Tuberculosis contact follow-up cascade in four regional referral hospitals, Uganda, 2022

Abstract Introduction: Uganda continues to experience a high tuberculosis (TB) burden, with persistent gaps in contact identification and linkage to care. We evaluated the TB contact follow-up cascade in four regional referral hospitals in Uganda from January to December 2022 to inform programmatic improvements. Methods: We conducted a descriptive cross-sectional analysis using routinely collected data from the TB unit and contact tracing registers. We summarised cascade indicators using proportions and 95% confidence intervals (CIs), including contact listing, screening, diagnostic testing, treatment initiation, and eligibility for TB preventive therapy (TPT). Results: Among 491 index TB cases, 231 (47.0%, 95% CI: 42.7–51.5) had contacts listed, yielding 1,215 contacts with a median age of 19 (IQR: 8–32) years. Of these contacts, 88.0% (1067/1215) were screened, 21% (222/1067) were presumptive for TB, 98% (217/222) of presumptive contacts were tested, and 10%(21/217) tested positive. Among confirmed TB cases, 91% (19/21) were initiated on treatment. Despite eligibility, no contacts under five years of age or living with HIV were initiated on TPT. Conclusion: While screening and diagnostic testing were well implemented, substantial gaps remain in contact listing and TB preventive therapy initiation for high-risk groups. Strengthening systematic contact identification and integrating TPT into routine TB services are critical to improving cascade completion and advancing Uganda’s End TB targets. Our findings are based on routinely collected data from four purposively selected facilities, which may limit generalizability and underestimate cascade proportions where data were missing.