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Cycle 1

Principal Investigator:  Achilles Katamba, Makarere University 
NIH-Supported Collaborator: Adithya Cattamanchi, University of California, San Francisco
Title of NIH Award: TB Guideline Observation and Adherence in Low Income Countries (TB GOAL)

1-61 Katamba - Kizito poster
Kizito Samuel, a GHES Fellow, presenting poster at the 47th Union Meeting in Liverpool, UK in October 2016. (photo courtesy of PI Katamba)
Project Overview
Uganda has an estimated 67,000 annual TB cases (incidence 193/100,000 persons), but suffers from among the lowest case detection and treatment success rates of the 22 high-burden countries. Moreover, case detection and reporting among children is virtually non-existent. The recently published “Desk Guide for Diagnosis and Management of TB in Children”, developed with USAID funding, is an evidence-based, simple decision aid to improve early and accurate identification of children with TB in resource-constrained settings. However, uptake of the Desk Guide has been limited to date and little is known about how best to facilitate implementation in routine practice settings. The overall objective of the project is to develop and evaluate an intervention to facilitate successful adoption of the Desk Guide at primary health centers in Uganda. This project has 3 phases: 1) to identify barriers and enablers to implementation of the Desk Guide at primary health care facilities in Kampala; 2) to develop a multi-faceted intervention to promote Desk Guide implementation and adoption at primary health care facilities in Kampala; and 3) to evaluate the impact of the intervention on Desk Guide implementation at primary health care facilities in Kampala. These studies will take place at 8 Kampala City Council Authority clinics, which are representative of urban primary care centers in sub-Saharan Africa. The overall hypothesis is that a multi-faceted intervention will increase the proportions of 1) children identified as TB suspects; 2) child TB suspects evaluated for TB; and 3) children diagnosed and reported as TB cases. The research is consistent with USAID Uganda’s goal to strengthen health systems and improve the delivery of health services. This research will provide USAID and the Government of Uganda with important information on factors that influence Desk Guide use and strategies to promote its uptake at primary level health facilities, which will lead to increased diagnoses of pediatric TB in Uganda.

Summary of Recent Activities: 

As of June 2017, the team continued routine supervisory visits to the health facilities to monitor the use of the Patient Record Forms (PRFs). Follow-up/refresher trainings were provided which focused on training of staff who complete PRFs at the KCCA health facilities. Thisincludes the clinicians, the teams at the OPD, the laboratory teams, and the dispensing teams. On job training continues to be conducted based on the weaknesses in data capture identified during routine supervisory visits. The research team continued to enter approximately 50,000 records of children at or below the age of 15 into the online RedCap database. A survey tool to assess clinician knowledge, attitudes, and self-efficacy and assess the impact of the intervention has been developed and will be administered in the next quarter before introduction of the intervention. The same tool will be administered after implementation of the intervention at each clinic. The intervention to improve diagnosis of childhood tuberculosis (TB) was completed and the components include: Education; Training; communication to stimulate action (persuasion), create an expectation of reward or cost (incentivisation or coercion); making more resources available for childhood TB diagnosis (environmental restructuring) model positive examples of desired childhood TB evaluation practices and outcomes (modelling) and utilize technology or other means to reduce workload (enablement). In September 2017, the intervention will be implemented in a step-wedge manner at the six primary health centers.

The Fogarty Global Health Equity (GHE) Fellow, Dr Samuel Kizito, who worked under the PEER project had his abstracted accepted for presentation at the 20th African Union Conference on Tuberculosis. The abstract was titled “Identifying gaps in pediatric Tuberculosis screening – diagnosis – treatment cascade: findings from six health facilities in Kampala Uganda”. In addition to the abstract, the GHE fellow, Dr. Samuel Kizito, has finalized a manuscript titled “Assessing the quality of Routine Evaluation of Children for Tuberculosis at Primary Care Clinics in Kampala, Uganda” and will be submitted for publication next quarter in the Journal of the International Union Against TB and Lung Disease. In the manuscript the TB care cascade using clinical algorithm adapted from the Desk Guide is characterized and the number of additional TB cases that could have been identified if providers adhered to the Desk Guide were quantified. A second manuscript documenting the barriers identified and mapping intervention functions to constitute the intervention(s) and modes of delivery is near completion and will also be submitted next quarter.

Health Cycle 1 Recipients