Development of Pulmonary Rehabilitation for Post-TB Lung Disease in Uganda

Background: Post-tuberculosis lung disease (PTLD) is a growing public health concern in low-and-middle-income settings (LMIC) where the burden of tuberculosis is greatest. However, effective, accessible interventions remain limited.

Aim: This PhD research aimed to develop, implement, and evaluate a culturally appropriate, low-cost pulmonary rehabilitation (PR) programme for individuals with PTLD in Uganda.

Approach: Using a mixed-methods approach, quantitative data as well as qualitative interviews were collected from PTLD patients and healthcare workers, followed by a randomised controlled trial (RCT) to assess the clinical efficacy and cost-effectiveness of a 6-week PR programme for adults with PTLD.

Results: The thesis findings highlight that it is feasible to conduct PR in Uganda and it was clinically meaningful for patients with PTLD. The PR programme was culturally adaptable, and co-designable with local experts and patient communities. There was strong patient enthusiasm for PR. The identified key barriers to PR programme access, included limited referral pathways and lack of healthcare worker training and the need to educate patients. In-country “master teachers” were trained to cascade PR training as a crucial step for scale up. The RCT demonstrated significant improvements in exercise capacity, health related quality of life for participants in PR vs Usual care, and the PR Programme was cost-effective.

Recommendations: These findings support the integration of PR into standard of care of PTLD care. The thesis findings emphasize the importance of local adaptation, co-design with stakeholders and the need for broader implementation research to support scale-up of PR.