Background

Tuberculosis (TB) continues to be a major public health problem, with an estimated 10.4 million new (incident) TB cases worldwide each year.1 To reduce the burden of TB disease, case detection and treatment gaps should be addressed to interrupt transmission chains and reduce individual morbidity. Sputum smear microscopy, the most widely used test for diagnosing TB, has a sensitivity of only 50% among active TB cases and contributes to a delay in diagnosis and continued transmission. Sputum smears with chest X-ray, where available, are the tests routinely applied for TB diagnosis. However, the inaccessibility and cost of X-ray diagnosis make it prohibitive for rural settings like Northern Uganda. The GeneXpert machine is preferred because it requires less expertise, is more sensitive than microscopy and can detect multidrug-resistant TB.2

Case notification for TB in the 16 districts in Northern Uganda is 134 cases/100 000 population, well below the national target of 161/100 000.3 Improved TB diagnostics in this region is critical to attain timely case detection and management of TB, and reduce mortality, transmission and prevalence of the disease.

Objective

With the aim of increasing the number of GeneXpert samples processed, the US Agency for International Development Applying Science to Improve Systems (ASSIST) Project began working to improve GeneXpert services at five laboratory hubs in the Northern Uganda region in March 2016: Kitgum, Anaka and Apac hospitals, and Amolatar and Madi-opei health centre IVs. All five GeneXpert machines can run up to four samples every 2 hours, yet weekly data showed that about …