Conference Abstract | Volume 8, Abstract NACNDC/19JASH076 (Poster A6) | Published: 01 Dec 2025
Clark Joshua Brianwong1, Diana Cherotin1, Adriko Godfrey1, Lam Edeet2, Miriam Ichemu3, Damalie Waisswa4, Lwanga Ssekiswa1, Richard Jjuuko 1, Jane Nakawesi1, Patricia Nahirya1, Alexander Mugume1, Dithan Kiragga1
1Baylor Foundation Uganda, 2Tororo DLG, Uganda, 3Tororo General Hospital, Uganda 4Mbale Regional Referral Hospital, Uganda
&Corresponding author: Clark Joshua Brianwong, Baylor Foundation Uganda, Email: clarkjoshua001@gmail.com ORCID: https://orcid.org/0009-0005-1548-2684
Received: 30 Aug 2025, Accepted: 20 Oct 2025, Published: 01 Dec 2025
Domain: Infectious Disease Epidemiology
Keywords: Tuberculosis, HIV, C-Reactive Protein (CRP), Quality Improvement, People Living with HIV (PLHIV)
©Clark Joshua Brianwong et al. Journal of Interventional Epidemiology and Public Health (ISSN: 2664-2824). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cite this article: Clark Joshua Brianwong et al., Nine-fold increase in TB yield: CRP and symptom-based dual screening among PLHIV in Eastern Uganda. Journal of Interventional Epidemiology and Public Health. 2025;8(ConfProc6):076. https://doi.org/10.37432/JIEPH-CONFPRO6-00076
Uganda is among the top 30 high TB/HIV burden countries, with over 80,000 TB cases annually, of which more than 32% occur among people living with HIV (PLHIV). Despite intensified case finding, 44% of TB cases among PLHIV are missed yearly. In FY 2022/23, 97% of 328,778 PLHIV in Bukedi/Bugisu were screened using symptom-based tools, yet only 0.64% were diagnosed, highlighting low sensitivity. WHO recommends dual screening with symptoms and C-reactive protein (CRP) testing every six months. Uganda adopted this strategy in high-volume ART clinics, but uptake has been poor, with <8% coverage at Tororo Hospital in mid-2024. This quality improvement (QI) initiative aimed to increase CRP-based TB screening coverage among PLHIV ≥10 years from 8% to ≥90% within 12 weeks.
In August 2024, a multidisciplinary QI team supported by Baylor Uganda conducted a root cause analysis, identifying knowledge gaps, workflow inefficiencies, cartridge storage issues, and lack of standardized documentation. Guided by the Plan-Do-Study-Act model, interventions included: continuous professional development and workflow reorganization; training lay workers; introducing a CRP screening booklet and job aids; relocating the CRP machine to triage with cool boxes for cartridges; using LabXpert messaging for same-day results; and establishing digital reporting platforms with WhatsApp feedback and monthly performance reviews.
From August to December 2024, dual TB screening coverage increased from 8% to 98% (2700/2714). TB yield improved nine-fold, rising from 0.12% (Oct–Dec 2023) to 1.03% (Oct–Dec 2024). Integrating CRP testing at triage reduced client loss and improved provider adherence, while digital platforms facilitated real-time stock monitoring, data sharing, and performance tracking.
CRP-based dual screening, supported by QI approaches, significantly enhanced TB detection among PLHIV in a high-volume ART clinic. Embedding CRP into workflows, addressing operational barriers, and leveraging digital tools were critical to success. Scale-up, EMR integration, and national HMIS alignment are recommended for sustained impact.
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