Managing tuberculosis (TB) in Uganda follows a patient-focused approach. Treatment is designed not only to cure TB but also to support patients throughout their journey, including monitoring, managing side effects, and helping patients stick to their treatment plan. Understanding the steps and what to expect can help patients feel empowered and confident while on TB treatment.
If you or a family member have TB, Hope Plus can connect you to a licensed healthcare provider in minutes. Through Hope Plus, you can receive guidance on the right TB medicines, monitoring, and support to complete treatment safely and effectively.
Key Takeaways
- TB treatment in Uganda is patient-centered and supervised, using either a treatment supporter or digital adherence technologies (DAT).
- Treatment is divided into two phases: an initial intensive phase and a continuation phase, with duration depending on the type and severity of TB.
- Medicines come in fixed-dose combinations to simplify treatment and reduce mistakes.
- Drug-resistant TB requires specialised treatment at designated MDR-TB centres.
- Monitoring includes clinical checks, sputum tests, and supportive care, with treatment outcomes documented for every patient.
Principles of TB Treatment
Patient-Centred Care
Uganda has adopted a patient-centred care model, which ensures patients receive personalised support during TB treatment. Key elements include:
- Directly Observed Therapy (DOT): A treatment supporter watches the patient take each dose to improve adherence.
- Digital Adherence Technologies (DAT): Tools such as phone apps or SMS reminders to support patients who cannot attend DOT daily.
- Fixed-Dose Combinations (FDC): TB medicines are combined into single tablets to make treatment simpler and reduce errors.
Phases of Treatment
TB treatment is given in two phases:
- Intensive Phase: Usually 2 months, where multiple TB medicines are taken to quickly reduce bacteria in the body.
- Continuation Phase: Usually 4 months, to ensure all remaining TB bacteria are killed.
- Severe forms of TB, like TB meningitis or bone TB, may require longer treatment, sometimes up to 12 months.
Treatment regimens are expressed in a simple format: for example, 2RHZE/4RH
- R = Rifampicin
- H = Isoniazid
- Z = Pyrazinamide
- E = Ethambutol
- Numbers indicate the duration in months for each phase, and the slash separates the intensive and continuation phases.
Shorter-Term Regimens
For certain patients, shorter 4-month regimens may be used:
- Children (2 months to 16 years): 2HRE(Z)/2RH
- Adults with specific conditions: 2HPMZ/2HPM
Monitoring and Side Effects
TB medicines can have side effects, and these are carefully monitored by healthcare providers. Common strategies include:
- Checking liver function if on Isoniazid or Rifampicin
- Monitoring vision if on Ethambutol
- Addressing nausea, joint pain, or other side effects promptly
Healthcare providers also monitor treatment through:
- Clinical checks: Weight gain, overall wellbeing, and adherence
- Sputum tests: At month 2, month 5, and end of treatment to confirm bacteria clearance
- Radiological tests: Chest X-rays if needed, but not as the only monitoring method
TB Medicines and Doses
| Drug | Adult Dose | Child Dose | Contraindications / Interactions |
|---|---|---|---|
| Isoniazid (H) | 5 mg/kg (max 300 mg) | 10 mg/kg (range 7–15 mg/kg) | Liver disease, hypersensitivity; interacts with carbamazepine, phenytoin |
| Rifampicin (R) | 10 mg/kg (max 600 mg) | 15 mg/kg (range 10–20 mg/kg) | Liver disease, hypersensitivity; interacts with oral contraceptives, nevirapine, warfarin |
| Pyrazinamide (Z) | 30–40 mg/kg (max 2500 mg) | 35 mg/kg (range 30–40 mg/kg) | Liver disease, hypersensitivity |
| Ethambutol (E) | 15 mg/kg | 20 mg/kg (range 15–25 mg/kg) | Pre-existing optic nerve disease, kidney failure |
| Moxifloxacin (M) | 10–15 mg/kg | N/A | Resistance to fluoroquinolones |
Note: Rifampicin reduces the effectiveness of estrogen-containing contraceptives. Use additional barrier methods if necessary.
First-Line Treatment for Susceptible TB
Patients without rifampicin resistance receive first-line TB medicines.
Intensive and Continuation Phases
| Type of TB | Intensive Phase | Continuation Phase | Location (LOC) |
|---|---|---|---|
| All forms of TB (excluding TB meningitis or bone TB) | 2RHZE | 4RH | HC3 |
| TB meningitis, Bone TB | 2RHZE | 10RH | HC4+ |
| Children 2 months–16 years, non-severe TB | 2HRE(Z) | 2RH | General Hospital+ |
| Adults >12 years, weight >40 kg, HIV positive with CD4 >100 | 2HPMZ | 2HPM | General Hospital+ |
Drug-Resistant TB (DR-TB) Treatment
Patients suspected of DR-TB are tested using culture and drug susceptibility tests. Treatment requires specialised second-line regimens at designated MDR-TB centres.
| Type of DR-TB | Regimen | Location |
|---|---|---|
| INH mono-resistance | 6(H)REZ–Levofloxacin | DTU/HC3+ |
| RR/MDR TB | Second-line treatment as per national guidelines | MDR-TB initiation centre |
| Pre-XDR / XDR TB | Second-line treatment under national expert panel guidance | MDR-TB initiation centre / hospital |
Adjunctive Treatment
- Vitamin B6 (Pyridoxine) 25 mg/day with Isoniazid to prevent nerve damage
- Prednisolone for severe inflammation (e.g., TB meningitis) at 1–2 mg/kg for 4 weeks, then tapered
Monitoring TB Treatment
Pulmonary TB Monitoring
Month 2 (End of Intensive Phase):
- Sputum negative → continue continuation phase
- Sputum positive → GeneXpert to check for rifampicin resistance
- Rifampicin-resistant → refer for MDR-TB treatment
- Rifampicin-sensitive → continue first-line, explore adherence issues
Month 5:
- Sputum negative → continue treatment
- Sputum positive → diagnose treatment failure and check for drug resistance
Month 6 (End of Continuation Phase):
- Sputum negative → declare treatment success (cured or completed)
- Sputum positive → investigate treatment failure and manage accordingly
Clinical Monitoring for All TB Cases:
- Check wellbeing and weight gain
- Monitor adherence and manage side effects
- Support lifestyle changes to improve recovery
Note: X-rays are supportive but should not be used alone for monitoring.
Managing Treatment Interruptions
Patients who miss doses or interrupt treatment should be assessed according to the National TB & Leprosy Programme (NTLP) guidelines, and restarted safely under supervision.
TB Treatment Outcomes
Healthcare providers document an outcome for every patient:
| Outcome | Description |
|---|---|
| Cure | Pulmonary TB patient bacteriologically confirmed at start, negative at last month and at least once before |
| Treatment Completed | Completed treatment without evidence of failure, but no records of negative sputum/culture |
| Lost to Follow-Up | Stopped treatment for 2+ consecutive months or did not start treatment |
| Died | Patient died before or during treatment |
| Treatment Failure | Sputum/culture positive at month 5 or later |
| Not Evaluated | No treatment outcome assigned (e.g., transferred out) |
| Treatment Success | Sum of cured + treatment completed |
This guide ensures patients understand what medicines they will take, how long treatment lasts, how it is monitored, and what support is available. Clear communication and adherence to treatment are the keys to curing TB and preventing complications.
