Explaining the successes and failures of tuberculosis treatment programs; a tale of two regions in rural eastern Uganda.

BACKGROUND: Optimally performing tuberculosis (TB) programs are characterized by treatment success rate (TSR) of at least 90%. In rural eastern Uganda, and elsewhere in sub Saharan Africa, TSR varies considerably across district TB programs and the reasons for the differences are unclear. This study explored factors associated with the low and high TSR across four districts in rural eastern Uganda. METHODS: We interviewed District TB and Leprosy Supervisors, Laboratory focal persons, and health facility TB focal persons from four districts in eastern Uganda as key informants. Interviews were audio recorded, transcribed verbatim, and imported into ATLAs.ti where thematic content analysis was performed and results were summarized into themes. RESULTS: The emerging themes were categorized as either facilitators of or barriers to treatment success. The emerging facilitators prevailing in the districts with high rates of treatment success were using data to make decisions and design interventions, continuous quality improvement, capacity building, and prioritization of better management of people with TB. The barriers common in districts with low rates of treatment success included lack of motivated and dedicated TB focal persons, scarce or no funding for implementing TB activities, and a poor implementation of community-based directly observed therapy short course. CONCLUSION: This study shows that several factors are associated with the differing rates of treatment success in rural eastern Uganda. These factors should be the focus for TB control programs in Uganda and similar settings in order to improve rates of treatment success.

Treatment supporters and level of health facility influence completion of sputum smear monitoring among tuberculosis patients in rural Uganda: A mixed-methods study.

OBJECTIVES: To investigate whether treatment supporters influence the completion of sputum smear monitoring (SSM) among adult persons with bacteriologically confirmed pulmonary tuberculosis (BC-PTB), and to explore the reasons for incomplete SSM according to healthcare workers, persons with BC-PTB, and their treatment supporters in rural eastern Uganda. METHODS: A mixed-methods design was used. Quantitative data were abstracted from tuberculosis unit registers, while qualitative data were obtained through key informant interviews with healthcare workers and in-depth interviews with persons with BC-PTB and their treatment supporters. Quantitative data were analyzed with Stata. Qualitative data were transcribed verbatim and analyzed using a thematic content approach. RESULTS: Records were abstracted for 817 patients. Of these, 226 (27.7%) completed SSM. Factors independently associated with SSM completion included having a treatment supporter (adjusted risk ratio (ARR) 2.40, 95% confidence interval (CI) 1.23-4.70), treatment at a district hospital (ARR 1.61, 95% CI 1.04-2.49), treatment at a regional referral hospital (ARR 2.00, 95% CI 1.46-2.73), and every additional year since 2015 (ARR 1.29, 95% CI 1.17-1.43). Reasons for incomplete SSM related to health system, patient, treatment supporter, and healthcare provider factors. CONCLUSIONS: Completion of SSM was low. Persons with BC-PTB who have a treatment supporter were more likely to complete SSM compared to those without, and those receiving treatment at higher level facilities were more likely to complete SSM compared to those at lower level ones.

Integration of HIV-Sexual Reproductive Health Services for Young People and the Barriers at Public Health Facilities in Mbarara Municipality, Southwestern Uganda: A Qualitative Assessment.

BACKGROUND: Sexual and Reproductive Health (SRH) and HIV risk behaviors for young people are intertwined. This rationalizes the need for integration of HIV and SRH services within the health care system, especially in countries with high HIV burden. In this study, we explored the current status of HIV-SRH integration for young people and barriers of integration from different stakeholders at public health facilities in Mbarara Municipality, southwestern Uganda. METHODS: We conducted an exploratory qualitative study at public health facilities in Mbarara district of southwestern Uganda. Data were collected among young people (n=48), health care providers (n=63), and key informants (n=11). We used in-depth interviews and focus group discussions to collect the data. Coding and analysis of qualitative data were done using Atlas.ti. RESULTS: Overall there was no differentiation of HIV-SRH services between adults and young people. Integration of HIV-SRH services was reported at all facility levels; however, there was poor differentiation of services for the young persons and adults. Integrated HIV and SRH services for young people were acknowledged to improve access to information and risk perception, improve continuity of care, and reduce cost of services and would also lead to improved client-health worker relationships. The potential barriers to achieving HIV-SRH integration included individual provider characteristics like lack of training and attitudes, generic health system challenges like low staffing levels, poor infrastructure with lack of space and privacy to deliver these services. At the policy level vertical programing and unclear policies and guidelines were identified as challenges. CONCLUSION: Our study shows integration of HIV and SRH services exists in general but services for adults and young people are blended or poorly differentiated. Significant health system barriers need to be overcome to achieve differentiation of the services for young people and adults.