{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T09:12:32Z","timestamp":1768468352104,"version":"3.49.0"},"reference-count":42,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2020,12,29]],"date-time":"2020-12-29T00:00:00Z","timestamp":1609200000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","award":["623-A-13-0003"],"award-info":[{"award-number":["623-A-13-0003"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Worldwide, Drug-resistant Tuberculosis (DR-TB) remains a big problem; the diagnostic capacity has superseded the clinical management capacity thereby causing ethical challenges. In Sub-Saharan Africa, treatment is either inadequate or lacking and some diagnosed patients are on treatment waiting lists. In Uganda, various health system challenges impeded scale-up of DR-TB care in 2012; only three treatment initiation facilities existed, with only 41 of the estimated 1010 RR-TB\/MDR-TB cases enrolled on treatment yet 300 were on the waiting list and there was no DR-TB treatment scale-up plan. To scale up care, the National TB and leprosy Program (NTLP) with partners rolled out a DR-TB mixed model of care. In this paper, we share achievements and outcomes resulting from the implementation of this mixed Model of DR-TB care. Routine NTLP DR-TB program data on treatment initiation site, number of patients enrolled, their demographic characteristics, patient category, disease classification (based on disease site and human immunodeficiency virus (HIV) status), on co-trimoxazole preventive therapy (CPT) and antiretroviral therapy (ART) statuses, culture results, smear results and treatment outcomes (6, 12, and 24 months) from 2012 to 2017 RR-TB\/MDR-TB cohorts were collected from all the 15 DR-TB treatment initiation sites and descriptive analysis was done using STATA version 14.2. We presented outcomes as the number of patient backlog cleared, DR-TB initiation sites, RR-TB\/DR-TB cumulative patients enrolled, percentage of co-infected patients on the six, twelve interim and 24 months treatment outcomes as per the Uganda NTLP 2016 Programmatic Management of drug-resistant Tuberculosis (PMDT) guidelines (NTLP, 2016). Over the period 2013\u20132015, the RR-TB\/MDR-TB Treatment success rate (TSR) was sustained between 70.1% and 74.1%, a performance that is well above the global TSR average rate of 50%. Additionally, the cure rate increased from 48.8% to 66.8% (P = 0.03). The Uganda DR-TB mixed model of care coupled with early application of continuous improvement approaches, enhanced cohort reviews and use of multi-disciplinary teams allowed for rapid DR-TB program expansion, rapid clearance of patient backlog, attainment of high cumulative enrollment and high treatment success rates. Sustainability of these achievements is needed to further reduce the DR-TB burden in the country. We highly recommend this mixed model of care in settings with similar challenges.<\/jats:p>","DOI":"10.1371\/journal.pone.0244451","type":"journal-article","created":{"date-parts":[[2020,12,29]],"date-time":"2020-12-29T23:04:45Z","timestamp":1609283085000},"page":"e0244451","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":20,"title":["Addressing the drug-resistant tuberculosis challenge through implementing a mixed model of care in Uganda"],"prefix":"10.1371","volume":"15","author":[{"given":"Samuel","family":"Kasozi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas Sebuliba","family":"Kirirabwa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5302-7077","authenticated-orcid":true,"given":"Derrick","family":"Kimuli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henry","family":"Luwaga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enock","family":"Kizito","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stavia","family":"Turyahabwe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deus","family":"Lukoye","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raymond","family":"Byaruhanga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pedro","family":"Suarez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2020,12,29]]},"reference":[{"key":"pone.0244451.ref001","unstructured":"WHO. World Health Organization,2016, Fact sheet N\u00b0104, March 2016. 2015."},{"key":"pone.0244451.ref002","unstructured":"WHO. Guidelines for the programmatic management of drug-resistant tuberculosis. 2008:i."},{"key":"pone.0244451.ref003","unstructured":"WHO. Companion handbook to the WHO guidelines for the programmatic management of drug-resistant tuberculosis. 2015:1\u2013447."},{"key":"pone.0244451.ref004","unstructured":"WHO. World Health Organization MDR Fact sheet update November 2015. 2015."},{"issue":"1","key":"pone.0244451.ref005","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1186\/s12879-017-2323-y","article-title":"Multidrug resistant tuberculosis in Ethiopian settings and its association with previous history of anti-tuberculosis treatment: a systematic review and meta-analysis","volume":"17","author":"S Eshetie","year":"2017","journal-title":"BMC infectious diseases"},{"issue":"1","key":"pone.0244451.ref006","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1183\/09031936.00157212","article-title":"Rapid molecular TB diagnosis: evidence, policy making and global implementation of Xpert MTB\/RIF","volume":"42","author":"K Weyer","year":"2013","journal-title":"European Respiratory Journal"},{"issue":"Suppl 2","key":"pone.0244451.ref007","doi-asserted-by":"crossref","first-page":"S9","DOI":"10.5588\/ijtld.10.0434","article-title":"Ethical issues in tuberculosis diagnosis and treatment","volume":"15","author":"MJ Selgelid","year":"2011","journal-title":"The international journal of tuberculosis and lung disease: the official journal of the International Union against Tuberculosis and Lung Disease"},{"issue":"7","key":"pone.0244451.ref008","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1016\/S1473-3099(17)30247-5","article-title":"Estimating the future burden of multidrug-resistant and extensively drug-resistant tuberculosis in India, the Philippines, Russia, and South Africa: a mathematical modelling study","volume":"17","author":"A Sharma","year":"2017","journal-title":"The Lancet Infectious diseases"},{"key":"pone.0244451.ref009","first-page":"1","author":"WHO","year":"2016","journal-title":"Global Tuberculosis report"},{"key":"pone.0244451.ref010","first-page":"1","author":"WHO","year":"2015","journal-title":"Use of high burden country lists for TB by WHO in the post-2015 era"},{"issue":"8","key":"pone.0244451.ref011","doi-asserted-by":"crossref","first-page":"e70763","DOI":"10.1371\/journal.pone.0070763","article-title":"Anti-tuberculosis drug resistance among new and previously treated sputum smear-positive tuberculosis patients in Uganda: results of the first national survey","volume":"8","author":"D Lukoye","year":"2013","journal-title":"PloS one"},{"issue":"3","key":"pone.0244451.ref012","doi-asserted-by":"crossref","first-page":"348","DOI":"10.5588\/ijtld.11.0473","article-title":"HIV-positive patients treated for multidrug-resistant tuberculosis: clinical outcomes in the HAART era","volume":"16","author":"E Palacios","year":"2012","journal-title":"The international journal of tuberculosis and lung disease: the official journal of the International Union against Tuberculosis and Lung Disease"},{"issue":"1","key":"pone.0244451.ref013","doi-asserted-by":"crossref","first-page":"25","DOI":"10.5588\/pha.15.0068","article-title":"Management and treatment outcomes of patients enrolled in MDR-TB treatment in Viet Nam","volume":"6","author":"NT Phuong","year":"2016","journal-title":"Public health action"},{"issue":"1","key":"pone.0244451.ref014","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1164\/rccm.200907-0989OC","article-title":"HIV coinfection in multidrug- and extensively drug-resistant tuberculosis results in high early mortality","volume":"181","author":"NR Gandhi","year":"2010","journal-title":"American journal of respiratory and critical care medicine"},{"issue":"3","key":"pone.0244451.ref015","doi-asserted-by":"crossref","first-page":"e0144249","DOI":"10.1371\/journal.pone.0144249","article-title":"Tuberculosis Case Fatality and Other Causes of Death among Multidrug-Resistant Tuberculosis Patients in a High HIV Prevalence Setting, 2000\u20132008, South Africa","volume":"11","author":"M van der Walt","year":"2016","journal-title":"PloS one"},{"issue":"1","key":"pone.0244451.ref016","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1097\/QAI.0000000000001169","article-title":"High Treatment Success Rates Among HIV-Infected Multidrug-Resistant Tuberculosis Patients After Expansion of Antiretroviral Therapy in Botswana, 2006\u20132013","volume":"74","author":"SS Shin","year":"2017","journal-title":"Journal of acquired immune deficiency syndromes (1999)"},{"issue":"2","key":"pone.0244451.ref017","doi-asserted-by":"crossref","first-page":"187","DOI":"10.5588\/ijtld.14.0961","article-title":"Undertreated HIV and drug-resistant tuberculosis at a referral hospital in Irkutsk, Siberia.","volume":"20","author":"SK Heysell","year":"2016","journal-title":"The international journal of tuberculosis and lung disease: the official journal of the International Union against Tuberculosis and Lung Disease"},{"key":"pone.0244451.ref018","first-page":"1","volume-title":"Global tuberculosis report 2017","author":"WHO","year":"2017"},{"key":"pone.0244451.ref019","first-page":"2014","author":"NTLP","year":"2015","journal-title":"Report on the Population-based Survey of Prevalence of Tuberculosis Disease in Uganda"},{"key":"pone.0244451.ref020","first-page":"1","author":"USAID\/UGANDA MONITORING EVALUATION AND LEARNING PROGRAM","year":"2016","journal-title":"TRACK TB- A mixed methods assessment strategies, partnerships, leverage points and learnings"},{"key":"pone.0244451.ref021","first-page":"1","author":"MSH","year":"2014","journal-title":"TRACK TB project Baseline Assessment Report"},{"key":"pone.0244451.ref022","first-page":"1","author":"UBOS","year":"2016","journal-title":"National population and housing census (2014)-Uganda Bureau of Statistics"},{"key":"pone.0244451.ref023","first-page":"1","author":"MoH","year":"2017","journal-title":"Revised National Strategic Plan 2015\/16-2019\/20 -March 2017"},{"key":"pone.0244451.ref024","unstructured":"NTLP. Uganda expansion plan 2012\u20132016 and operational guidance on programmatic management of drug resistant TB. 2012."},{"issue":"4","key":"pone.0244451.ref025","doi-asserted-by":"crossref","first-page":"e94393","DOI":"10.1371\/journal.pone.0094393","article-title":"Intensive-phase treatment outcomes among hospitalized multidrug-resistant tuberculosis patients: results from a nationwide cohort in Nigeria","volume":"9","author":"O Oladimeji","year":"2014","journal-title":"PloS one"},{"issue":"12","key":"pone.0244451.ref026","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1136\/thoraxjnl-2015-207374","article-title":"Achieving high treatment success for multidrug-resistant TB in Africa: initiation and scale-up of MDR TB care in Ethiopia\u2014an observational cohort study","volume":"70","author":"D Meressa","year":"2015","journal-title":"Thorax"},{"key":"pone.0244451.ref027","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1186\/1472-6963-14-81","article-title":"\"Home is where the patient is\": a qualitative analysis of a patient-centred model of care for multi-drug resistant tuberculosis","volume":"14","author":"S Horter","year":"2014","journal-title":"BMC health services research"},{"issue":"8","key":"pone.0244451.ref028","doi-asserted-by":"crossref","first-page":"998","DOI":"10.5588\/ijtld.11.0713","article-title":"Integrated, home-based treatment for MDR-TB and HIV in rural South Africa: an alternate model of care","volume":"16","author":"JC Brust","year":"2012","journal-title":"The international journal of tuberculosis and lung disease: the official journal of the International Union against Tuberculosis and Lung Disease"},{"issue":"1","key":"pone.0244451.ref029","first-page":"Cd009593","article-title":"Xpert(R) MTB\/RIF assay for pulmonary tuberculosis and rifampicin resistance in adults","author":"KR Steingart","year":"2014","journal-title":"The Cochrane database of systematic reviews"},{"issue":"7","key":"pone.0244451.ref030","doi-asserted-by":"crossref","first-page":"e1001061","DOI":"10.1371\/journal.pmed.1001061","article-title":"Comparison of Xpert MTB\/RIF with other nucleic acid technologies for diagnosing pulmonary tuberculosis in a high HIV prevalence setting: a prospective study","volume":"8","author":"LE Scott","year":"2011","journal-title":"PLoS medicine"},{"issue":"1","key":"pone.0244451.ref031","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1164\/rccm.201101-0056OC","article-title":"Evaluation of the Xpert MTB\/RIF assay for the diagnosis of pulmonary tuberculosis in a high HIV prevalence setting","volume":"184","author":"G Theron","year":"2011","journal-title":"American journal of respiratory and critical care medicine"},{"key":"pone.0244451.ref032","first-page":"1","year":"2016","journal-title":"NTLP. Uganda National Guidelines for the Programmatic Management of Drug-resistant Tuberculosis, 2nd edition."},{"key":"pone.0244451.ref033","unstructured":"MSH. TRACK-TB Annual reports project year IV & V, October 1, 2015\/16 \u2013September 30, 2016\/17 2016\/17:1-86\/55-58."},{"issue":"11","key":"pone.0244451.ref034","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.1111\/tmi.12183","article-title":"Multidrug-resistant TB in Zambia: review of national data from 2000 to 2011","volume":"18","author":"N Kapata","year":"2013","journal-title":"Tropical medicine & international health: TM & IH"},{"issue":"1","key":"pone.0244451.ref035","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.tube.2012.10.012","article-title":"The role of sex differences in the prevalence and transmission of tuberculosis","volume":"93","author":"AS Rhines","year":"2013","journal-title":"Tuberculosis (Edinburgh, Scotland)"},{"issue":"2","key":"pone.0244451.ref036","first-page":"96","article-title":"A review of sex differences in the epidemiology of tuberculosis","volume":"2","author":"CB Holmes","year":"1998","journal-title":"The international journal of tuberculosis and lung disease: the official journal of the International Union against Tuberculosis and Lung Disease"},{"issue":"2","key":"pone.0244451.ref037","first-page":"123","article-title":"Gender and tuberculosis: a comparison of prevalence surveys with notification data to explore sex differences in case detection","volume":"4","author":"MW Borgdorff","year":"2000","journal-title":"The international journal of tuberculosis and lung disease: the official journal of the International Union against Tuberculosis and Lung Disease"},{"issue":"9","key":"pone.0244451.ref038","doi-asserted-by":"crossref","first-page":"e1002119","DOI":"10.1371\/journal.pmed.1002119","article-title":"Sex Differences in Tuberculosis Burden and Notifications in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis","volume":"13","author":"KC Horton","year":"2016","journal-title":"PLoS medicine"},{"key":"pone.0244451.ref039","article-title":"A systematic review on the role of gender in tuberculosis control","author":"S van den Hof","year":"2010","journal-title":"Report prepared for Tuberculosis Control Programme (TB CAP) September"},{"issue":"Suppl 2","key":"pone.0244451.ref040","doi-asserted-by":"crossref","first-page":"S50","DOI":"10.5588\/ijtld.10.0447","article-title":"The Innovative Socio-economic Interventions Against Tuberculosis (ISIAT) project: an operational assessment","volume":"15","author":"C Rocha","year":"2011","journal-title":"The international journal of tuberculosis and lung disease: the official journal of the International Union against Tuberculosis and Lung Disease"},{"issue":"1","key":"pone.0244451.ref041","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/s12879-016-2114-x","article-title":"Hospitalized care for MDR-TB in Port Harcourt, Nigeria: a qualitative study","volume":"17","author":"KL Bieh","year":"2017","journal-title":"BMC infectious diseases"},{"issue":"12","key":"pone.0244451.ref042","doi-asserted-by":"crossref","first-page":"e28066","DOI":"10.1371\/journal.pone.0028066","article-title":"Ambulatory multi-drug resistant tuberculosis treatment outcomes in a cohort of HIV-infected patients in a slum setting in Mumbai, India","volume":"6","author":"P Isaakidis","year":"2011","journal-title":"PloS one"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0244451","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,12,29]],"date-time":"2020-12-29T23:05:23Z","timestamp":1609283123000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0244451"}},"subtitle":[],"editor":[{"given":"Joseph","family":"Telfair","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2020,12,29]]},"references-count":42,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020,12,29]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0244451","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,29]]}}}