TRACK TB Home Visits in Uganda Help Strengthen Adherence to TB Treatment

 {Photo credit: Tadeo Atuhura/MSH}Flora Mugisa receives incentives (porridge and milk) from the hospital team during a home visit.Photo credit: Tadeo Atuhura/MSH

As is the norm in the extended family support system in Uganda, Flora Mugisa helped care for her sister who was suffering from multidrug-resistant tuberculosis (MDR-TB). A year later, Flora also fell sick. She lost her appetite, grew thin, and complained of a heavy chest with severe pain.

“I could not sleep at all,” said Mugisa, 70. “I would cough throughout the night. My grandson knew that I would die anytime.”

A team of health workers supported by the TRACK TB project identified Mugisa as a potential TB case while conducting routine community home visits. TRACK TB, a five-year project funded by the US Agency for International Development (USAID) and led by Management Sciences for Health (MSH), aims to increase TB case detection and treatment success rates to meet Uganda’s national targets for reducing the burden of TB, MDR-TB, and TB/HIV.

Mugisa was initially diagnosed with drug-sensitive TB, but after she failed to respond to treatment at Hoima District Hospital, she received a diagnosis of MDR-TB and was sent to Mulago National Referral Hospital. “She was very bad off and we had to refer her quickly for support,” said Janet Anguzu, a senior TB nursing officer at Hoima District Hospital.

Although Hoima was closer, it lacked the capacity to handle MDR-TB cases like Mugisa, who required hospitalization. After 10 months of treatment at Mulago, Mugisa recovered enough to be sent back home for close monitoring and support. The MDR-TB care team at Hoima conducted trainings and mentorship at a lower-level health facility near Mugisa’s home where she received daily directly observed treatment.

Through TRACK TB-supported monthly clinical reviews, medicine deliveries, quarterly home visits, and mentorships conducted by Hoima District Hospital, Mugisa completed her treatment after nearly two years. She gained weight, had more energy, and resolved all TB symptoms. She said:

I can now grow my own food. Before, I could not support myself and depended on my neighbors for everything. I now feel strong and happy.

TRACK-TB has helped many people like Mugisa. Fifty-two MDR-TB patients had been enrolled at the selected hospitals at the beginning of the project, compared to 462 by the end of 2015. At a ratio of 150 TB patents for every 100,000 people, Hoima District has one of the highest TB prevalence rates in the country. Hoima District Hospital manages over 900 TB clients annually, making it the ninth highest TB-burdened district in Uganda.

TRACK-TB supports 6 of 15 MDR-TB treatment facilities in Uganda and provides treatment services to over two-thirds of all MDR-TB patients in the country.

[This is 1 of 12 stories in the 2016 special edition Global Health Impact newsletter. Click here to read more.] {Photo: Gwenn Dubourthournieu}This is 1 of 12 stories in the 2016 special edition Global Health Impact newsletter. Click here to read more.Photo: Gwenn Dubourthournieu