Conference Abstract | Volume 8, Abstract NACNDC/19JASH074 (Oral 2E) | Published: 01 Dec 2025
Clark Joshua Brianwong1,&, Damalie Waisswa2, Lwanga Ssekiswa1, Winnie Akobye1, Alex Mugume1, Dithan Kiragga1
1Baylor Foundation Uganda, 2Mbale Regional Referral, Uganda
&Corresponding author: Clark Joshua Brianwong, Baylor Foundation Uganda, Email: clarkjoshua001@gamil.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: Ambulatory model, drug-resistant tuberculosis, decentralization, treatment outcomes, capacity building
©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., Transforming DR-TB care: Success of a fully ambulatory model during TB outbreak in Namisindwa district, Uganda. Journal of Interventional Epidemiology and Public Health. 2025;8(ConfProc6):074. https://doi.org/10.37432/JIEPH-CONFPRO6-00074
In Uganda, drug-resistant tuberculosis (DR-TB) care commonly follows a mixed model where patients initiate treatment at tertiary hospitals before transitioning to ambulatory care at lower-level facilities. During a DR-TB outbreak in Namisindwa District (October 2022–March 2023), a fully ambulatory model was piloted at Bumbo Health Center III. This study compares patient outcomes under this model with those from the traditional approach.
In November 2022, following confirmation of 21 rifampicin-resistant TB cases, the Ministry of Health declared an outbreak and, due to space limitations at the tertiary hospital, recommended fully ambulatory management. Baylor Foundation Uganda and Mbale Regional Referral Hospital trained health workers at Bumbo to provide daily directly observed therapy (DOT), treatment monitoring, adverse event screening, and contact tracing. Patients remained at Bumbo for the full course of care. Key support included mentorship, job aids, monthly follow-up clinics, and resource reallocation. Data was abstracted from the DR-TB treatment register.
Of the 21 patients treated at Bumbo, 62% were female, with a median age of 43.5 years. Ninety percent were newly diagnosed; one had prior second-line treatment, one had prior first-line treatment, and 19% were HIV-positive (three newly diagnosed). Modified shorter treatment regimens were used in 86% of patients. All received health worker-led DOT. Treatment success was 95%, with one patient lost to follow-up, compared to 88% among patients treated at the tertiary hospital.
The fully ambulatory model demonstrated that lower-level facilities can deliver high-quality DR-TB care with outcomes comparable or superior to tertiary hospitals. Key enablers included rapid capacity building, strong community linkages, and localized decision-making, though challenges such as stigma and drug supply persisted. Based on this success, the Ministry of Health established five additional DR-TB sites. Future priorities include cost-effectiveness analyses, integration of digital adherence tools, psychosocial support, and sustainability assessments to strengthen Uganda’s DR-TB decentralization strategy.
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