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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)

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 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.

Public Health Impact:
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.

NIH Collaborator:
Dr. Cattamanchi’s research is focused on two thematic areas: 1) Development and evaluation of TB diagnostics and 2) Implementation and dissemination of evidence-based interventions for TB. This study builds on previous collaborations between Drs. Cattamanchi and Katamba on an NIH- funded study to improve provider adherence to guidelines for evaluation of adult TB suspects presenting to rural health centers. 

Health Cycle 1 Recipients