Differentiated Service Delivery for Multi Drug Resistant TB through Community Satellite Clinics – Strengthening linkage and retention in TB care

Andrew Ogei

In mid-November 2022, the USAID Local Services Delivery for HIV/AIDS Activity Tuberculosis team were notified of a looming TB emergency in Namisindwa district. During one of the community hotspot TB screenings, the field team presumed eighteen cases. On testing, they were positive for TB but with multiple drug resistance. This situation was alarming since not many such cases had been found in the same location in a long time. The Ministry of Health was informed and a team of experts was set up to follow up this incident.

The first four cases identified were transported from Namisindwa to Mbale regional referral hospital for management. The shiftiness and attention with which the officers managed the situation scared the patients and community members. On the fourth day of admission, two patients escaped from the regional referral hospital. They entered Kenya through the porous borders along the Elgon escarpment.

With support from the Bungoma County Administration in Kenya, the two were returned to Uganda. They decried the loneliness and confinement that they had to go through while receiving treatment at the regional referral hospital. “The hospital is far from home, I started feeling bored since I did not have a caretaker”, narrated one of the patients.

Photo 1: A group of men drink a local brew “Malwa” at one of the local bars in Namisindwa district.

The USAID/LSDA team held stakeholder and community engagement meetings in the sub counties of Bukhoko and Bumbo. “Community dialogue meetings were held to sensitize the community on multi drug resistant TB (MDR TB). An MDR TB satellite clinic was set up at Bumbo Health Centre (HCIII), the centre of the hotspots. Health workers at Bumbo HCIII were trained in management of MDR TB” narrates Dr Dan Mugisha, the TB Advisor.

Figure 1Photo 2: A group photo at the Bungoma County offices in Kenya after the Ugandan delegation met the Kenyan team to resolve cross border TB monitoring/ tracking.

The MDR satellite clinic addressed the concern of patients having to move far from their homes and strengthening linkage of new MDR patients into care. Nasimiyu S, 36, is among the patients that were identified as having MDR TB in Talata village in Bumbo sub county. On testing positive for TB, all her contacts were traced and tested. She was referred for treatment to the MDR TB satellite clinic together with her daughter of less than 5 years.

“Ongoing hot spot screening and contact tracing has helped identify the disease burden of tuberculosis in Namisindwa district. It has empowered VHTs who have previously only been engaged in polio and other illnesses. The model that involves VHTs improves retention of clients and monitoring because these are community members and it is less expensive to trace the clients”, says Daniel Wakhasa, the TB Focal Person at Magale Health Centre IV.


As of March 2023, six months down the road, all the twenty patients that were diagnosed with MDR TB are still receiving treatment at the satellite clinic.

St. Elizabeth Magale Health Centre IV is among the private not for profit health facilities supported by the USAID Local Services Delivery for HIV/AIDS Activity. The health centre is a model facility in TB management in Namisindwa district.


Local Service Delivery for HIV And AIDS Activity (LSDA)

Uganda Protestant Medical Bureau (UPMB) | Plot 728, Namirembe, UPMB Close (off Balintuma Road), Mengo, Kampala, Uganda. Website: https://upmb.co.ug


For more information, contact the Chief of Party, Johnson Masiko on: jmasiko@upmb.co.ug


March 2023                                                           

This success story is made possible by the generous support of the American People through the United States Agency for International Development (USAID). The contents of the story are the responsibility of UPMB and do not necessarily reflect the views of USAID or the United States Government.