Kiboga Town is located in the heart of Kiboga District, a two-hour drive from Kampala along
Hoima Road. Residents largely survive on subsistence agriculture and live in poor, remote villages spread throughout the large region. In Kiboga's Bira Village, many houses are mud-and
wattle and one-room shacks are common; community members trek for hours to get to the nearest medical centre. Local leaders say the area has been hit hard by the scourge of Tuberculosis (TB) and HIV/AIDS, leaving many orphaned children and widows.
32-year-old Rose Nalwadda of Bira was suffering from a bad cough that persisted for over two months. "I used local herbs and visited several traditional healers without any improvement. During what I thought at the time was my last day on earth, a community health worker dragged me to Namata Health Center in Kiboga District for TB screening," said Nalwadda. "I was diagnosed with TB. I told the health worker that my husband had died of a strange disease two years before. I was advised to also take an HIV test, and was found positive for HIV, too. I was put on TB treatment, and I have been taking the drugs for over seven months under the supervision of a community health volunteer. Through the help of the community health volunteer, I have also acquired knowledge on how to live positively with both diseases," she explained.
Nalwadda's story is similar to many in Uganda, which ranks 16th on the list of 22 high-burden
TB countries in the world. The disease impacts all sectors of the population, and presents a
major challenge to improving the overall health situation of the country. More effort is still required to make quality care accessible to all Ugandans, regardless of gender, age and social setting.
Co-infection with TB and HIV, and the emergence of multidrug-resistant (MDR) TB in Uganda makes this even harder. TB is a major cause of death among people living with HIV and AIDS. In Uganda, 50% of TB patients are infected with HIV and 30% of AIDS-related deaths are attributed to TB. Eliminating TB depends on the development of new drugs and vaccines, and coordinated efforts to fight diseases in an integrated, collaborative way. In Kiboga and Luwero districts, to address
these issues, African Medical and Research Foundation (AMREF) is piloting a model of collaborative, integrated disease management in line with Ministry of Health (MoH) policies with on-going
support and partnership from the international pharmaceutical company, AstraZeneca.
The Malaria, AIDS, and TB Integrated Model Project (MAT) works with the district health teams, health unit staff and village health teams to reach out with collaborative interventions to those most
at risk from illness and death from these killer diseases. Health workers have been trained and new laboratories built in line with national strategies for providing collaborative testing, counseling, and treatment measures for HIV, TB, and Malaria.
"We have managed to identify and offer treatment to 62% of the TB cases in the district. However, we are still below the World Health Organization's (WHO) target of 70%," said Dr Allan Muruta, the District
Director of Health Services in Kiboga. For TB to be eradicated in Uganda, efforts from every side, including from government, NGOs, health systems, and communities must be coordinated. Collaborative, integrated disease education, management, and control efforts are vital. Stand-alone HIV programmes implemented by development partners must be streamlined with TB interventions. Districts must continue monitoring and guiding the work of local health partners to ensure comprehensive services are made available to all community members, and that individuals are given the strength to work together and support one another to combat death from this treatable and preventable disease.