AI-enabled diagnostics and digital innovation in Uganda’s tuberculosis response: Achieving 45% mortality reduction in three years

Abstract

Introduction Tuberculosis (TB) remains a major public health challenge in Uganda, contributing to high morbidity, mortality, and economic hardship. In 2023, 87,876 TB cases were notified (92% of the estimated incidence), with mortality at 5 per 100,000, and 53% of patients facing catastrophic costs. Despite a 2.7% annual decline in incidence under the 2020/21–2024/25 National TB & Leprosy Strategic Plan, mortality remained high due to delayed diagnosis, advanced HIV disease, and poor adherence. Methods To address these gaps, Uganda implemented a digitally enabled package of interventions. The CAST+ campaign and mobile clinics equipped with GeneXpert and AI technology expanded early detection. Pediatric diagnosis improved through stool-based (SOS) testing, while screening for advanced HIV disease was strengthened via urine TB-LAM. Treatment adherence was enhanced through the use of Digital Adherence Technologies and continuous quality improvement initiatives. Integrated mortality reviews piloted in 24 facilities were scaled nationally to identify root causes and guide interventions, including early referrals from private facilities, vital assessments, intern mentorship, and access to oxygen for hypoxic patients. Digital tools such as checklists and dashboards supported clinical decision-making and accountability. Findings were disseminated across national, regional, and facility levels, resulting in their adoption as standard practice. Results Between 2020/21 and 2023/24, Uganda achieved a 45% reduction in TB mortality, with deaths declining from 18,000 to 9,900. Treatment coverage rose from 73% to 93%, and treatment success improved from 78% to 91%. Facilities implementing AI-supported diagnostics and digital audits reported earlier referrals, improved assessments, and better clinical outcomes. These results are detailed in Tables 1 and 2, highlighting performance indicators and the reach of digital interventions. Conclusion Uganda’s experience demonstrates that AI-enabled diagnostics and digital adherence innovations can drive rapid reductions in TB mortality. Sustained investment in technology, data systems, and integrated care is essential to accelerate progress toward TB elimination by 2030.

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