Status of TB Epidemic in Uganda

Dr. Francis ADATU-ENGWAU Programme Manager NTLP-MOH

MBN Symposium 2012

The burden of TB in Uganda

Population about 28 million people. The country is affected by the dual epidemic of TB and HIV. Uganda is ranked 16th among the 22 TB high burden countries in the world (2010 WHO report).

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The burden of TB in Uganda

WHO estimates;
- 102,000 TB cases per year 56,000 HIV+ - Incidence (All clinical forms) 330/100,000 population - Incidence (SS+) 136/100,000 population - Mortality 93 per 100,000 population

A total of 49,009 TB cases were notified and 25,448 (52%) of them were smear positive TB cases, while 12,824 were Sputum smear negative (2011 NTLP data)

55% of all the TB cases notified were dually infected with HIV (2011 national quarterly reports)
TB affects the economically active age group between 15-55 years. The male/female sex ration is about 1 to1

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Key drivers of the TB Epidemic

HIV co-infection
(55% of notified TB cases are HIV co-infected)

High Latent TB rates

(Stott et al: 50-70% adult population is infected)

Attitudes and Health seeking behaviour

(Both Patient and Health system delays average 6-8 weeks)

Intercurrent Disease states

(Under-nutrition, Diabetes Mellitus, Social habits-alcoholism, smoking)

High population growth

(3.2% per annum 2002 National Census)

High population movements

(Urbanization Living conditions in Slums)

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Embrace and Support Implementation of the STOP TB Strategy and the Global Plan to STOP TB For A world free of Tuberculosis
STOP TB STRATEGY Vision: 1. Elements of the Global Plan to DTOP TB

Pursue quality DOTS expansion and enhancement 5 elements of DOTS A TB-free world 2. Address TB/HIV, MDR and Other challenges TB in prisons, refugees and Goal: other risk groups and special situation To dramatically reduce the global burden TB/HIV collaborative activities, Prevent of TB by 2015 in line with the MDGs and MDR, Address TB in prisons the STOP TB Partnership targets 3. Contribute to health system strengthening Objectives: Participate in policy, HR, H-financing, Mgt, S-delivery, HMIS, Sharing Achieve universal access to quality innovations, PAL, adapting other diagnosis and patient centered treatment innovations. Reduce human suffering and 4. Engage all care providers socioeconomic burden associated with TB Public-Public, Public-Private mix, ISTC Protect vulnerable populations from TB, 5. Empower people with TB and TB/HIV and MDR-TB communities Support development of new tools and ACSM, Community participation in TB enable their timely and effective use care 6. Enable and Promote research Program based OR, Research for new diagnostics, drugs and vaccines MBN Symposium 2012

Targets
MDG 6: Target 8: Halt and begin to reverse the incidence of TB by 2015

Targets linked to MDGs and endorsed by Stop TB Partnership

- 2005: Detect at least 70% of infectious TB cases and Cure at least 85% of them - 2015 reduce prevalence of and deaths due to TB by 50% relative to the 1990 baseline - 2050 Eliminate TB as a public health problem (1 case per million population)

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Current performance
Case Detection Rate: 57.4% (2011 NTLP data)

Treatment Success Rate: 70.3%

Default: 10.7%

Death: 4.5%
Treatment Failure: 0.7%

Transferred out: 5.3%

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Key challenges
Financing for TB control
PHC grants to districts are low

Human Resources for Health

Laboratory personnel

Health seeking behaviour

Patient delay and Health system delay

Diagnostic issues in Children and TB/HIV patients

Algorithm, High Smear negative rates
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THANK YOU ALL FOR LISTENING Apparently the solution lies in PARTNERSHIP

Patients Communities

Partners

Government Health systems

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