An evaluation conducted across six high-volume tuberculosis (TB) clinics in Uganda has shown promising results in identifying and treating household contacts (HHCs) of people with pulmonary TB, according to a study published in the March 2025 issue of MMWR.
The evaluation, implemented by the International Union Against Tuberculosis and Lung Disease (The Union) in collaboration with the Uganda Ministry of Health and U.S. Centers for Disease Control and Prevention (CDC), aimed to address long-standing challenges in TB case detection and delivery of TB preventive treatment (TPT) among household contacts. The innovative approach taken has demonstrated how such challenges can be overcome and that achieving the End TB Strategy goal of reducing TB incidence by 90% by 2030 is possible with the right interventions.
“Household contacts are among the highest risk groups for developing active TB, and this project proves that with the right systems in place, we can find and protect these individuals,” said Dr Riitta Dlodlo, Senior Advisor at The Union.
Between November 2023 and September 2024, health workers visited 465 households of people with TB, screening 1,739 household members. Through home-based symptom screening, sputum collection and referrals for chest X-rays, the intervention diagnosed 80 people with TB, many of whom would likely have gone undetected under routine facility-based approaches. Chest radiography played a pivotal role in diagnosing 76% of these individuals, particularly among those without symptoms.
The evaluation also offered HIV testing and intensive counselling during home visits. Among the household contacts screened, 3.5% tested HIV positive, further enabling linkage to care and integrated disease prevention.
Of the 1,496 people eligible for TPT, 83% initiated treatment, with over 95% completing it. “This is a remarkable achievement in a country where TPT uptake historically lags due to structural and social barriers”, added Riitta.
The provision of short-course TPT regimens (1 month of daily isoniazid and rifapentine), reimbursement of travel costs, and consistent engagement and mentorship for healthcare workers were key to this successful implementation.
“Shorter regimens, home visits, and direct engagement made all the difference,” said Dr Henry Luzze of the National TB and Leprosy Programme. “This model shows us what’s possible when those affected are at the centre of our TB response.”
Dr Anand Date, Chief of Global TB at CDC: “With continued investment and scale-up, this model could serve as a blueprint for national programmes worldwide and help us reach our global TB elimination targets.”
Read the full report published in the CDC Morbidity and Mortality Weekly Report.