Abstract
BackgroundOptimally 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.MethodsWe 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.ResultsThe 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.ConclusionThis 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.
Highlights
Performing tuberculosis (TB) programs are characterized by treatment success rate (TSR) of at least 90%
The study participants consisted of health facility TB focal persons (TBFPs), District TB and Leprosy Supervisors (DTLS), and District Laboratory focal persons (DLFPs) from both settings, districts with low and high TSR
Our study identified the emergent themes as facilitators of and barriers to treatment success rate
Summary
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. DOTS has been adopted and implemented widely, the achievement of the WHO desired treatment success rate (TSR) of at least 90% remains a challenge for most TB programs globally. Recent statistics suggest that the global TSR for newly diagnosed bacteriologically confirmed pulmonary TB (BC-PTB) has declined from 86% in 2014 to 83% in 2017 [4]. This decline presents an unprecedented concern for TB programs because of exacerbations in TB morbidity and mortality [5]. The between country variation is seen from TSR of 83.4% in Cameroon [6], 90.1% in Ethiopia [7], and 75.7% in Nigeria [8]
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