TB hunters! A revolution against TB in Northern Uganda

Martin Muhire

Improvement Advisor, Uganda, USAID ASSIST Project/URC

TB hunters in action

An ASSIST staff a VHT attached to Ngai HC III in Oyam district on their way from TB contact tracing. Photo credit: Martin Muhire.

I am part of the USAID ASSIST team engaged in active tuberculosis (TB) case finding and ensuring that TB cases identified are reported into the national reporting system – the DHSI2. Since December 2016, the team and I launched a series of intervention activities to search for TB cases in 16 districts of Northern Uganda, working with staff within the district offices, health facility and community.

The main reason for our work is to look for TB cases and enroll them in TB treatment. Once, a staff member referred to our team as "TB hunters" and the name stuck. For just as a hunter searches for animals for food in the jungle or a birdwatcher hunts for a rare bird, we – the TB hunters – must be persistent and search for many hours to find people with active TB and bring them into care.

One staff member observed, “As you can see, today we identified 4 active cases out of 94 samples from Wansolo and Kiga fishing sites. Even a hunter is not always successful, but for us we have been able to bring four patients into treatment thanks to our persistence and hard work.”

Since November 2016, the USAID ASSIST team has been working with district teams, health facility and community teams to actively hunt down TB cases; the process commonly referred to as active case finding. Different teams—comprising of district teams, facility health workers and community village health teams—search for TB cases in the community.

Very few TB cases (15 total) have been identified from the prisons in the region. The findings challenged my assumptions because I expected to “catch” many TB cases in the regional prisons.

“Why is it there are no TB cases in your prisons?” I asked one of the Loro prison officers.

“Because most of our places are prison farms, so we always screen all prisoners at admission into the prison to make sure we have strong prisoners. Those who are sickly or have a persistent cough are sent to the central prisons, such as Lira central prison, to start TB treatment at the nearby regional hospitals and central prison health facility,” he replied.

'Wow! There is a system in place in prisons for screening and managing sickness among prisoners!' I thought to myself. This meant it was no longer the situation to expect TB cases in every prison. I wonder whether prison systems throughout the world have a similar screening process!

An ASSIST staff, a VHT attached to Aboke HC IV, Kole district talk to a TB patient about his other contacts. Photo by Monica Bagaya.

Teams also embarked on “hunting” for TB among contacts to index TB cases—these are family or community members living close to the TB patients—and so far (as of end the of February 2017), 27 cases have been identified. Could this mean there is more TB among the TB contacts than at the prisons? Probably yes!

Ok, let us turn our attention to TB among the fishing communities.

In January 2017, at a site visit, I asked the in-charge of a health centre III in Apac district which village in their catchment area had the highest number of TB cases and why.

“The fishing/landing sites on lake Kyoga because they are so congested and housing is so poor,” he quickly replied.

I then asked that he let us plan to screen people in those communities.

Out of 152 samples collected from 3 landing site communities, 8 were positive for TB. The team had discovered a new TB vulnerable population, the fishing communities, who were not originally a target for our TB active case finding intervention activities.

We now know where to hunt for TB: in the fishing communities, prisons, and among contacts. And I think we should target the HIV clients attending HIV clinics as well. “We must help facility teams to at least enroll more than 2 cases every day,” one staff commented.

See also:

Despite universal access to life-saving antiretroviral medications (ARVs), children infected with HIV in rural communities in Uganda are still dying. Because their caregivers believe they won’t make it in life, the support rendered to them is inadequate. 
Related Countries: 
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