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Policy Brief – Financing Tuberculosis Management in Uganda

 

“If your health services largely depend on the kindness of other countries, then you know you are a banana republic.

If you have to hold a ceremony to receive just 9 GeneExpert machines, which your country cannot afford to buy without a fuss, then you are a banana republic.”

The immediate quotation above is a comment by Geoffrey Buga in response to a story, “Uganda receives Shs 500m Tuberculosis machines” that was published in the Daily Monitor newspaper.

The story in the Daily Monitor was accompanied by a photo of Uganda’s State Minister for Health (General Duties), Hon. Sarah Opendi, receiving GeneXpert tuberculosis (TB) testing machines from the Ambassador of the United States of America to Uganda, Her Excellency Deborah Malac; a photo that was taken by Rachel Mabala.

Read more: Policy Brief – Financing Tuberculosis Management in Uganda

Policy Brief - Uganda’s Capacity to Diagnose Tuberculosis (TB)

 

“Considerable technological advances have been made in the diagnosis and treatment of TB but they remain less accessible to the communities that need it the most. Only 2/3 of the global reported TB cases are confirmed by a laboratory test. The widely available microscopy is less sensitive and requires high interpretative skill while the traditional mycobacterial culture is complex, marred by contamination and long time to result, which emphasises the urgent need for molecular diagnostics. The WHO (World Health Organisation) approved Xpert MTB/Rif and Line probe assay for rapid detection of TB and drug resistance have been laboratory evaluated and found implementable. Implementation remains limited to a few regional or national centres and we (the TWENDE Consortium) are asking why?”

Read more: Policy Brief - Uganda’s Capacity to Diagnose Tuberculosis (TB)

Qualitative Investigation of TB in Uganda in Progress

“Find the missing patients with tuberculosis ... One of the major reasons contributing to missing of cases is poor health seeking behaviour of those reporting chronic cough. About 39% of symptomatic presumptive TB patients and 36.7% of symptomatic prevalent TB cases did not take any action for their symptoms.

The reasons for not seeking care included ignored illness (31.1%), self-treated (31%), hindered by cost (16%), did not recognise illness (12%), long distance (5.4%), long waiting time (1.3%) and others (2.9%).

Understanding and addressing patients’ barriers to service access is crucial to maximize the demand for service utilisation. Furthermore use of poor TB diagnostic services contributes to missed TB cases. There is need to use up to date TB screening services; including use of new developments in diagnostics.”

Read more: Qualitative Investigation of TB in Uganda in Progress

TWENDE Qualitative Data Collection in Progress in Uganda

 

Qualitative data collection by CPAR Uganda Ltd (CPAR) has intensified for the University of St. Andrews led empirical research and advocacy study project code named: “Tuberculosis: Working to Empower Nations’ Diagnostic Efforts (TWENDE)” that is funded by the European & Developing Countries Clinical Trials Partnership (EDCTP).

Read more: TWENDE Qualitative Data Collection in Progress in Uganda

TWENDE Qualitative Research Investigation – Progress in Uganda

As of 19th June 2017, CPAR Uganda Ltd (CPAR) has so far conducted qualitative research investigations in six districts of Uganda for the European & Developing Countries Clinical Trials Partnership (EDCTP) funded empirical research and advocacy study project code named: “Tuberculosis: Working to Empower Nations’ Diagnostic Efforts (TWENDE).”

In those six districts CPAR has conducted one-on-one interviews with a total of 30 persons, including: Resident District Commissioners, District Chairpersons, District Health Officers, Health Care Facility Administrators, Health Personnel, Tuberculosis (TB) patients or survivors and TB patients care givers.

Read more: TWENDE Qualitative Research Investigation – Progress in Uganda

TWENDE Qualitative Data Collection in Progress

 

Since May 2017 Qualitative Data Investigators (QDIs) for the European & Developing Countries Clinical Trials Partnership (EDCTP) funded Tuberculosis: Working to Empower Nations’ Diagnostic Efforts (TWENDE) research and advocacy study are actively collecting ‘new’ qualitative data – conducting interviews and focus group discussions – in Tanzania, Kenya and Uganda.

Read more: TWENDE Qualitative Data Collection in Progress

TWENDE Receives Approval in Tanzania

 

The Government of the United Republic of Tanzania (GoT) has given the research project: “Tuberculosis Working to Empower Nations’ Diagnostic Efforts (TWENDE)” a “Clearance Certificate for Conducting Medical Research in Tanzania”  

Dr. Mwelecele N. Malecela – Chairperson Medical Research Coordinating Committee of the GoT and Prof. Muhammad Bakari Kambi – Chief Medical Officer of the Ministry of Health, Community Development, Gender, Elderly and Children of the GoT, in a letter dated 11th October 2016, communicated to the TWENDE Principal Investigator for Tanzania the GoT’s decision granting TWENDE ethical clearance and therefore permission to conduct the TWENDE study in Tanzania.

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TWENDE Receives Ethics Approval in Kenya

“The Study (Tuberculosis Working to Empower Nations’ Diagnostic Efforts (TWENDE)) is granted approval for implementation”, wrote the Kenya Medical Research Institute (KEMRI) Scientific and Ethics Review Unit (SERU) in a letter to the TWENDE Consortium dated 15th August 2016 and signed by Mr. Ambrose Rachier, SERU Chairman.

This means, therefore, that SERU has approved to be conducted in Kenya the East Africa wide TWENDE research study. The Principal Investigator for TWENDE  in Kenya is Dr. Evans Inyagala Amukoye. Ms. Norah Owaraga is the TWENDE Social Scientist and she will support the TWENDE Kenya Team as an advisor for the qualitative data collection, processing and analysis. Dr. Wilber Sabiiti is the TWENDE Team Leader. 

Read more: TWENDE Receives Ethics Approval in Kenya

TWENDE RECEIVES ETHICS APPROVAL IN UGANDA

The Makerere University Kampala (MUK) School of Biomedical Sciences Higher Degree Research and Ethics Committee (SBS-HDREC) has approved to be conducted in Uganda the East Africa wide research study titled: “Tuberculosis Working to Empower Nations’ Diagnostic Efforts (TWENDE)” 

In a letter signed by Dr. Erisa Mwaka, Chairperson, SBS-HDREC and that is dated 9th September 2016 the SBS-HDREC informed the TWENDE Consortium as follows: “In the matter concerning the review of a research proposal entitled: “Tuberculosis Working to Empower Nations’ Diagnostic Efforts” the Investigator has met all the requirements as stated by SBS-HDREC and therefore, the protocol is APPROVED.” 

Read more: TWENDE RECEIVES ETHICS APPROVAL IN UGANDA

Control of tuberculosis is costly, but necessary

By Prof. Blandina Theophile Mmbaga (right – participating the TWENDE Knowledge Transfer workshop) and Ms. Norah Owaraga.

“It is very expensive to be poor.” This observation by Mwalimu Julius Nyerere (RIP) is perhaps even more poignant today in the context of the tuberculosis (TB) scourge within East Africa – at regional, country and individual household levels. Poverty indeed sustains TB 

Control of TB requires proper diagnosis and treatment among other public health interventions. The gold standard for diagnosis of TB for many years, since the 18th century, and which is still the most accessible in TB high incidence countries, is the Sputum Smear Microscopy. However its sensitivity is below 80 percent. 

Read more: Control of tuberculosis is costly, but necessary