The effect of Scale up of TB-DOTS Services on
Case Detections and Treatment success rates
in Central Uganda.
By
Denis Kaffoko,(MSC.DE,B.STAT,PCGME)
Outline
• Overview
• Background
• Methods
• Results
• Conclusion
•
Recommendation
Acronyms
• CB DOTS :Community Based Directly Observed
Treatment
• CDR
Case Detection Rate
• DOTS
Directly Observed Treatment
• TSR
Treatment Success Rate
• MDR
Multi Drug Resistance
Background:
According to 2012/2013 ASPR ,
•TB Treatment Success Rate increased from 71.1% in 2011/12 to
79% in 2012/13.
•DOTS coverage increased from 47% in 2011/12 to 55% in 2012/13.
•And in 2008,Uganda had one of the highest new cases with the new
case detection rate at 1.12 per 100,000 of population and about 8
percent of new cases were children under 15 years of age, (WHO Global
TB Report,2008).
Background cont’d
• In the same period, WHO-recommended a treatment strategy for
detection and treatment of TB called "Directly Observed Treatment,
Short-course" (DOTS) which combines five elements:
– Political commitment,
– Microscopy services,
– Drug supplies,
– Surveillance and monitoring systems
– Use of highly efficacious regimes with direct observation of
treatment.
Background Cont’d
• Amref Health Africa’s Mission is to improve the health of people in
Africa
by partnering with and empowering communities, and
strengthening health systems.
• Amref Health Africa in Uganda between 2007 – 2012, supported
three district health offices to scale up TB case detection, treatment
and control
through the TB REACH Project using the DOTS
strategy as recommended by WHO.
Background Cont’d
Description of the Intervention
• TB REACH was a 3 year project which started in2008 and had some
of the following activities ;
» Supply of essential drugs
» Community mobilization and awareness creation about
DOTs
» Capacity
building
through
trainings
of
various
stakeholders
» Strengthening of the referral system
» Strengthening of the Microscopy services through
equipping Laboratories with essential materials and
Medicines
Purpose of Study
• The study was to establish the effect of the scale for TB-DOTS
strategy on case detection rates and treatment success rate for the
central region in Uganda.
Objectives of the study:
• To establish the coverage of DOTS and the understanding of the
benefits in regards to improving treatment success rates in the
community
• To establish the effect of CB-DOTS strategy on improving Case
Detection Rates and Treat Success Rates in Central Region of
Uganda.
Method:
Study area:
The study was conducted in the 3 districts(Kiboga, Wakiso and Luwero)
where the TB REACH project had been implemented and Nakaseke
district as the control district
Research Design:
•
The study used a cross-sectional survey design both at Baseline and End
line ,using qualitative and quantitative methods of data collection were
used together with retrospective design on the TB clients.
Method cont’d:
Sampling Design:
• Multi stage sampling was used as follows;
• Purposive sampling to select districts of the study, Sub Counties,
Parishes and Health Facilities
• Simple random sampling was used to select Households, Health
facilities and Key Informants.
•
Sample size determination:
The study calculated the sample size for the Households using
Keish & Leslie, 1996
Sampling Framework
Sample Unit
N
Households
1034
Health Units
n
Intervention Districts Control Distrist
160
120
40
35
15
12
3
TB Patients
211
32
25
7
VHT
350
32
25
7
Community
Leaders
153
32
25
7
Health
Workers
139
48
44
4
Data collection methods
Structured questionnaire:
– Household heads, TB patients and Expert clients
• Key informant interview guide:
– Health units, VHTs , community leaders , teachers ,health
workers were selected
• Desk Reviews:
– Health facility records which included NTLP Register
• Data Analysis on raw data was done using SPSS and secondary
data was done in Excel
%age coverage of CB-DOTs by districts and year
between 2008 - 2012
35%
30%
25%
20%
15%
10%
5%
0%
Intervention Area
Non Intervention Area
2008
5%
2%
2009
18%
3%
2010
19%
2%
2011
22%
0%
2012
29%
0%
The Effect of CB-DOTS strategy on CDR and TSR in
Central Uganda
CDR
TSR
100.00%
90.00%
80.00%
%age of respodents
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
2008
2012
Kiboga district
2008
2012
Luwero district
Intervention Districts
2008
2012
Wakiso district
2008
2012
Nakaseke district
Control District
The Proportion of various stakeholder who reported
adequacy of support for scale up of CB-DOTS strategy
to improve CDR and TSR
TB patients
VHTs
%age of respodents
Household heads
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Wakiso
Luwero
Kiboga
Intervention Districts
Implementation area
Nakaseke
Control District
Conclusion:
Overall, the Scale up of TB-DOTS Services Contributed to
improving;
– The CDR from an average of 58% in 2008 to and average of
62% in 2012
– TSR from an average of 71% in 2008 to an average of 75% in
2012 slightly below the national TSR of 79% in the
implementation area of TB reach in Central Uganda.
• The CB DOTS coverage improved from an average of 10% 2008
to an average of 70% in 2012 higher than the national target of
55% in the implementation
Conclusion cont’d
• The control district the level of awareness was noticeably low as
compared to districts where the project was implemented.
• The poorly performing districts were faced with
challenges of
severe drug stock outs, low staffing levels and absenteeism, the low
capacity of some health units to detect and treat TB.
Recommendations
• Strengthen the drug and other logistics supply to communities
and health facilities.
• Facilitate VHTs and community health workers to Monitor and
track TB patients
• Palliative care needs to be strengthened through the integrated
Community-Family Based DOTS initiative suggested.
• There is still need to have an effective outreach programmes in
communities that would raise awareness and change peoples’
attitudes towards Tuberculosis which is presently highly
stigmatized.
THANK YOU