MAKERERE - UGANDA

Evaluation of the smear negative TB (in the context of HIV) WHO interim guideline in Uganda

The Human Immunodeficiency Virus (HIV) is the greatest risk factor for the progression of latent or recent TB infection to active TB. Diagnosis of tuberculosis in cases with HIV co-infection is difficult because of atypical clinical and radiological presentation. Thus, there is a need for diagnosis and care pathway guidelines that are effective and feasible in low-income settings. A WHO expert group developed algorithms to assist the diagnosis of TB and HIV in areas where HIV is highly prevalent with aims of minimising mortality, incorrect diagnosis, and speeding up the diagnostic process. However, carefully designed operational research is needed to validate these algorithms and evaluate their feasibility and effectiveness in routine public health practice. This study was therefore conducted in collaboration with WHO StopTB, Makerere University Faculty of Medicine and the Ugandan National Tuberculosis and Leprosy Programme.

The overall goal is validating a simplified version of the new WHO diagnostic algorithm for pulmonary tuberculosis (PTB) in HIV prevalent settings. The study was conducted at "Reach Out", an HIV/AIDS initiative in Kampala. the specific objectives of the study were: to assess the effectiveness of the new simplified algorithm consistent to local settings and to design an appropriate training package to support its implementation. The study was conducted among ambulatory adult patients (>18years) presenting with cough > 2weeks with no danger signs and no history of previous treatment for TB. The results of the study would have a paramount implication to TB control in terms of improving the quality of patient care and case detection in the sub-Saharan region.