Beyond the Numbers: Interpreting WHO's Global Tuberculosis Report 2016 to Inform TB Policy and Practice in the East African Community

By 2000, 5 East African Community (EAC) member states—Uganda, Kenya, Tanzania, Rwanda, and Burundi—had adopted the World Health Organization's (WHO's) policy of directly observed treatment short-course (DOTS) for tuberculosis (TB). This policy is meant to speed up the control of TB through effective diagnosis and treatment. However, the rate of reduction of TB burden has been slow, and as of 2016, 3 EAC member states—Uganda, Kenya, and Tanzania—are still categorised as high TB burden countries. We analysed WHO's Global Tuberculosis Report 2016 and drew key lessons to inform policy and practice for effective control of TB. From the report, we acknowledge the existence of national TB control policies operationalised through national TB control programmes in all EAC member states. However, we found persistent underfinancing of the TB control programmes; low national coverage of TB diagnostic and treatment services, meaning that many TB cases are most likely going undetected; and deaths due to lack of treatment. We also found poor reporting practices; for example, there was no data on the number of cases detected with rapid diagnostics in Uganda and Tanzania, which was unexpected since there are more than 170 Xpert MTB/RIF machines for rapid diagnosis of TB in the 2 countries. We recommend comprehensive implementation of existing TB policy, including adequate financing, universal access to diagnosis and treatment, and socioeconomic empowerment of affected communities, all of which are critical for ending TB in East Africa and the world at large.