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

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.

Discontinuation of tuberculosis treatment among children in the Kampala Capital City Authority health facilities: a mixed-methods study

“…A previous study in eastern Uganda reports that inadequate financing of the TB control program and deficiencies in the implementation of the CB-DOTS strategy is associated with suboptimal treatment success [ 18 ]. The study further showed that the disappearance of symptoms of TB especially after treatment initiation results in DTT [ 18 ].…”

“…A previous study in eastern Uganda reports that inadequate financing of the TB control program and deficiencies in the implementation of the CB-DOTS strategy is associated with suboptimal treatment success [ 18 ]. The study further showed that the disappearance of symptoms of TB especially after treatment initiation results in DTT [ 18 ]. Physical and economic barriers have been reported in a previous study as one of the reasons for not completing required sputum smear monitoring visits [ 19 ], emphasizing that people with TB face several barriers along the pathway to continuing with treatment.…”

HIV infection modifies the relationship between distance to a health facility and treatment success rate for tuberculosis in rural eastern Uganda

“…In Kumi district, rural eastern Uganda, almost three in 10 people travel ≥5 km (km) to access a health facility, public or private [9] . The majority of people with TB usually walk to receive TB services at these health facilities and face physical and economic barriers [10] . A patient is required to make a minimum of eight visits during the 6-month treatment period, with four visits in the first two months and a monthly visit in the last four months.…”

The Impacts of Temporary and Permanent Public Health Policies on HRQOL in a Small Open Economy

“…First, when discussing government spending including health expenditure, we must recognize the governance issues specific to poor countries, including such topics as democratization, corruption control, capacity-building, and electoral and judicial systems [2]. Although many studies in [2][3][4][5][6][7] argue for the importance of sustained public health programs and systems, the rise in government spending in many poor countries can slow or be repealed. Indeed, by using a panel dataset for 111 countries from 1984 to 2004, the share of GDP devoted to government expenditure in developed countries such as the United States has been steady and increasing since 1970, while government expenditure in developing countries over the past three decades has shown an inconsistent trend [8].…”