Improving TB Treatment Response Monitoring at Nine TB Diagnostic Treatment Units: Tested Changes and Guidance from Uganda

In Uganda, ASSIST worked with the MOH and implementing partners to build the capacity of health workers to be able to screen, diagnose, and manage TB to improve TB care services using the continuous quality improvement (QI) model as well as the collaborative approach. This change package details the experience of improving TB treatment response and provides guidance to others who may want to improve TB treatment response.
Following a baseline assessment conducted in October 2015 at the participating health facilities it was found that sputum follow-up monitoring was at 55.8% at two months, 34.1% at five months, and 31.5% at 6/8 months of TB treatment. USAID ASSIST engaged the facility-based health workers to into regular review and analysis of performance on sputum follow-up monitoring and identify possible process changes to test and implement. In December 2015, ASSIST provided orientation on the basics of QI to the TB case providers followed with regular support to the teams. Facility QI teams comprised of TB focal person, facility in-charge, sub-county health worker, departmental heads, lab personnel and linkages facilitators/VHT were formed.
Between May 2015 to August 2016, the teams were able to increase the percentage of confirmed TB cases that had follow-up sputum testing at two months from around 60% to nearly 100%. Those with sputum follow-up at five months improved similarly, from 45% to nearly 90%. All the tests turned negative indicating good response to TB treatment.
These changes are recommended because the nine health facilities that tested and implemented these changes reported significant improvement in TB clients that had sputum follow-up done at two and five months. Persons involved in TB work need to focus on:  
•    Communicating the guidelines and importance of sputum follow-ups
•    Assigning roles
•    Integrating of activities
•    Appropriate scheduling and tracking of clinic appointments
•    Accessibility to sputum follow-up logistics and supplies
•    Improving documentation and utilize TB data
•    Improvised a TB appointment register
This change package is intended to provide guidance among individuals and QI teams wishing to improve sputum follow up at two and five months for bacteriologically confirmed TB clients. It provides the general idea and acts as a guidance on concepts with examples of innovative changes that can be done when aiming at improving sputum follow-up. Teams are urged to adapt these changes to suit their clinic settings for improvement to occur.

Report Author(s): 
Sylvia Nakibuuka, Herbert Kisamba, Esther Karamagi, Mirwais Rahimzai
ASSIST publication: 
ASSIST publication
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