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Key objectives included: 
(1) reviewing interim data from the paediatric TB algorithm roll-out in Uganda (Busoga and North central regions) and identifying successes and bottlenecks; 
(2) gathering input from facility-, district- and national-level stakeholders on implementation challenges and adaptation needs; 
(3) offering a platform for cross-site learning and peer-mentorship among participating health facilities; and 
(4) agreeing on corrective actions, timelines and responsibilities to enhance fidelity to the algorithm and strengthen systems for paediatric TB detection and treatment under the study.

Stakeholders

The meeting brought together a broad mix of stakeholders, reflecting the multi-layered structure of the project. These included representatives from the Makerere University Lung Institute – The implementing facility, implementing partners, facility in-charges and medical superintendents, and paediatric TB focal persons and clinicians from intervention sites, regional and district health-office TB coordinators, and a representative of the NTLP within the Ministry of Health – (Co-Investigator) Uganda. Mentors and supervisory staff engaged in the OPTIC-TB study also participated, alongside data-management leads. This breadth of participation ensured that both the operational (facility-level) and strategic perspectives were captured.

Challenges Identified

During the meeting, several recurrent themes emerged. While the algorithm tool had been distributed and training had begun, variation in its consistent use was noted across sites. Some facilities reported incomplete assessment of children (e.g., limited recording of HIV status, contact history or weight loss) and deficits in documentation of follow-up visits at two weeks and two months. Staff turnover, inadequate hand-over of roles, and insufficient orientation of new staff into the OPTIC-TB protocol also reduced implementation fidelity. Supply-chain issues were raised: anti-TB drug stock-outs in some high-risk children, as well as shortages of simple supplies (registers, sheet-protectors) which impacted data capture. Moreover, electronic data entry lagged in some locations due to absence of dedicated data-entry personnel. Finally, the feedback loop between facilities and district or partner implementers was weak, which constrained timely corrective action.

Solutions Proposed

To address these issues, meeting participants endorsed a series of remedial actions. These included scheduling regular refresher trainings (both in-person and virtual) for all staff rotating into OPTIC-TB sites; establishing a mentorship calendar linking more experienced sites to those needing extra support; strengthening documentation protocols and monthly audits of registers, patient files and the REDCap database; ensuring immediate restocking of child-appropriate TB formulations and essential equipment; and liaising closely with regional and district health offices to secure reliable laboratory support and diagnostic services. A further commitment was made to establish a more formalised feedback mechanism: monthly review meetings between facility, district and implementing partners, and elicit active monitoring of follow-up visit completion.

Results and Way Forward

The meeting culminated in a clear ‘action-plan’ with assigned responsibilities, timelines and deliverables. Participating sites verbalised renewed commitment to improve algorithm fidelity and data quality. Several ‘learning-pairs’ of facilities were agreed upon (linking high-performing and lower-performing sites) to foster peer support. The national TB programme confirmed its support to integrate lessons from OPTIC-TB into broader paediatric TB policy discussions. Although quantitative outcomes (e.g., increased detection or treatment initiation) were not yet available to present, the meeting successfully galvanised stakeholders around the next phase of implementation and signalled stronger alignment between research, service delivery and national policy. The effective co-ordination achieved at the meeting provides a strong foundation for the continued scaling and evaluation of the algorithm across intervention sites.