A quasi-experimental study evaluating the effectiveness of a male-specific tuberculosis screening and diagnosis...

Despite men having a higher burden of TB, they are frequently missed by TB services due to social, behavioural, and health system factors that limit healthcare access. In Uganda, where there are no gender-specific guidelines for TB, we implemented and evaluated a gender-specific intervention to find and treat men with TB.

We conducted a quasi-experimental study comparing TB notifications before (January-June 2023) and after (July-December 2023) the intervention at both intervention (Gombe and Mityana hospitals) and control (Luwero and Kiboga hospitals) sites. The intervention package aimed to enhance TB screening documentation by using checklist stamps, distribute TB educational materials, and introduce male-friendly TB clinics with evening opening hours, health education delivered by male champions, and integrated screening for TB, HIV, diabetes, and hypertension. We extracted data from TB registers and fitted a quasi-Poisson regression model, adjusting for catchment population dynamics by gender, to assess the intervention's effects on TB case notification rates.

Overall, 6,415 people in the participating hospitals were presumed to have TB, and 53.3% of these were females. Post-intervention, TB notifications increased by 46.3% (Female 0%, Male 88.4%) in Gombe and 36.4% (Female 26.3%, Male 45.1%) in Mityana; while they reduced by 26.7% (Female 28.8%, Male 25.5%) in Luwero and by 15.4% (Female + 23.9%, Male - 31.8%) in Kiboga. The baseline case notification rate was 246/100,000 population. Post-intervention analysis demonstrated that the intervention significantly increased TB case notification rates (RR: 1.51, 95% CI: 1.03-2.22), and males had a higher notification rate than females (RR: 1.5, 95% CI: 1.23-1.83). The treatment initiation rates pre- and post-intervention ranged between 97.4% and 100% in women, and 91.4% to 97.7% in men.

Gender-specific interventions for screening people with TB and linking them to care can be mutually beneficial at improving notifications among men and women.

The trial was registered retrospectively on the Pan African Clinical Trial Registry (PACTR202509682831484) on 29th September 2025.