Tuberculosis Research Group

Our Approach

1. Multidisciplinary Expertise: Our research group comprises experts from various fields, each contributing a unique perspective to our TB research endeavors. By merging clinical insights, epidemiological analysis, health economics considerations, health informatics and laboratory excellence, we ensure a comprehensive approach to addressing the TB challenge.
2. Research Excellence and Innovation: We are dedicated to conducting innovative research of the highest caliber. Our investigations are designed to generate robust evidence that informs policy decisions, accelerates interventions, and contributes substantively to the larger goal of TB elimination.
3. Evidence-Based Impact: We are committed to rigorous evaluation and data-driven decision-making. Our research endeavors aim not only to demonstrate feasibility and effectiveness but also to contribute robust evidence that informs policy changes and enhances TB control efforts.
4. Policy focus: We recognize the critical role of research in shaping effective policies. By aligning our research findings with policy goals, we create a direct bridge between knowledge generation and implementation, driving tangible change in TB control strategies.
5. Equity and Inclusivity: Our research group is dedicated to promoting equity and inclusivity in TB healthcare access. We strive to address disparities in healthcare-seeking behaviors and outcomes, with a particular emphasis on vulnerable populations, ensuring that no one is left behind
6. Community-Centered Approach: We believe in the power of community engagement and involvement. By actively involving local communities in our research design, implementation, and evaluation processes, we ensure that our interventions are culturally sensitive, contextually relevant, and impactful.
7. Global Collaboration: Our research group is part of a larger global effort to combat TB. We actively collaborate with international partners, contributing to the global knowledge pool and sharing lessons learned to collectively advance the fight against this global health challenge.

Our Impactful Contributions

1. TB Elimination Focus: Our overarching ambition is the elimination of TB from Uganda. Through innovative research, evidence-based interventions, and strategic partnerships, we aim to significantly reduce the burden of TB, contributing to a healthier and more resilient nation.
2. Research uptake: Our research outputs are designed to be actionable. We prioritize disseminating research findings in formats that are accessible to policymakers and stakeholders, ensuring that our insights directly influence policy development and implementation.
3. Community-Centered Interventions: Our interventions are rooted in the communities we serve. By involving local stakeholders and understanding the social, cultural, and economic dynamics, we develop interventions that resonate with the people, promoting better engagement and adherence to TB care.

Vision

We envision a world where TB is no longer a public health threat, and everyone has access to timely and effective TB screening, diagnosis, and care. Through cutting-edge research, unwavering community engagement, and a commitment to equity, our TB Research Group at the Makerere University Lung Institute strives to transform this vision into reality.

Join Our Journey Towards TB Elimination:

At the MTRG, we invite all who share our passion for eradicating TB to join hands. By uniting expertise, sharing insights, and fostering collaboration, we are determined to contribute significantly to the global movement towards a TB-free world.

Together, we can turn research into action, policies into progress, and aspirations into accomplishments.

TB Research at MLI 2020 to date

LIGHT TB project Ongoing

• Aims to provide new evidence on the effectiveness of different gender-sensitive pathways and approaches to health for those with TB in urban, HIV-prevalent settings.
• The IGNITE study (Improving TB case detection using a GeNder sensitive TB screening InTErvention in urban public health facilities in Uganda) propose to introduce a gender-sensitive TB screening intervention tailored towards people, particularly men, attending urban public health facilities to increase the number of TB cases detected and initiated on treatment.
• The study engage stakeholders to codesign a gender-sensitive health facility-based TB screening intervention targeting men and will evaluate the intervention’s feasibility, effectiveness and cost-effectiveness.

The second Uganda National Anti-tuberculosis Drugs Resistance Survey DRS 2 Ongoing

DSD-TB model evaluation that was implemented by IDI Completed

Draft report

TEEN- TB study Completed

• The Aim was to  improve uptake of tuberculosis (TB) care services among adolescents at Ugandan health facilities.
• Using a human centered design, we developed an adolescent TB awareness and screening package.
• The package consisted of 3 interventions (TB screening cards, awareness poster messages and local song)  that were deployed in selected project health facilities and surrounding communities.
• Data on Socio-demographic and clinical characteristics of adolescents were collected respectively  to assess for their response to the intervention package and knowledge on TB/ awareness. Additionally, to determine the effect of the package, before and after intervention data was collected.
• A total of 394 adolescents were included and the majority (76%) were still in school.
• The average number of adolescents screened increased by 94% from 159 to 309, 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 Gene X-pert and microscopy increased 3 times more 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 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

NB. Overall, the intervention improved adolescent TB care in the four health facilities.

TB-Fibrosis study Ongoing

• Aims at investigating the serologic and pulmonary mediators of post-tuberculosis lung fibrosis in a Ugandan cohort

GPK Completed

• Aimed to establish the gender differences evident in TB care cascade, gender barriers and facilitators and the list TB KVPs relevant to the Ugandan context
• Men were underrepresented in the TB care cascade but had a higher TB burden across the years reviewed.
• In 2022, 45% of people presumed to have TB were men and a higher proportion didn’t submit test samples (male 7%, female 2%) or access GeneXpert (male 24%, female 18%).
• The diagnostic yield was higher among males (male 12%, female 6%) who accounted for 61% of the 652 people with TB.
• The TB/HIV co-infection rate was higher among females in all regions except one.
• In 2020/21, 46% of the 558 people notified with multi-drug resistant TB were female, whose initial loss to follow-up rate was higher (male 8%, 19% female).
• Men cited cultural norms and fear of losing jobs/ income as key barriers while women reported a fear of separation/divorce and dependency on men for finances. The involvement of community resource persons and spousal support was beneficial to men while socially ascribed gender roles influenced women.

EXIT TB Completed

• Aims at increasing TB case detection among children, women, diabetic, HIV+ patients using chest x-ray as additional screening tool to the usual ICF
• Contributed to increased TB case detection, improved detection of Multidrug-resistant TB patients, reduced delays and waiting time for diagnosis, raised the index of TB suspicion, and improved decision-making among HCWs.
• Attributed to (i) free X-ray screening services; (ii) integrating TB case-finding activities in other clinics such as Reproductive and Child Health clinics (RCH), and diabetic clinics; (iii), engagement of CHWs, policymakers, and ministry level program managers; (iv) enhanced community awareness and linkage of clients; (v) cooperation between HCWs and CHWs, (vi) improved screening infrastructure, (vii) the adoption of the new simplified screening criteria and (viii) training of implementers.

STREAM trial Completed

• Stage 2 results showed that the efficacy of both the Oral regimen and the Six-month regimen are not only non-inferior but are superior to the Control regimen.
• Both regimens were significantly less likely to result in treatment failure or recurrence compared to the Control regimen. Very low levels of acquired resistance seen in all arms
• STREAM HE Completed
• Oral vs. Control: Cost-effectiveness analysis: Oral regimen cost-effective in Ethiopia, India and Uganda if the willingness-to-pay thresholds per each additional favourable outcome are higher than $15,900, $3,150 and $4,350 respectively
• Six-month vs. Control:Cost-effectiveness analysis: Six-month regimen is cost-effective in both Ethiopia and India

QTSA Completed

Quantitative:

• Good performance areas: availability of drugs/medicines, HIV services, pediatric TB screening and treatment services, and provider training and behaviors.
• Gaps identified: unavailability of rapid TB diagnosis testing, long testing turnaround times, and limited services for DRTB, knowledge and understanding gap of TB among patients, poor health-seeking behavior of symptomatic patients, lack of supportive services for TB patients on treatment, continuing stigma and discrimination.

Qualitative:

• Stigma: Participants reported that they often witnessed PWTB being insulted, ridiculed, discriminated against, socially excluded, and isolated. Stigma is a common phenomenon in both urban and rural settings, among all age groups, and regardless of sex.
• Mixed knowledge and understanding levels of of TB.
• The perceived danger of acquiring TB symptoms was usually the basis for stigma, and stigma toward individuals was expressed as a means of distancing oneself from risk.