Strategies to resolve the gap in Adolescent Tuberculosis care at four health facilities in Uganda: The TEEN TB pilot project

Abstract

AbstractIntroductionIn 2021, an estimated 10.6 million people fell ill with tuberculosis (TB) globally, 1.2 million of these were children. About 40% of them aged between 5 and 14 years with TB are missed annually. In Uganda, 44% of adolescents with chronic cough of ≥2 weeks do not seek care from health facilities. Therefore, strategies to promote health care-seeking behaviour among adolescents are urgently needed. We piloted a project (TEEN TB project) aimed at improving uptake of tuberculosis (TB) care services among adolescents at Ugandan health facilities.MethodologyWe developed an adolescent TB awareness and screening package using the human centred design. This technique puts real people at the centre of the development process. The package consisted of 3 interventions (TB screening cards, adolescent-TB awareness poster messages and a local TB awareness song) deployed in the project health facilities and their surrounding communities. Data on socio-demographic and clinical characteristics of adolescents were collected for the period between October 2021 and March 2022 at 4 project health facilities (Kawolo, Iganga, Gombe and Kiwoko). We collected before and after intervention data from facility level records to determine the effect of the package.ResultsA total of 394 adolescents were included and the majority (76%) were still in school. Overall, the intervention improved adolescent TB care in the four project health facilities. The average number of adolescents screened increased by 94% from 159 to 309, with an incidence rate ratio (IRR) of 1.9 (95% CI: 1.9-2.0, p <0.001), there was a 2-fold increase among those presumed to have TB; from 13 to 29, IRR of 2.2 (95% CI: 1.9-2.5, p <0.001) and those tested with GeneX-pert and microscopy increased more than 3 times from 8 to 28, IRR of 3.3 (95% CI: 2.8-3.8, p <0.001). There was a minimal increase in the average monthly number of adolescents with a positive result from 1.6 to 2.4 and linkage to TB care services from 2 to 3.1. These were not statistically significant at p=0.170 and p=0.154 respectively.ConclusionThe project improved uptake of TB services among adolescents along the TB care cascade (screening, TB testing and linkage to care). We recommend a robust and fully powered randomized controlled trial to evaluate the effectiveness of the package.