Strategies to resolve the gap in Adolescent Tuberculosis care in Uganda: The TEEN TB Project.
Introduction: Strategies to promote health care-seeking behavior 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
Methodology: We developed an adolescent TB awareness and screening package using the human centered design. The package had 3 interventions: TB screening cards, TB awareness poster messages and a local song deployed in project health facilities and surrounding communities. Data on socio-demographic & clinical characteristics of adolescents were collected between October 2021 & March 2022 at Kawolo, Iganga, Gombe and Kiwoko hospitals. Before and after intervention data from facility records was collected and analyzed using logistic regression to determine the effect of the package.
Results: A total of 394 adolescents were included and the majority (76%) were school-going. 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 (p= <0.001, 95% CI 1.9- 2.0), there was a 2 fold increase among those presumed to have TB; from 13 to 29, (IRR of 2.2, p= <0.001, 95% CI 1.9-2.5) and those tested with Gene-Xpert increased more than 3 times from 8 to 28 (IRR of 3.3, p= <0.001, 95% CI 2.8-3.8). 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.
Conclusion: The 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.