UGANDA NATIONAL TUBERCULOSIS AND LEPROSY CONTROL PROGRAMME

MINISTRY OF HEALTH UGANDA TIOL TUBERCULOSIS AND LEPROSY CONTROL PROGRAMME Revised Strategic Plan 2015/16-2019/20 Monitoring and Evaluation Plan Narrative of the Operational, Budget and Technical Assistance Plan June 2017

TABLE OF CONTENTS 1. Introduction 3 Overview of the NTLP M&E System 3 Data Collection Methods 4 2. Monitoring and Evaluation Plan 5 M&E Plan Objectives 5 s by objective and strategic intervention 6 definitions 27 3. Narrative of the Operational, Budget and Technical Assistance Plan 42 Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 2

1. Introduction Tuberculosis (TB) and leprosy continue to threaten public health in Uganda. The Ugandan Ministry of Health addresses TB and leprosy response in its Health Sector Development Plan II 2015/2016 2019/20. TB is the fifth most common cause of death in Uganda, potentially resulting in adverse socioeconomic impacts as the majority of notified patients/cases are in their years of greatest economic productivity. Leprosy is still endemic in Uganda. A total of 1,003 new cases were reported to NTLP during the last 3 years. In 2013, over 60% of new cases were concentrated in 10 of 116 districts. Recent advances in the fight against TB and leprosy, findings from the 2014/15 National TB Prevalence Survey, and revisions to the Uganda Xpert MTB/Rif policy and urban DOTS model necessitated revisions to the current NTLP National Strategic Plan (NSP) 2015/16 to 2019/20. Accordingly, the NTLP revised the monitoring and evaluation (M&E) plan to reflect changes in the strategic plan 2015/16 2019/20. Overview of the NTLP M&E System The goal of the current M&E plan is to enable evidence-based decision-making to improve performance. Based on this, the M&E plan sets out to: Guide the process of collecting, analysing and presenting specific data, based on predefined indicators; Describe and guide the process of measuring progress towards NTLP targets; Ensure the set of indicators, tools and M&E systems are adapted to monitor the quality and coverage of service delivery, both at health facility and community levels; Ensure effective implementation of the M&E plan by regularly monitoring and periodically evaluating the plan itself; and Provide a framework for implementation of NTLP monitoring and evaluation activities. The WHO and MOH joint review of the NTLP conducted in September 2013 revealed that NTLP are not channelled through the Electronic Health Information System, Uganda s District Health Information System 2 (DHIS2). Managed by the MOH Division of Health Information, the DHIS2 has a user-friendly interface and 100% health facility reporting coverage for the public and private non-for-profit sectors. Although health facilities are reporting some TB indicators through DHIS2, these are often incomplete and inaccurate hence not analysed or used. More so, the TB indicators have not been completely integrated into the DHIS2. The only indicators in DHIS 2 are; proportion of PLHIV screened for active TB; proportion of PLHIV diagnosed with TB and proportion of PLHIV diagnosed with TB who are started on TB treatment. A disadvantage of the DHIS2 is that it aggregates data, preventing individual data for cohort analysis. The NTLP is still investigating how to integrate TB data collection and management in the DHIS2 while providing for the NTLP s data needs (List of the proposed indicators to be included in DHIS2 is in Table 4). Table 1 provides an overview of the current NTLP and data sources. Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 3

Table 1: Description of NTLP and data sources. Data Source Relevant Time of Responsibility Period Collection National TB 2014-2015 Every 5-10 years NTLP & Partners Prevalence Survey NTP and Previous year ly NTLP, WHO WHO Global Tuberculosis Report NTP quarterly Previous quarter NTLP EQA quarterly Previous quarter National TB Reference Laboratory (NTRL) TB services in prisons Previous quarter Prison Health Service Supervisory visit Previous quarter for selected districts NTLP, NTRL Data Collection Methods The routine reporting system follows these lines of reporting: Diagnostic and Treatment Units (DTU) report to the district. Districts report to regions. Regions report to the central NTLP office. Currently, the M&E unit at the central NTLP office consists of an M&E specialist, epidemiologist, data manager and data analyst. The M&E specialist and data manager, funded through the Global Fund to Fight AIDS, TB, and Malaria (Global Fund), collate and analyse data from the districts. Partners provide additional staff to support the NTLP s efforts to improve recording, reporting and use of TB data at all levels of the health system. As recommended in the Program Review Report (September 2013), the NTLP is developing standard operating procedures (SOPs) to guide health facilities as well as district, regional and national level officers to improve data completeness, quality and use for performance improvement at different levels. In addition, quarterly review meetings help to improve the accuracy of data and timeliness of reporting. During regional quarterly review meetings, district supervisors (District TB and Leprosy Supervisors (DTLS), District laboratory Focal Persons (DLFP) verify outcomes of TB patients transferred from one district to another within the region and Regional TB and Leprosy Focal Persons (RTLPs) validate the before submission to the national level. The district local governments have recruited biostatisticians to improve collection, analysis and use of health information at the district level. The biostatisticians will support the district TB supervisors to improve timely reporting through the DHIS2 and analysis of TB data for performance improvement. Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 4

2. Monitoring and Evaluation Plan This M&E plan aims to monitor the TB and leprosy control, implementation of the NSP 2015/16 2019/20, and investments to improve M&E for TB and leprosy in Uganda. M&E Plan Objectives Objectives of the M&E component of the NSP The NTLP National Strategic Plan prioritizes M&E in its fourth objective to establish and strengthen systems for effective management of tuberculosis & leprosy services to meet the NSP targets. Broad Objective To establish and strengthen M&E systems for tracking performance and measuring outcomes and impacts to guide decision-making Specific Objectives 1. Improve recording and reporting, data management and analytical capacity at national and sub-national levels 2. Develop an electronic TB monitoring and evaluation system (etb) 3. Strengthen TB supervision at all levels Under the same objective, the National Strategic Plan calls for implementation of a research agenda through collaboration of NTLP and the Uganda TB research community. This intervention includes a drug resistant survey and inventory studies to assess under-reporting, to be conducted in the 2015/16 2019/20 period. The NSP M&E intervention aims to strengthen data management and quality through by regularly assessing data quality and developing guidelines and standard operating procedures. To improve timely availability of data, NTLP plans to develop an electronic system that will capture more data as well, for example of key populations, by of this NSP. To support these developments, NTLP will strengthen supervision to all levels. Table 2: Main activities under the M&E strategic intervention Start date M/Year End date M/Year Target by 2019/20 Total investment Objective 4: To strengthen systems for effective management of tuberculosis & leprosy services to meet the NSP targets Strategic Intervention 4.7. To strengthen M&E systems for tracking performance and measuring outcomes and impacts to guide decision-making Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 5

4.7.1. Improve recording and reporting, data management and analytical capacity at national and sub-national levels. 4.7.2. Develop electronic TB monitoring and evaluation system (etb). 4.7.3. Strengthen TB supervision at all levels. Apr-16 Oct-15 Jul-15 Jun-20 Jun-20 Jun-20 4.7.1 Percentage of districts submitting timely complete according to national guidelines (factor = timeliness x completeness) >90% $5,280,167 $649,060 $1,089,382 Total Investment M & E $7,018,608 s by objective and strategic intervention Figure 1 illustrates the monitoring framework to track progress of TB control and NSP implementation in Uganda. Figure 1. TB monitoring framework Through a consultative process, stakeholders set initial targets in June - July 2014. The NTLP modified these targets during revisions to the National Strategic Plan, according to 2014/15 National TB Prevalence Survey results and revisions to the Uganda Xpert MTB/Rif policy and urban DOTS model and recommendations from local, international and global technical partners. Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 6

Goal: To reduce TB incidence by 5%, i.e. from 234 cases of TB (all forms) per 100,000 population in 2015 to 222/100,000 by 2020 Year Value 2015/16 2016/17 2017/18 2018/19 2019/20 source 1.0 Incidence rate Impact 2015 234 234 234 230 227 222 Uganda national TB survey Objective 1: To increase case notification rate of incident TB from 119/100,000 in 2015/16 to 156/100,000 in 2019/20 and to increase treatment success rate among notified incident cases from 74% in 2015/16 to 85% in 2019/20 1.1. Notification rate of incident TB cases per 100,000 population Outcome 2015 119 (42,320) 119 (42,320) 115 (42,320) 128 (48,245) 141 (54,999) 156 (62,699) TB annual & quarterly 1.2. Treatment success rate for incident TB cases (Denominator) Outcome 2015 cohort 74% (42,320) 74% (42,320) 78% (42,320) 82% (42,320) 85% (48,245) 85% (54,699) TB quarterly 1.3. Cure rate among new PBC TB cases Outcome 2015 cohort 51% 51% 56% 60% 65% 75% TB quarterly 1.4. Treatment success rate among all forms of TB Outcome 2015 cohort 79% 79% 80% 82% 84% 85% TB quarterly Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 7

Year Value 2015/16 2016/17 2017/18 2018/19 2019/20 source 1.5. Case fatality rate among all forms of TB Outcome 2015 cohort <5% <5% <5% <5% <5% <5% TB quarterly 1.6. Loss to follow-up rate among all forms of TB Outcome 2015 cohort 12% 12% <5% <5% <5% <5% TB quarterly Strategic intervention 1.1: Increase the capacity of health workers to screen and diagnose TB, with a focus on childhood, extra-pulmonary and clinically diagnosed TB. 1.1.1. Percentage of children (0-14 years) among all forms of incident TB patients notified 7.4% 7.4% 9% 11% 13% Output 2015 (3,132) (3,132) (3,809) (5,307) (7,150) TB 15% quarterly (8,935) Strategic intervention 1.2: Improve access to and use of quality laboratory and radiology services for TB diagnosis and treatment monitoring. 1.2.1. Number of new pulmonary bacteriologically confirmed patients Output 2015 cohort 25,382 25,382 25,382 28,778 32,807 37,400 TB quarterly notified Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 8

1.2.2. Percentage of new and relapse TB patients tested using WHO recommended rapid tests at time of diagnosis 1.2.3. Drug susceptibility testing coverage (%) 1.2.4. Percentage of labs participating in external quality assurance (EQA) 1.2.5. The percentage of high false negative reported in diagnostic and treatment units Output 2015 21% 21% 26% 36% 46% 56% TB quarterly Output 2015 25% 25% 31% 41% 51% 61% TB quarterly National and Output 2015 88% 88% 90% 92% 94% 96% regional quarterly EQA National and Output 2015 3% 3% < 3% < 2% < 2% < 2% regional quarterly EQA Strategic intervention 1.3: Register and initiate treatment with all diagnosed TB patients, and support their adherence to treatment regimens. Year Value 2015/16 2016/17 2017/18 2018/19 2019/20 source 1.3.1. TB treatment coverage in % (Denominator) Output 2015 51% (83,380) 51% (83,380) 49% (85,958) 55% (87,209) 62% (88,479) 70% (89,310) report Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 9

1.3.2. Proportion of all TB patients registered in care who are treated under Directly Observed Therapy (DOT) TB Output 2015 77% 77% 77% 80% 85% 90% report Strategic intervention 1.4: Empower patients, their families and communities to recognise and refer presumptive TB patients to diagnostic facilities, support treatment adherence and conduct contact tracing 1.4.1. Percentage of TB cases (all forms) notified in the VHT diagnostic and treatment units Output Unknown 7% (42,320) 8% (42,320) 9% (48,245) 10% (54,999) 11% (62,699) registers, CSO/CBO who were referred by the village health team/cso 1.4.2. Contact investigation coverage Output 2015 3% 8% 13% 20% 28% 35% Unit TB register 1.4.3. Contact investigation coverage among Output 2015 14% 14% 14% 24% 34% 50% Unit TB register PBC-TB cases Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 10

1.4.4. Number of close contacts (<5years) of PTB patients provided IPT 1.4.5. Latent TB treatment (IPT) coverage ( <5years contacts of PTB patients) TB Output 2015 831 831 1,122 2,026 3,937 7,070 quarterly TB Output 2015 8% 8% 18% 28% 38% 50% quarterly Strategic intervention 1.5: Establish and strengthen facility and community health systems to facilitate referral of presumptive TB patients to diagnostic facilities as well as support treatment adherence and systematic TB screening among contacts (CHEWs, CLFs and VHTs). 1.5.1 Proportion of mapped CSOs that are implementing TB control activities 1.5.2 Proportion of mapped CSO s reporting using recommended tools 1.5.3 Proportion of mapped CSOs trained in TB management Output 2013 Unknown 10% 10% 15% 20% 25% URSB directory CHEWs/ Output 2013 Unknown 10% 10% 20% 35% 50% VHT register NTLP Output 2013 Unknown 10% 10% 60% 65% 70% training Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 11

Strategic intervention 1.6: Strengthen TB care and prevention in congregate settings. 1.6.1. Percentage new prisoners screened for TB (entry screening) Prison Output 2013 55% 60% 65% 70% 75% 80% health services 1.6.2. Number bacteriological confirmed TB in new prisoners Output 2013 91 169 186 205 224 243 Prison health services Strategic intervention 1.7: Strengthen and expand public-private mix approaches for TB care and control, in line with the national policy framework. 1.7.1. Number of private for-private & private not-forprofit health facilities accredited to function as diagnostic and treatment units Output 2015 100 100 326 400 500 600 Surveys Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 12

Strategic intervention 1.8: Implement an urban TB care and prevention strategy for cities and municipalities. 1.8.1. Treatment success rate for incident TB cases on first-line drugs in cities and municipalities Output 2015 87% 87% 88% 89% 90% 90% DHIS 2 cohort 1.8.2. Contact investigation coverage in cities & municipalities Output 2015 28% 28% 40% 50% 60% 70% DHIS 2 1.8.3. Number of close contacts (<5years) of PTB patients provided IPT in cities & municipalities Output 2015 376 376 537 671 806 950 DHIS 2 1.8.4. Latent TB treatment (IPT) coverage (<5years contacts of PTB patients) in cities & municipalities Output 2015 17% 17% 25% 35% 45% 60% DHIS 2 Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 13

Objective 2: To strengthen TB/HIV integrated care for co-infected patients and increase ART coverage among TB/HIV co-infected among TB/HIV co-infected patients from 88% in 2015/16 to 95% by 2019/20 Note: These indicators and targets are aligned with the Uganda TB/HIV policy (2013). Year Value 2015/16 2016/17 2017/18 2018/19 2019/20 source 2.1. Percentage of registered incident TB patients coinfected with HIV who started on and/or continued Outcome 2015 88% (17,088) 88% (17,088) 90% (17,211) 92% (20,022) 94% (22,825) 95% (26,020) TB quarterly anti-retroviral therapy (ART) (Denominator) Strategic intervention 2.1: Strengthen collaboration, coordination and monitoring mechanisms for TB/HIV integration. Year Value 2015/16 2016/17 2017/18 2018/19 2019/20 source 2.1.1. Percentage of TB/HIV joint planning meetings Output 2015 Unknown 25% 50% 75% 100% 100% Minutes of held meetings Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 14

Strategic intervention 2.2: Scale up implementation of the one-stop model for co-infected TB patients at health facilities. Year Value 2015/16 2016/17 2017/18 2018/19 2019/20 source 2.2.1. Percentage of health centres Surveys, (IV and above) providing TB/HIV Output 2015 Unknown 5% 10% 25% 50% 70% supervision, services in an DQA integrated manner Strategic intervention 2.3: Implement TB/HIV interventions to decrease the burden of HIV among patients with presumptive and diagnosed TB. 2.3.1. Percentage of registered new and relapse TB patients with documented HIV status 2.3.2. Percentage of registered HIVpositive TB patients who started on and/or continued co-trimoxazole preventive treatment (CPT) TB Output 2015 97% (42,320) 97% (42,320) 98% (42,320) 99% (48,245) 100% (54,999) Output 2015 98% 98% 99% 99% 99% (17,088) (17,088) (17,211) (20,022) (22,825) 100% quarterly (62,699) TB 99% quarterly (26,020) Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 15

Strategic intervention 2.4: Support implementation of Intensified Case Finding (ICF) i.e. active TB case finding among people living with HIV and provision of IPT in HIV care clinics. 2.4.1. Percentage of people living with HIV who were newly enrolled in HIV care and screened for TB 2.4.2. Latent TB treatment coverage among newly enrolled people living with HIV Output 2015 68% 68% 75% 80% 90% 95% HMIS 106a Output 2015 Unknown Unknown 5% 10% 20% 30% HMIS 106a Strategic intervention 2.5: Implement TB infection control (TBIC) practices in all health care facilities, congregate and community settings. 2.5.1. Number of health workers diagnosed with TB in the last year 2.5.2. Percentage of prisoners screened for TB in the last year unit TB register Output 2015 Unknown 93 83 73 63 53 & quarterly report Output 2015 2015 15% 25% 40% 50% 60% HMIS 106a Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 16

Objective 3: To increase case detection rate of MDR/RR/-TB from 17% in 2015/16 to 51% in 2019/20 and raise the treatment success rate from 74% in 2015/16 to 80% by 2019/20 3.1. Number and percentage of detected MDR/RR-TB patients among estimated MDR/RR TB cases 3.2. Treatment success rate for MDR/RR-TB cases TB 401 401 498 780 1,041 Outcome 2015 17% 17% 21% 32% 42% 1,278 quarterly 51%, Lab DR-TB Outcome 2015 74% 74% 75% 76% 78% 80% surveillance system Strategic intervention 3.1: Ensure early detection of MDR/RR/-TB. 3.1.1. Percentage of previously treated TB patients tested for MDR TB with documented Genexpert MTB/Rif or culture result TB Output 2015 65% 65% 73% 80% 87% 95% quarterly Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 17

3.1.2. Percentage of close contacts of MDR/RR-TB patients traced and screened for TB at least once DR-TB Output 2015 96% 96% 97% 98% 99% 100% unit registers Strategic intervention 3.2: Ensure early initiation of treatment and improve the quality of care for MDR/RR-TB patients. 3.2.1 Number (%) of confirmed DR-TB cases started on DR-TB treatment Output 2015 Year Value 2015/16 2016/17 2017/18 2018/19 2019/20 311 (78%) 311 (78%) 398 (80%) 663 (85%) 937 (90%) 1214 (95%) source DR-TB surveillanc e system Strategic intervention 3.3: Expand access to and improve MDR/RR/-TB patient management (including home-based care for patients unable to visit a follow-up facility). 3.3.1. Number of functional MDR/RR- TB treatment initiation sites DR-TB Output 2015 15 15 16 17 18 19 surveillance system Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 18

Strategic intervention 3.4: Implement Infection control practices in all MDR/RR/-TB treatment initiation and follow-up facilities as well as in communities. Baseline Targets Year Value 2015/16 2016/17 2017/18 2018/19 2019/20 Data source 3.4.1. Number of health workers diagnosed with DR- TB in the previous one year Output 2015 0 0 <5 <5 <5 <5 assessments Strategic intervention 3.5: Strengthen data management, monitoring and evaluation of MDR-TB care. 3.5.1. Percentage of MDR/RR-TB treatment facilities submitting timely, complete according to national guidelines NTLP Output 2015 Unknown Unknown >90% 100% 100% 100% DHIS2 Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 19

Objective 4: To strengthen systems for effective management of tuberculosis and leprosy services to meet the NSP targets Strategic intervention 4.1: Advocate for increased financial resources from domestic sources and ensure efficient and effective use of available finances. 4.1.1. Percentage of the NTLP annual budget funded by government NTLP Output 2015 4% 4% 6% 9% 12% 15% central unit 4.1.2. Percentage of TB affected households that experience catastrophic costs due to TB Output 2015 Unknown Unknown 30% [Update after survey] 25% 20% 10% NTLP central unit Strategic intervention 4.2: Engage communities and stakeholders in TB and leprosy prevention and care. 4.2.1. New community TB and leprosy groups active in TB and leprosy care USTP Output 2015 20 25 35 45 55 65 annual Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 20

Strategic intervention 4.3: Improve human resource capacity at all levels to effectively deliver TB and leprosy services. 4.3.1. Proportion of filled positions in the NTLP human resources structure NTLP Output 2015 33% 33% 40% 45% 50% 50% annual report Strategic intervention 4.5: Improve the quality of TB care and ensure patient safety at all levels. 4.5.1. Percentage of initial loss to follow up Output 2015 11% 11% 8% <5% <5% <5% DQA report, surveys 4.5.2. Loss to follow up rate for notified cases Output 2015 11% 11% 9% 5% <5% <5% TB quarterly Strategic intervention 4.6: Improve availability of quality assured TB and leprosy medicines, supplies and equipment at all levels. 4.6.1. Percentage of treatment units reporting no stock outs of anti-tb medicines in the last 3 months before assessment LMIS Output 2015 69% 69% 80% 85% 90% 95% quarterly Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 21

4.6.2. Percentage of diagnostic and treatment units reporting no stock outs of TB lab supplies in the last 3 months before assessment LMIS Output 2015 Unknown >90% >90% >95% >95% >95% quarterly Strategic intervention 4.7: Strengthen M&E systems for tracking performance and measuring outcomes and impacts to guide decision-making. 4.7.1. Percentage of districts submitting timely, complete according to national guidelines (factor = timeliness x completeness) NTLP/DHI Output 2015 Unknown Unknown >90% >90% >90% >90% S2 Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 22

Strategic intervention 4.8: Implement NTLP-led TB research agenda in collaboration with the Uganda TB research community. 4.8.1. Operational research projects conducted and findings disseminated NTLP Output 2015 4 4 6 10 14 18 report Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 23

Leprosy Goal: To reduce the incidence of Grade 2 disabilities (Gr2D) among new leprosy cases from 2.3 per million population in 2014 to less than 1 per million population by 2019/20. 1. To increase the proportion of leprosy endemic districts with annual plans containing leprosy activities aligned to NSP from 50% in 2014 to over 95% in 2020. 2. To reduce the proportion of new child leprosy cases with Grade 2 disabilities from 12% in 2014 to zero by 2020. 3. To increase Multi Bacillary MDT completion from 91% in 2014 to 95% in 2020. 4. To increase the proportion of persons affected by leprosy with insensitive feet who are provided protective footwear from 50% in 2014 to 100% in 2020. 5. To increase the proportion of persons affected by leprosy accessing self-care support from less than 5% in 2014 to 35% in 2020. Baseline Targets Year Value 2015 2016 2017 2018 2019 2020 Data source L.1 Prevalence of grade 2 disabilities among new cases/1,000,000 population Impact 2015 2.3 per million 1.9 1.7 1.4 1.1 0.9 < 1 per 1 million Leprosy quarterly L.2 Percentage of new cases of Leprosy leprosy with grade Outcome 2015 33% 30% 28% 23% 19% 16% 15% quarterly 2 disabilities Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 24

Strategic intervention L1. Increase the proportion of leprosy endemic districts with annual plans containing leprosy activities aligned to NSP from 50% in 2014 to over 95% in 2020 Baseline Targets Year Value 2015 2016 2017 2018 2019 2020 Data source L.1.1 Percentage of leprosy districts endemic with annual plans containing leprosy Output 2015 50% 60% 80% 90% >95% >95% >95% Supervisory activities aligned to NSP Strategic intervention L.2. Reduce the proportion of new child leprosy cases with Grade 2 disabilities from 12% in 2014 to zero by 2020. Baseline Targets Year Value 2015 2016 2017 2018 2019 2020 Data source L.2.1 Percentage of new child leprosy cases with Grade 2 disabilities from Output 2014 12% 12% 12% 9% 6% 3% 0% NTLP quarterly 12% in 2014 to zero by 2020. Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 25

Strategic intervention L.3. Increase the Multi Bacillary MDT completion from 91% in 2014 to 95% by 2019/20. Baseline Targets Year Value 2015 2016 2017 2018 2019 2020 Data source L.3.1 Percentage of MB leprosy cases that successfully complete Outcome 2015 83% 85% 87% 90% 92% 95% >95% Leprosy quarterly prescribed MDT Strategic intervention L.4. Increase the proportion of persons affected by leprosy with insensitive feet who are provided protective footwear from 50% in 2014 to 100% in 2020. Baseline Targets Year Value 2015 2016 2017 2018 2019 2020 Data source L.4.1 Percentage of leprosy affected Leprosy persons in need of Output 2015 50% 60% 70% 80% 90% 100% 100% quarterly protective footwear actually provided Strategic intervention L.5. To increase proportion of persons affected by leprosy accessing self-care support from <5% in 2014 to 35% in 2020. Baseline Targets Data source Year Value 2015 2016 2017 2018 2019 2020 L.5.1 Percentage of persons affected by leprosy accessing self-care support Outcome 2014 5% 5% 5% 10% 15% 25% 35% Leprosy quarterly Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 26

Table 3: definitions Definition Numerator Denominator Number of all new and relapse TB 1.0 Incidence Rate patients per 100,000 population per year determined from longitudinal survey 1.1. Notification rate of Number of notified new and relapse TB Number of notified new and incident TB cases (CNR) per patients in a calendar year per 100,000 relapse TB patients in a calendar Number of inhabitants 100,000 population population year 1.2. Treatment success rate for incident TB cases Number of notified new and relapse TB patients who are cured plus those who completed treatment as a percentage of all notified new and relapse TB patients in a given period Number of notified new and relapse TB patients who are cured plus those who completed treatment All notified new and relapse TB patients in a given period Number of New Bacteriologically 1.3. Cure rate among new PBC Confirmed (P-BC) patients declared Cured as a percentage of total Number of new P-BC cases Number of new P-BC cases with cured treatment outcome Total Number of new P-BC cases Number of notified TB patients (all 1.4. Treatment success rate among all forms of TB forms) who are cured plus those who completed treatment as a percentage of notified TB patients (all forms) in a Number of notified TB patients (all forms) who are cured plus those who completed treatment Notified TB patients (all forms) in a given period given period 1.5. Case fatality rate among all forms of TB Number of notified TB patients (all forms) who died while on TB treatment as a percentage of notified TB patients (all forms) in a given period Number of notified TB patients (all forms) who died while on TB treatment Notified TB patients (all forms) in a given period Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 27

Definition Numerator Denominator Number of notified TB patients (all 1.6. Loss to follow up rate among all forms of TB forms) who were lost to follow up while on TB treatment as a percentage of notified TB patients (all forms) in a Number of notified TB patients (all forms) who were lost to follow up while on TB treatment Notified TB patients (all forms) in a given period given period 1.1.1. Percentage of children Number of notified incident (new and aged younger than 15 years relapse) TB patients younger than 15 Number of notified new & relapse Number of notified new and among all forms of incident years of age in the period under review TB patients younger than 15 years relapse TB patients in period under (new and relapse) TB cases as a percentage of the total number of age in the period under review review notified notified (new + relapse) TB patients 1.2.1. Number of Number of bacteriologically confirmed bacteriologically confirmed patients (new and relapse) TB patients patients notified in the period under review Patients tested using a WHO 1.2.2. Percentage of new and relapse TB Patients tested using WHO recommended rapid tests at time of diagnosis recommended rapid test at the time of diagnosis, divided by the total number of new and relapse TB Number of patients tested using a WHO recommended rapid test at the time of diagnosis Total number of new and relapse TB patients patients, expressed as a percentage Number of TB patients with DST results for at least rifampicin divided by the total number of notified (new and 1.2.3. Drug susceptibility testing (DST) coverage (%) retreatment) cases in the same year, expressed as a percentage. DST coverage includes results from Number of TB patients (new and retreatment) with DST results for at least rifampicin Total number of notified (new and retreatment) cases in the same year molecular (e.g. Xpert MTB/RIF) as well as conventional phenotypic DST results. Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 28

Definition Numerator Denominator 1.2.4 Percentage of labs participating in external quality assurance (EQA). Number of laboratories participating in EQA (defined as sending slides for blind rechecking) as a percentage of the total number of laboratories with smear microscopy Number of laboratories participating in EQA (defined as sending slides for blind rechecking) Number of laboratories with smear microscopy Number of false negative slides (slide 1.2.5. Percentage of high false read as negative when the controller Number of false negative slides negative reported in diagnostic reads positive 1, 2 or 3) as a (slide read as negative when the Number of slides rechecked and treatment units. percentage of number of all slides controller reads positive 1, 2 or 3) rechecked Number of new and relapse cases that 1.3.1. TB Treatment coverage (%) were notified and treated, divided by the estimated number of incident TB cases in the same year, Number of new and relapse cases notified and treated in a given year Estimated number of incident TB cases in the same year expressed as a percentage. Number of TB patients treated with 1.3.2. Treatment coverage new TB drugs (%) regimens that include new (endorsed after 2010) TB drugs, divided by the number of notified patients eligible for treatment with new TB drugs, Number of TB patients treated with regimens that include new (endorsed after 2010) TB drugs The number of notified patients eligible for treatment with new TB drugs expressed as a percentage. 1.4.1. Percentage of TB cases (all forms) notified in DTUs who were referred by the village health team or CSO. Number of TB cases (all forms) notified in DTUs who were referred by VHT/CSO as a percentage of all TB cases (all forms) notified Number of TB cases (all forms) notified in DTUs referred by VHT/CSO Number of all TB cases (all forms) notified 1.4.2. Contact investigation coverage Number of contacts of people with bacteriologically-confirmed TB who were evaluated for TB, divided by the Number of contacts of people with bacteriologically-confirmed TB who were evaluated for TB Total number of contacts of people with bacteriologically confirmed TB Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 29

Definition Numerator Denominator number eligible, expressed as a percentage. Number of PBC-TB patients whose 1.4.3. Contact investigation coverage among PBC-TB contacts have been traced and investigated for TB as a percentage of all PBC-TB patients diagnosed in a Number of PBC-TB patients whose contacts have been traced and investigated for TB PBC-TB patients diagnosed in a given period given period 1.4.4. Number of close contacts (<5years) of PTB patients provided IPT Number of close contacts (<5years) of PTB patients provided IPT Number of children younger than 5 1.4.5. Latent TB treatment (IPT) coverage (<5years contacts of PTB patients) years who are household contacts of cases started on latent TB infection (LTBI) treatment, divided by the number eligible for treatment, expressed as a Number of children younger than 5 years who are household contacts of cases started on LTBI treatment Total number of children younger than 5 years eligible for LTBI percentage 1.5.1 Proportion of mapped CSOs that are implementing TB control activities Number of mapped CSOs that are implementing TB control activities as a percentage of all CSO s registered with URSB Number of mapped CSOs that are implementing TB control activities Total number of CSO s registered with URSB 1.5.2 Proportion of mapped CSO s reporting using recommended tools Number of mapped CSOs that are reporting using recommended TB tools as a percentage of mapped CSO s implementing TB control activities Number of mapped CSOs that are reporting using recommended TB tools Number of mapped CSOs that are implementing TB control activities Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 30

Definition Numerator Denominator Number of mapped CSOs that are 1.5.3 Proportion of mapped CSOs trained in TB management trained in TB management as a percentage of mapped CSO s Number of mapped CSOs that are trained in TB management Number of mapped CSOs that are implementing TB control activities implementing TB control activities 1.6.1. Percentage new prisoners screened for TB (entry screening) Number of new prisoners screened for TB (entry screening) as a percentage of number of all prisoners entering the prison system Number of new prisoners screened for TB by entry screening Number all prisoners entering the prison system 1.6.2. Number bacteriological confirmed TB in new prisoners Number bacteriological confirmed TB in new prisoners found through entry screening 1.7.1. Number of private forprofit and private not-forprofit health facilities accredited to function as diagnostic and treatment units Number of private for-profit and private not-for-private health facilities functioning as DTUs (DTUs) Number of bacteriologically confirmed patients (new and previously treated Number of bacteriologically 1.8.1. Treatment success rate for incident TB cases on firstline drugs in cities and municipalities relapse) TB patients in the period under review successfully treated (cured and treatment completed) as a percentage of the total number bacteriologically confirmed patients confirmed patients (new and previously treated relapse) TB patients in the period under review successfully treated (cured and treatment completed) in cities and Number bacteriologically confirmed patients starting firstline drugs in cities and municipalities starting First Line Drugs (FLD) in cities municipalities and municipalities Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 31

Definition Numerator Denominator 1.8.2. Contact investigation coverage in cities and municipalities Number of contacts of people with bacteriologically-confirmed TB in cities and municipalities who were evaluated for TB, divided by the number eligible, expressed as a percentage. Number of contacts of people with bacteriologically-confirmed TB in cities and municipalities who were evaluated for TB Total number of contacts of people with bacteriologically confirmed TB in cities and municipalities 1.8.3. Number of close contacts (<5years) of PTB patients Number of close contacts (<5years) of provided isoniazid preventive PTB patients provided IPT in cities and therapy (IPT) in cities and municipalities municipalities 1.8.4. Latent TB treatment (isoniazid preventive therapy) coverage (<5years contacts of PTB patients) in cities and municipalities Number of children younger than 5 years who are household contacts of cases started on LTBI treatment in cities & municipalities, divided by the number eligible for treatment, expressed as a percentage Number of children younger than 5 years who are household contacts of cases started on LTBI treatment in cities and municipalities Total number of children younger than 5 years eligible for LTBI in cities and municipalities 2.1. Percentage of TB patients co-infected with HIV who started on and/or continued anti-retroviral therapy (ART) Number of HIV-positive TB patients started on and/or continued ART as a percentage of all HIV+ TB patients notified in the period under review Number of HIV-positive TB patients on ART in the period under review Number of all HIV+ TB patients notified in the period under review 2.1.1. Percentage of TB/HIV joint planning meetings held Number of TB/HIV joint planning meetings held as a percentage of the number of planned meetings Number of TB/HIV joint planning meetings held Number of planned meetings 2.2.1. Percentage of TB (HCIV and above) and HIV clinics providing TB/HIV services in an integrated manner Number of TB (HCVI and above) and HIV clinics implementing one-stop centre model for co-infected TB patients as a percentage of total number of ART accredited facilities Number of TB (HCVI and above) and HIV clinics implementing onestop centre model for co-infected TB patients Total number of TB (HCVI and above) and HIV clinics Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 32

Definition Numerator Denominator 2.3.1. Percentage of registered TB patients with documented HIV status Number of TB patients with known HIV status as a percentage of all notified TB patients in the period under review Number of TB patients with known HIV status Number of all notified TB patients 2.3.2. Percentage of HIVpositive TB patients who started on and/or continued co-trimoxazole preventive treatment (CPT) Number of HIV-positive TB patients treated with CPT as a percentage of all HIV+ TB patients notified in the period under review Number of HIV-positive TB patients treated with CPT in the period under review Number of all HIV+TB patients notified in the period under review Number of people living with HIV who 2.4.1. Percentage of people living with HIV who were newly enrolled in HIV care and screened for TB were newly enrolled in HIV care and screened for TB, divided by the total number of people living with HIV eligible for screening for TB, expressed Number of people living with HIV who were newly enrolled in HIV care and screened for TB in a given period Total number of people living with HIV who were newly enrolled in HIV care in the same period as a percentage 2.4.2. Latent TB treatment (IPT) coverage among people living with HIV newly enrolled in HIV care Number of people living with HIV newly enrolled in HIV care started on LTBI treatment (IPT) divided by the number eligible for treatment, expressed as a percentage. Number of people living with HIV newly enrolled in HIV care started on LTBI treatment (IPT) Total number of people living with HIV newly enrolled in HIV care eligible for LTBI (IPT) 2.5.1. Number of health Number of health workers diagnosed workers diagnosed with TB in with TB in the last year at health the last year facilities Number of prisoners screened at least 2.5.2. Percentage of prisoners screened for TB in the last year once for TB in a given period divided by total number of prisoners in the same period, expressed as a Number of prisoners screened at least once for TB in a given period Number of prisoners screened at least once for TB in the same period percentage Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 33

Definition Numerator Denominator 3.1. Number and percentage of detected MDR/RR-TB patients among estimated MDR/RR TB cases Number of detected MDR/RR-TB patients as a percentage of estimated MDR/RR-TB cases Number of detected MDR/RR-TB patients Number of estimated MDR/RR-TB patients in the population Number of MDR/RR-TB patients who 3.2. Treatment success rate for MDR/RR-TB cases have cured plus those who completed treatment as a percentage of total number of MDR/RR TB patients started Number of MDR/RR-TB patients who have cured plus those who completed treatment Total number of MDR/RR TB patients started on treatment in a given period on treatment in a given period 3.1.1. Percentage of previously treated TB patients tested for MDR TB with documented Genexpert MTB/Rif or culture result Number of previously treated TB patients tested for MDR TB with documented Genexpert MTB/Rif or culture result as a percentage of the total number of previously treated TB patients in a given period Number of previously treated TB patients tested for MDR TB with documented Genexpert MTB/Rif or culture result Total number of previously treated TB patients in a given period 3.1.2. Percentage of close contacts of MDR/RR-TB patients traced and screened for TB at least once Percentage of close contacts of MDR/RR-TB patients traced and screened for TB at least once Number of close contacts of MDR/RR-TB patients traced and screened for TB at least once Number of close contacts of MDR/RR-TB patients 3.2.1. Number of confirmed MDR/RR-TB cases started on MDR/RR-TB treatment Number of confirmed MDR/RR-TB cases started on MDR/RR-TB treatment 3.3.1 Number of functional MDR/RR-TB treatment initiation sites Number of functional MDR/RR-TB treatment initiation sites Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 34

Definition Numerator Denominator 3.4.1. Number of health workers diagnosed with MDR/RR-TB in the previous one year Number of health workers diagnosed with MDR/RR-TB in the previous one year 3.5.1. Percentage of MDR/RR- Number of MDR/RR-TB treatment TB treatment facilities facilities submitting timely and Number of MDR/RR-TB treatment Total number of MDR/RR-TB submitting timely and complete as a percentage of facilities submitting timely and treatment facilities in the same complete according to total number of DR-TB treatment complete period under review national guidelines facilities in a given period 4.1.1. Percentage of the NTLP annual budget funded by government Percentage of the NTLP annual budget funded by government contribution from the Government of Uganda NTLP budget per the National Strategic Plan 4.1.2. Percentage of TB affected households that experience catastrophic costs due to TB Number of people treated for TB (and their households) who incur catastrophic costs (direct and indirect combined), divided by the total number of people treated for TB. Number of people treated for TB (and their households) who incur catastrophic costs (direct and indirect combined) Total number of people treated for TB. 4.2.1. New TB and leprosy Number of new TB and leprosy community groups active in TB community groups active in TB and and leprosy care leprosy care 4.3.1. Proportion of filled positions in the NTLP human resources structure Number of filled positions in the NTLP human resources structure as a percentage of the number in the NTLP human resources structure Number of filled positions in the NTLP human resources structure Total number of positions in the NTLP human resources structure 4.5.1. Percentage of initial loss to follow up Number of diagnosed TB patients who do not initiate treatment divided by total number of diagnosed TB patients Number of diagnosed TB patients who do not initiate treatment in a given period of time Total number of diagnosed TB patients in the same period of time Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 35

Definition Numerator Denominator in the same period of time, expressed as a percentage Number of diagnosed TB patients who do not initiate treatment plus those Number of diagnosed TB patients 4.5.2. Loss to follow up rate for notified cases who initiate treatment but do not complete treatment divided by total number of diagnosed TB patients in who do not initiate treatment plus those who initiate treatment but do not complete treatment in a Total number of diagnosed TB patients in the same period of time the same period of time, expressed as given period of time a percentage 4.6.1. Percentage of treatment units reporting no stock-outs of anti-tb medicines in the last 3 months before assessment Number of health facilities reporting no stock-outs of anti-tb medicines in the last 3 months before assessment as a percentage of the number of health facilities assessed Number of health facilities reporting no stock-outs of anti-tb medicines in the last 3 months before assessment Total number of health facilities assessed 4.6.2. Percentage of diagnostic and treatment units (DTUs) reporting no stock-outs of TB lab supplies in the last 3 months before assessment Percentage of DTUs reporting no stock-outs of TB lab supplies in the last 3 months before assessment Number of DTUs reporting no stock outs of TB laboratory supplies in the last 3 months before assessment Total number of DTUs assessed 4.7.1. Percentage of districts submitting timely and complete according to national guidelines Number of districts submitting timely and complete according to national guidelines (factor = timeliness x completeness) as a percentage of number of district submitting Number of districts submitting timely and complete according to national guidelines (factor = timeliness x completeness) Total number of district submitting 4.8.1. Operational research Number of operational research projects conducted and projects conducted and findings findings disseminated disseminated Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 36

Definition Numerator Denominator L.1 Prevalence of grade 2 disabilities among new cases/1,000,000 population Number of leprosy patients with grade 2 disabilities among new cases/1,000,000 population Number of leprosy patients with grade 2 disabilities among new cases population L.2 Percentage of new cases of leprosy with grade 2 disabilities Number of leprosy patients with grade 2 disabilities as a percentage of new leprosy cases Number of leprosy patients with grade 2 disabilities Total number of new leprosy cases L.1.1 Percentage of leprosy endemic districts with annual plans containing leprosy activities aligned to NSP Number of leprosy endemic districts with annual plans containing leprosy activities aligned to NSP as a percentage of the number of leprosy endemic districts Number of leprosy endemic districts with annual plans containing leprosy activities aligned to NSP Total number of leprosy endemic districts L.2.1 Percentage of new child leprosy cases with Grade 2 disabilities Number of new child leprosy cases with Grade 2 disabilities as a percentage of total number of leprosy cases with grade 2 disabilities Number of new child leprosy cases with Grade 2 disabilities Total number of leprosy cases with grade 2 disabilities L.3.1 Percentage of Multi Bacillary leprosy cases that successfully complete prescribed MDT Number of Multi Bacillary leprosy cases that successfully complete leprosy MB treatment as a percentage of total number of MB leprosy cases Number of MB leprosy cases that successfully complete leprosy MB treatment Total number of MB leprosy cases L.4.1 Percentage of leprosy affected persons in need of protective footwear actually provided Number of leprosy affected persons in need of protective footwear actually provided as a percentage of the people in need of protective footwear Number of leprosy affected persons in need of protective footwear actually provided Total number of leprosy affected persons in need of protective footwear L.5.1 Percentage of persons Number of persons affected by leprosy affected by leprosy accessing self-care support accessing self-care support as a percentage of total number of leprosy affected persons Number of persons affected by leprosy accessing self-care support Total number of leprosy affected persons Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 37

Table 4: List of indicators to be included into DHIS2 name Denominator Description Numerator Description Multiplier factor Expected TB cases 100000 National projected Population 234 Expected MDR-TB cases (All New TB cases X 0.014) +( (Total all - total New) X 0.121) TB Case Detection Rate per 100,000 Pop National projected Population New + Relapse bacteriologically confirmed PTB (P- BC) cases 100000 TB Case notification for all TB forms (new & relapse) per 100,000 population National projected Population All New + all Relapse TB cases 100000 TB prevalence rate per 100,000 Pop National projected Population Total number of TB cases 100000 Percentage of TB patients on DOT Total number of all TB cases registered in the same period Number of patients on DOT(Facility + Community based DOT) 100 Percentage of TB patients tested for HIV Percentage of TB/HIV co-infected patients Total number of all TB cases registered in the same period Number of TB cases tested for HIV 100 Total Number of TB cases tested for HIV Number of TB cases tested HIV positive 100 Percentage of HIV-positive TB patients treated with Cotrimoxazole prophylaxis (CPT) Number of TB cases tested HIV positive Number of HIV-positive TB patients treated with Cotrimoxazole prophylaxis (CPT) 100 Uganda NTLP Rev. National Strategic Plan 2015/16 2019/20 Monitoring & Evaluation 38