Progress with intensified TB

Case Finding in Nigeria

Dr. E.B.A. Coker MD, MPH

Coordinator National HIV/AIDS

Programme

Presentation outline.

• Country information.

• HIV/AIDS profile.

• TB burden.

• Progress with intensifying TB case

findings

• Challenges.

• Conclusion.

Country Information

Kebbi

Akwa

Ibom

Sokoto

Katsina

Niger

Kaduna

Kwara

Kogi

FCT

Yobe

Kano

Jigawa

Bauchi

Plateau

Taraba

Borno

Adamawa

Oyo

Ogun

Lagos

Osun

Ondo

Edo

Delta

Benue

Cross

River

Rivers

Enugu

Anambra

ImoAbia

Nassarawa

Zamfara

Gombe

Ebonyi

Bayeisa

Ekiti

ADMINISTRATIVE MAP OF NIGERIAADMINISTRATIVE MAP OF NIGERIA • Situated in West Africa.

• Pop – 140M. (2006 census)

• Federation of 36 states and

FCT.

• 774 LGAs.

• 6 Geo Political zones

• 927,000 sq m - Area

• Presidential system of

government

• Health is on concurrent

legislative list (NCH)

NIGERIA: HIV/AIDS PROFILE

•Estimated Total PLWHAs 3m

•HIV Prevalence (2005) 4.4%

•PLWHAs Needing Treatment over 500,000

• Cumulative No of Deaths 1. 45 m.

• Number of PLWHAs on ARV by June 2008

234,030 (15,104 - children)

Nigerian HIV Prevalence Trend (1991-2005)

1.8

4.43.8

4.5

5.45.8

5.0

0

1

2

3

4

5

6

7

1991 1993 1996 1999 2001 2003 2005

Ranked State HIV Prevalence (2005)

1.61.81.8

2.02.72.8

3.03.23.23.33.43.4

3.63.63.73.73.83.94.04.0

4.24.2

4.54.6

4.94.9

5.35.45.55.6

6.16.1

6.36.5

6.78.0

10.0

-1.5 0.5 2.5 4.5 6.5 8.5 10.5

EKITIJIGAWA

OYOOSUN

KATSINAKWARA

ZAMFARASOKOTO

ONDOLAGOS

KANOBAUCHIBORNO

OGUNDELTA

YOBEBAYELSA

IMOABIA

KEBBIANAMBRAADAMAWA

EBONYIEDO

PLATEAUGOMBE

NIGERRIVERS

KOGIKADUNATARABA

CROSSFCT

ENUGUNASARAWAAKWA IBOM

BENUE

Prevalence (%)

Nigeria – TB burden

• Nigeria currently ranked 5th among the 22 high TB burden countries

• Estimated incidence for all cases is 311per 100,000 pop. (about 430,000 cases annually)

• Estimated incidence for SM+ cases is 137 per 100,000 pop

• Estimated prevalence of MDR-TB among new TB cases is 1.9%

• TB burden is further compounded by high HIV prevalence

• Prevalence of HIV among TB patients 27%

Progress with intensified TB Case

Finding in Nigeria

National target relating to

Intensifying TB case findings

2007 2008 2009 2010

Proportion of PLWHA

screened for TB

68.7% 80% 90% 100%

Strategies for strengthening Intensified TB case finding

• Co-location of DOTS and HIV services.

• Expansion of DOTS services to prisons and military barracks.

• Screening for symptoms and signs of TB among clients at HIV service delivery centers

• Early identification of signs and symptoms of TB.

• Diagnosis and prompt treatment of TB.

Question in the Screening tools (Routine screening

by HCWs of PLWHAs on a scale of 0-1)

Health providers at HCT centres on Client intake form ask for:

- Cough >3 weeks

- Fever >3 weeks

- Night sweats

- Unexplained weight loss >= 3 Kg in last 4 weeks

- Haemoptysis (coughing up blood or blood-tinged sputum)

- Enlarged lymph nodes (>2 cm)

- History of TB

- Contact with a person with TB disease

0

20000

40000

60000

80000

100000N

o o

f P

LW

HA

s

No of PLWHAs

screened for TB

No with Active

TB

No of PLWHAs

screened for TB

86897 57695

No with Active TB 15418 14378

2007 1st & 2nd Qt 2008

Screening for TB among PLWHAs

Linking Intensifying case finding to

IPT

• National Policy for IPT for PLWHAs available.

• IPT only for PLWHAs without active TB with no contraindication to INH.

• Supply of INH for IPT among PLWHAs inadequate.

• Linkage of PLWHAs (without active TB and contraindication to INH) to IPT still inadequate.

Linking Intensifying case finding to

IPT in 2007

2007

86897

15418

76

No of PLWHAs

screened for TB

No with Active TB

No on IPT

2007

Linking Intensifying case finding to

IPT (1st and 2nd quarter 2008)

1st & 2nd Qt 2008

57695

14378

1189

No of PLWHAs

screened for TB

No with Active TB

No on IPT

1st & 2nd Qt 2008

Progress – “other component of the 3 Is ”

• National TB infection control Guidelines

adapted.

• SOP for TB infection control adapted.

• Plan on to support trainings of State

Programme managers and GHWs on TB-

IC

Progress – “access to HCT among TB

patients”

Proportion of TB patients tested for HIV

0

10

20

30

40

50

60

70

80

2006 2007 2008(Q 1-3)

Year

Pro

po

rtio

n

Target

achieved

Challenges

• Weak systems for data collection,

transmission and feed back.

• Atypical presentation of TB in advancing HIV

disease making diagnosis of TB difficult.

• Inadequate linkage of Intensifying TB case

findings to IPT.

Conclusion

• Nigeria’s TB burden is compounded by high HIV

prevalence • National strategic framework for strengthening

Intensified TB case finding.

• National Policy for IPT for PLWHAs (without active TB with no contraindication to INH) available.

• Linking PLWHAs to IPT still inadequate (?supply of INH)

• Progress is being made with implementation of TB-IC (as a component of 3 Is)

• Access to HCT services by TB patients

Appreciation

• ILEP(GLRA, DFB, NLR, TLMN)

• USG (USAID, CDC, IHVN, MSH, AIDS relief,

ICAP-Columbia, APIN)

• CIDA

• GFATM

• WHO.

• NEPHWAN.