highlight interventions that can upscale the community’s role in the response to TB/HIV.

 

 Treatment and Care

#1: Increase community based treatment- through expansion of home based care

Evidence shows that strengthening the linkages between health facilities and the community improves

adherence and retention in care. Further, this may contribute towards promotion of disclosure and

reduction in stigma. A connected system also reached more people, especially youth and children, and

increased awareness about TB and HIV. Specially, civil society proposes the promotion of home-based

DOTs, adherence support, nutrition, awareness and linkages/referrals. For efficiency purposes, civil society

will build the capacity of existing structure such as PLHIV networks VHTs and establish TB peer support

groups to implement these activities. Civil society will train VHTs in HIV/TB and nutrition, advocate for

facilities to do home-based care transport, ensure constant supply of drugs, and conduct home-based TB

screening. This activity is integral for TB/HIV integration in Uganda, in order to improve contact tracing for

TB, home-based screening for HIV and TB, DOTs and awareness for HIV/TB.


#2: Reduce losses to follow-up

#3: Community based DOT to improve QOC and decrease drug resistance

#4: Contact tracing especially children and young people + older persons


Available data shows that treatment outcomes have been _uctuating, treatment success rate dipping

below 70% in 2008 and 2009 and steadily rising thereafter to 77% among the 2012 cohort, but well below

the AFRO average of 85% and the 90% Stop TB Program target set for 2015. The trend shows a steady but

not satisfactory increase in cure rates to just over 40% among the 2012 cohort. It further shows that

unfavorable treatment outcomes have persisted at over 20% (death 4.7%, failure 0.8%, default 12% and

transfer out at 5%). The trends further show lowest treatment success rate and highest default rate which

may be attributed to loss to follow up, poor recording and reporting, not obtaining the de_nitive

treatment outcomes of transfer outs, low DOT and CBDOTS coverage. It is therefore recommended that

the more investment be put in addressing the loss to follow up, ensuring that community based DOT are

implemented to improve the quality of care and reduce drug resistance. Also, ensure that tracing

especially among children and older persons is improved through supporting the TB peer support

groups.

#5 Procurement supply management system for TB commodities: The TB community proposes more

investment in improving the procurement and supply system to ensure availability of TB commodities and address irregular supply of TB reagents and supplies to diagnostic facilities.

#6 Nutrition-

Adherence to medicines for both HIV and TB are closely linked with access to a nutritious diet. The treatment cascade in Uganda highlights that there is a gap in keeping people on treatment who need it.

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