Use of a context-specific package to increase sputum smear monitoring among people with pulmonary tuberculosis in Uganda: a quality improvement study.

Background: People with bacteriologically confirmed pulmonary tuberculosis (BC-PTB) require sputum smear monitoring (SSM) to ascertain response to anti-TB treatment and cure from TB disease. We aimed to increase SSM at 2, 5 and 6 months among people with BC-PTB from the baseline (March to July 2021) of 68%, 37% and 39%, respectively, to 90% in February 2022 by implementing a context-specific improvement package at a rural health facility in northeastern Uganda.

Methods: We designed a continuous quality improvement (CQI) study for people with BC-PTB, developed and tested an improvement package that consisted of the following context-specific measures: (1) line listing of all eligible persons for SSM; (2) use of reminder stickers to identify eligible persons for SSM; (3) use of community health workers to conduct home visits for people with missed clinic visits; and (4) integration of SSM into community-based ART points for distant persons.