Tuberculosis (TB) is now a curable disease. Nevertheless, TB remains the leading cause of death among people who use drugs (PWUD) who are also living with HIV. The absence of appropriate TB care systems for PWUD causes low levels of TB diagnosis and treatment as well as the fast and concerning spread of multi-drug resistant TB (MDR-TB) among this key population.

As TB incidence has fallen or stabilized across most high-income countries it remains a big challenge in the sub saharan Africa Uganda inlclusive. The TB epidemic significantly and disproportionately affects PWUD, with TB being the leading cause of death among PWUD living with HIV. Death rates among people with TB in Uganda are incidentally very high.

This situation arises from a combination of factors. TB services are often difficult for PWUD to access or to remain engaged with as there is an over-reliance on lengthy inpatient treatment. This approach makes it very difficult for PWUD to sustain engagement in TB treatment. There is also a lack of integration of TB services with other healthcare services for PWUD; this further increases the challenges for PWUD trying to access and sustain engagement with TB treatment. The resulting low level of engagement in TB diagnosis and treatment results in extremely high TB and TB/HIV mortality rates, as well as in the development and spread of MDR-TB. Repressive drug policies coupled with stigma and discrimination against PWUD also undermine access to TB diagnosis and treatment services.

UHRN invites both drug user activists and harm reduction experts to join in building their TB knowledge and capacity as part of developing advocacy capacity within the region for change. A key advocacy demand remains the need to integrate TB into harm reduction and HIV treatment programs.