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.