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Defeat TB Project

NACWOLA USING THE COMMUNITY LINKAGE FACILITATORS TO FIGHT TB IN URBAN CENTRES


Background of NACWOLA
The USAID Defeat TB project is a five-year project (2017 – 2022) that aims to increase tuberculosis
(TB) case notification, case detection and treatment outcomes through health system
strengthening with the aim of ending the TB epidemic in Uganda. As a sub-recipient of University
Research Council (URC), the implementer of Defeat TB, a USAID-funded project, NACWOLA is implementing Defeat TB Project in Makindye division with KCCA by employing a community-
based model that has successfully worked through Community Volunteers and Linkage facilitators.

Community Linkage Facilitators (CLFs) are trained, coached and mentored to reach
out to the community with objective of linking communities to health facilities. The activities
include contact tracing, awareness raising, community dialogue, community screening, direct
observed therapy (DOT). The project is contributing to the National TB and Leprosy Program
(NTLP) for improved coordination at lower level to high impact and innovative interventions that
have appropriately responded to the TB epidemic in Uganda.

Overall Objectives:

Contribute to the reduction of morbidity and mortality rate associated to TB infection
Specific Objectives

  1. Increase access to quality health services for approximately 2300 patients from the 21 parishes of Makindye Division by 2020
  2. Increase the level of community awareness & demand for TB services
  3. Increase case finding for TB in the districts of Kampala Makindye Division by 20% in
    May 2020.
  4. Improve average treatment success rates for TB patients by 85% in Makindye
    division by May 2020.

Target Beneficiary Population Description (1 paragraph):
The project will engage the following target population

  • Children age 0 – 14 because they are normally missed or overlooked due to non-
    specific symptoms, difficulties with access to TB diagnosis and care, and often have clinical similarities with other common childhood diseases.
  • Women and spouses who luck good general lay knowledge of TB , its causes and
    treatment which is important for both prompt health care seeking and adherence
    to treatment.
  • Adolescents are high risk group that is not routinely tested and treated for latent TB
    infections,
  • Key populations are at heightened risk of HIV, TB and malaria, face reduced access to
    services they need, and the infection among the group is fueled by stigma,
    discrimination, harmful social norms, criminalization and poverty. There is need to
    concentrate efforts on providing, prevention, treatment and care to both key and
    vulnerable populations.

Proposed Location/Geographic Coverage:

NACWOLA is able to reach remote and marginalized communities in Makindye Division
targeting population within 21 parishes which include (Bukasa, Kabalagala, Katwe, Kibuye
Luwafu, Buziga, Kasanga, Kibuli, Kisugu, Nsabya Housing Estate, Salama, Nsambya Central,
Nsambya Railway, Gaba, Katwe One and KibuyiI Lukuli, Makindye II, Nsambya Police and
Wabigalo) of Makindye Division

Linkages with other stakeholders/community involvement:

NACWOLA intends to work closely with Kirudu Hospital 12 Health Units both private and
Government, The in charge of Police and Miltary barracks. The existing 40 Family support
groups will be first entry points within the community. The project will also work closely with
department of health, community development officer, the radio, TV stations and print Medias.
We shall have community facilitators, the CHW and Community Linkage Facilitators and TB
champions.

Project Activities

The specific project activities entail;

  •  Community mobilization & sensitization on TB as a contagious but curable disease.
    Creation of awareness enhances the ability of communities to identify & report
    presumptive cases whilst deciphering myths & misconceptions about TB.
  • TB case notification through community screening and contact tracing of index patients
    Follow-up & monitoring of patients to boost treatment adherence
    Tracking Lost To Follow Up (LTFU) TB patients i.e those who have disappeared from the
    health facility.
  • Comprehensive tracing of all contacts of index TB patients both at home & workplace.
     Referral of contacts who were identified with presumptive TB signs to health facilities
    for diagnosis.
  • Field collection of sputum samples from presumed TB cases both during contact
    screening & community outreaches.
  • Assignment of Direct Observers on Therapy (DOTs) to boost monitoring & ultimately
    adherence.

Achievements to date

  • The project has 15 trained Community Linkage facilitators working within Kampala.
  • NACWOLA has built the capacity of community volunteers who have now increased
    screening and case detection of all forms of tuberculosis in infants, children,
    adolescents, and adults at facility and community levels. Currently we have a total of
    45 cases notified from the communities and are linked to 12 Health facilities within
    the last two quarters.
  • The project has initiated and supported 90% completion of treatment for all patients
    diagnosed with all forms of TB within the last 6 months.
  • There is a strong community systems to support the continuum of TB prevention,
    screening, diagnosis, care, and treatment. In this financial year, the project has
    screened 2300 MARPS in 13 Hot spots within Makindye Division. The existing Village
    Health Teams {VHT} are continuing to support the CLF in tracking contacts.
  • NACWOLA has worked and enhanced staff with technical capacity to manage TB
    program both at regional levels to effectively guide implementation of TB control
    activities.
  • Contact tracing has been enhanced through coaching and mentoring staff and
    community volunteers to ensure effective screening of over 400 index clients who’s
    for last one year.
  • 89% lost to follow-up cases with Makindye division have been returned to care in
    the last 6 months of the project implementation.

The key implementation strategies include:

  • Leveraging multi-stakeholder partnerships including Kampala City Council (KCCA) Ministry
    of Health, Community Based Organization, the private sector and communities to ensure
    a coordinated and unified TB response that builds on best practices, complements and
    avoids duplication.
  • Using differentiated implementation models that recognize the need for tailored
    approaches for rural and urban settings is being piloted in Kasese region.
  • Strengthening the capacity of staff for quality improvement methods to data
    management in the field and the existing facilities for TB treatment outcomes
  • Using innovative, low-cost technologies for GIS patient tracking, diagnostics, SMS for TB
    case notification and treatment, and mapping of TB hotspots, including DR-TB
    identification and treatment adherence.

Defeat TB key recommendations include:

  • Increase screening and detection of all forms of tuberculosis in infants, children,
    adolescents, and adults at facility and community levels
  • Initiate and complete treatment for all patients diagnosed with all forms of TB
  • Ensure strong community systems to support the continuum of TB prevention,
    screening, diagnosis, care, and treatment
  • Enhance leadership and technical capacity of the TB program at community, national
    and sub national levels to effectively guide and manage implementation of TB control
    activities