Is awarded by The Global Fund to Fight AIDS, Tuberculosis and Malaria.

The East, Central and Southern Africa Health Community (ECSA-HC) is a regional inter-governmental health organisation established in 1974 to foster regional cooperation in health among member states. With over 43 years of experience, ECSA-HC is the largest health-specific organisation in the region outside the UN system, occupying a unique position to provide leadership on regional health sector issues.

In April 2013, through support from the ECSA-led East African Public Health Laboratory Networking Project (EAPHLNP), the Uganda National TB Reference Laboratory (NTRL) received WHO-designated status as a Supranational Reference Laboratory (SRL): the third SRL in Africa, and one of only 29 worldwide. Building on this recognition, ECSA-HC in collaboration with Uganda SRL was awarded a Global Fund grant to strengthen TB laboratory diagnostic capacity across the region.

The project supported 21 countries formally linked to Uganda SRL through Memoranda of Understanding, working toward a regional network of 21 National TB Reference Laboratories. A Mid-Term Review was conducted in December 2017 to assess progress against project outputs and guide the remaining implementation period.

• Build a regional network of NTRLs for inter-state laboratory quality assurance and management across ECSA countries
• Improve laboratory service provision for quality-assured 1st and 2nd line Drug Susceptibility Testing accessible to people in need
• Enhance impact of rapid molecular TB diagnostic testing and build NRL capacity for epidemiological surveillance including Drug Resistance Surveys

• All 21 NTRLs signed Memoranda of Understanding and enrolled in the Proficiency Testing Scheme (PTS)
• Project exceeded its targets for Proficiency Testing in TB microscopy across the network
• All NTRLs achieved capability to use GeneXpert, with high achievement scores in Proficiency Testing
• Four NTRLs began performing second-line Drug Susceptibility Testing as a direct result of project support
• Eleven of 21 countries acquired Line Probe Assay (LPA) machines, enabling second-line DST through Uganda SRL technical assistance
• Out of 14 countries enrolled in the 2016 EQA cycle, 10 reported results; with 8 scoring above the 87.5% pass mark
• Swaziland and Rwanda established TB Specimen Referral Systems covering 100% of their primary health care facilities

Is awarded by The KOFIH.

The KOFIH funds aimed to strengthen the bilateral cooperation through ODA and supported Uganda SRL with technical assistance in the field of tuberculosis diagnosis and management.

In July 2017, through support from the KOFIH, the Uganda National TB Reference Laboratory (NTRL) was funded to capacitate the Control Capacity Building in Uganda, continued to focus on building and strengthening of human resource technical capacity. This was to support the technical capacity growth of laboratory staff from peripheral facilities in Masaka, Bukomansimbi, Kalungu, and Kyotera district, contributed to DST technological enhancement and adoption through accreditation of the MKIT technology and infrastructural and technological development at the National TB Laboratory / SRL Uganda.

The project was to run from April 2017, to ’19, but was extended to 2022 due to COVID 19 pandemic.

• Improved capacity of TB management control and contribute to reducing TB incidence rate
• To build and strengthen human resource technical capacity at SRL/NTRL Uganda
• To strengthen the technical capacity of laboratory staff from peripheral facilities in Masaka, and Bukomansimbi districts
• To support DST technological enhancement through accreditation of the MKIT technology
• To support infrastructural and technological development of the National TB Reference Laboratory / SRL Uganda

• (1) Improvement of the diagnostic capacity of Multi-Drug Resistant Tuberculosis:
  • Operational Research training workshop
  • Laboratory Logistics and quantification training workshop
  • Procurement of Uninterrupted Power Supply (UPS)
  • Procurement of Online training Platform
  • Procurement of Laptops
  • SRL/NTRL Operational Costs
  • Blinded recheck Support supervision visits for each of the four districts within the greater Masaka region (including Masaka, Bukomansimbi, Kalungu and Kyotera)
  • EQA network (ZN, AFB Microscopy, GeneXpert) refresher training targeting Masaka and Bukomansimbi Districts peripheral lab staff
  • EQA network (ZN, AFB Microscopy, GeneXpert) refresher training targeting Masaka and Bukomansimbi Districts peripheral lab staff from 6 additional districts of Greater Masaka Region including Sembabule, Rakai, Lyantonde, Lwengo, Kalungu and Kyotera districts
  • To support DST technological adoption through accreditation of the MKIT technology (Certification of the MKIT technology)
• (2) Strengthened self-sufficiency capacity of Tuberculosis diagnosis in National TB Laboratory:
  • Curriculum development workshop, e.g. finalization of training materials and relevant training documentation [8 training modules], PT training modules, hence IACET standard requirements
  • Facility and Equipment maintenance at SRL/NTRL
  • Review and Finalization of curriculum training
  • SRL Operational Costs
  • Biosafety and Biosecurity Training in Masaka and Bukomansimbi

It was awarded by Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, as commissioned by the German Federal Ministry for Economic Cooperation and Development (BMZ) and co-financed by the UK Foreign, Commonwealth & Development Office (FCDO).

BACKUP Health is a GIZ-managed initiative supporting countries to strengthen institutions of the health sector; improving organisational competencies for managing global health financing, human resource capacity, and technical systems required for effective health service delivery, including laboratory infrastructure.

Uganda continues to carry a high TB burden, categorised by WHO among the 30 high TB and TB/HIV burden countries globally, with an estimated incidence of 200 per 100,000 population. TB control services are managed under the National TB and Leprosy Control Program (NTLP), with the National Health Laboratories and Diagnostic Services (NHLDS); housing the National TB Reference Laboratory (NTRL) – overseeing all laboratory diagnostics.

While Uganda’s TB diagnostic network expanded from 303 facilities in 2006 to 1,669 by 2020, significant quality gaps remained: only 14% of health regions had decentralised TB External Quality Assurance (EQA) services, just 73% of diagnostic facilities were enrolled in any form of TB EQA, and GeneXpert proficiency testing lacked adequate funding. This project was designed to close those gaps.

• Expand TB EQA coverage from 58% (2020) to 90% by 2025
• Increase decentralised TB EQA regions from 14% (2020) to 100% by 2025
• Support provision of proficiency testing panels for GeneXpert TB testing at 100% of GeneXpert sites nationally
• Ensure 100% of new laboratory staff receive induction training and 50% of TB facilities receive regular supervision by 2025
• Reduce laboratories reporting EQA errors from 5% to less than 1% by 2025

• Update, print and distribute revised TB diagnostic manuals; stakeholder workshops to revise the outdated 2012 TB diagnostic network manual, incorporating new tools like GeneXpert Ultra, LF-LAM and TB LAMP; printing and distribution of 5,000 copies to laboratories nationwide
• Decentralise TB EQA to selected regions; two-week training for regional TB focal persons, district laboratory focal persons and DTLS; procurement of computers for data management; targeted support supervision and mentorship; routine quarterly regional review meetings
• Preparation of Proficiency Tests for MTB diagnostics; biannual preparation and distribution of GeneXpert PT materials to all 250+ GeneXpert sites nationally; targeted support supervision and corrective action follow-up; central performance review workshops

The project was coordinated at NTRL/SRL in collaboration with NHLDS as the principal recipient of funds, with a dedicated focal person overseeing implementation. Technical collaboration extended to the National TB and Leprosy Control Program (NTLP), regional referral hospitals, and district health offices across the country.

Is an in-kind subaward issued by JSI Research & Training Institute, Inc. under the United States Agency for International Development (USAID) Tuberculosis Implementation Framework Agreement (TIFA)[cite: 40].

The Tuberculosis Implementation Framework Agreement (TIFA) is a USAID-funded initiative managed by JSI Research & Training Institute, Inc[cite: 40]. TIFA directly supports partner countries to implement equitable, essential tuberculosis interventions at scale by providing targeted TB Commitment Grants to strengthen national health institutions and local laboratory capacities[cite: 40].

In Uganda, an estimated 36% of children with TB go undiagnosed or unreported, placing them at severe risk of complications and mortality. A primary bottleneck is that standard sputum collection methods (e.g., sputum induction, nasopharyngeal or laryngeal aspiration) are highly invasive, requiring specialized skills and equipment rarely available at lower-level facilities.

To address this gap, the project was launched to introduce non-invasive stool sample processing using the Simple One-Step (SOS) method for Xpert MTB/RIF Ultra testing into routine clinical practice, allowing younger children (<5 years) to access bacteriological confirmation and drug susceptibility testing across Uganda’s healthcare network.

• Introduce the Simple One-Step (SOS) stool-based TB testing method for pediatric TB diagnosis using Xpert MTB/RIF Ultra at NTRL Uganda
• Adopt national guidelines, Standard Operating Procedures (SOPs), job aids, and M&E tools for SOS stool testing in children
• Roll out early implementation and on-site healthcare worker capacity building across national, regional, and general hospitals
• Digitalize the complete SOS training course to facilitate long-term nationwide scaling and technical sustainability
• Compile an early implementation report and national rollout plan to guide policy and program expansion with key stakeholders

• National Framework & Alignment: Developed, adapted, and finalized official SOS SOPs, job aids, M&E data collection tools, and training modules through high-level and subnational stakeholder engagements.
• Capacity Building & Training: Conducted Central Training of Trainers (ToT) for 60 laboratory personnel and pediatricians across 5 National Referral and 17 Regional Referral Hospitals.
• Decentralized On-Site Mentorship: Rolled out hands-on, two-day on-site training to clinicians, lab staff, and logisticians across 34 General Hospitals in 17 regions.
• Facility Equipping: Disseminated SOPs, job aids, and M&E tools to a total of 56 health facilities nationwide.
• Digitalization & Sustainability: Digitalized theoretical and practical SOS modules onto the MOH/NHLDS e-learning portal for continuous remote learning.

Is an in-kind subaward issued by JSI Research & Training Institute, Inc. under the United States Agency for International Development (USAID) Tuberculosis Implementation Framework Agreement (TIFA)[cite: 40].

The Tuberculosis Implementation Framework Agreement (TIFA) is a USAID-funded initiative managed by JSI Research & Training Institute, Inc[cite: 40, 56]. TIFA directly supports partner countries to implement equitable, essential tuberculosis interventions at scale by providing targeted TB Commitment Grants to strengthen national health institutions and local laboratory capacities across the region[cite: 40, 56].

As National TB Programs expand access to stool-based TB testing, there is a critical need to ensure available expertise in training, mentorship, and supervision of the Simple One-Step (SOS) stool processing method across the African continent[cite: 47]. The SOS method is USAID’s preferred choice for stool processing due to its operational simplicity, requiring no centrifugation or specialized tools beyond a wooden spatula[cite: 47].

Leveraging its WHO-designated Supranational Reference Laboratory (SRL) status and established technical network supporting 21 Sub-Saharan African countries, Uganda SRL/NTRL was selected to lead regional implementation, technical assistance, and capacity development for pediatric stool-based TB testing[cite: 47].

• Strengthen the capacity of Uganda-SRL consultants to provide training and mentorship in the SOS stool processing method for diagnosing TB among children in Sub-Saharan Africa[cite: 47]
• Support NTP programs in the region to develop and strengthen stool-based Xpert testing implementation plans within their respective networks[cite: 47]
• Support NTP programs in the region to roll out and scale up stool-based Xpert testing within their respective networks[cite: 47]
• Maintain a regional Community of Practice (CoP) across countries implementing stool processing methods to foster peer learning and routine progress monitoring[cite: 50, 51]

• Technical Leadership & Staffing: Appointed dedicated SRL and NTLP technical leadership and recruited specialized project support staff (M&E Specialist and Project Administrator) to drive implementation across target countries[cite: 49].
• M&E Framework & Data System: Developed and operationalized a comprehensive M&E framework, standardized data collection tools, and a performance tracking database to monitor pediatric TB testing indicators[cite: 50].
• Regional Community of Practice (CoP): Established and coordinated a multi-country CoP platform for quarterly progress reviews, best-practice sharing, and technical exchanges across 13 countries implementing SOS stool testing[cite: 51].
• In-Country Stakeholder Engagements: Conducted high-level virtual and in-person stakeholder engagement visits across target countries (including Zimbabwe, Liberia, Tanzania, and Botswana) to map stakeholders and formalize endorsed national rollout plans[cite: 51, 52].
• Targeted Technical Assistance (TA): Delivered on-site TA missions by Uganda SRL experts to guide country-specific guidelines, hands-on laboratory mentorship, and operational evaluations[cite: 52, 53, 54].

Is a Time and Material Purchase Order awarded under the United States Agency for International Development (USAID) Infectious Disease Detection and Surveillance (IDDS) project, implemented in partnership with ICF[cite: 118].

USAID’s Infectious Disease Detection and Surveillance (IDDS) initiative supports global health security by strengthening diagnostic networks and surveillance systems for infectious diseases[cite: 118]. For this initiative, Makerere University Biomedical Research Centre (MaKBRC) served as the fiduciary agent and project host overseeing implementation on behalf of the Uganda Supranational Reference Laboratory (Uganda SRL)[cite: 118].

While WHO recommends Xpert MTB/RIF and Ultra assays on stool samples for pediatric TB detection, rapid molecular WHO-recommended diagnostics (mWRDs) such as Truenat are being rapidly rolled out as point-of-care tools[cite: 118]. Truenat offers distinct operational advantages in remote settings, including battery-powered mobility, minimal infrastructure requirements, and integrated rifampicin resistance detection[cite: 118].

However, no published protocol previously existed for processing non-invasive stool samples on the Truenat MTB Plus and Truenat MTB-RIF Dx assays[cite: 118]. To build a solid evidence base prior to routine field piloting in priority countries like Nigeria, USAID IDDS engaged Uganda SRL to conduct proof-of-concept laboratory experiments and establish standardized diagnostic protocols using the Simple One-Step (SOS) method[cite: 118].

• Establish and validate a proof-of-concept protocol and Standard Operating Procedures (SOPs) for processing stool samples on the Truenat MTB platform[cite: 118]
• Secure Institutional Review Board (IRB) ethical approval and procure specialized diagnostic consumables for laboratory experimentation[cite: 118]
• Conduct controlled laboratory experiments evaluating Simple One-Step (SOS) stool processing performance on Truenat assays[cite: 118]
• Compile, analyze, and synthesize experimental laboratory findings to support peer-reviewed manuscript development and international data dissemination[cite: 118]
• Develop draft protocols, SOPs, and technical guidance to support Phase 2 routine field validation and pilot implementation across partner countries[cite: 118]

• Governance & Ethical Oversight: Secured formal IRB protocol approval and established project governance between MaKBRC, Uganda SRL, and USAID IDDS technical advisors[cite: 118].
• Procurement & Setup: Executed efficient procurement of diagnostic reagents, Truenat microchips, and laboratory consumables to launch experimental phases[cite: 118].
• Experimental Validation: Successfully conducted laboratory experiments establishing sample preparation parameters for the Simple One-Step (SOS) stool method on Truenat MTB Plus and Truenat MTB-RIF Dx microchips[cite: 118].
• Standard Operating Procedures: Authored standardized diagnostic SOPs and proof-of-concept protocols to transition Truenat stool testing from research to field validation[cite: 118].
• Technical Dissemination & Field Support: Contributed comprehensive data analyses, monthly progress reporting, and technical inputs to guide Phase 2 routine field implementation in target countries like Nigeria[cite: 118].