The Institute of Human Virology, Nigeria (IHVN), U.S. Agency for International Development, (USAID) and the Tuberculosis Local Organization Network, (TB LON 3), say Nigeria is expected to identify 432,000 tuberculosis cases annually.
The IHVN, Director, Technical Programs, TB LON 3 project, Dr. Olugbenga Daniel, disclosed this in an interview in Abuja on Wednesday.
The USAID TB LON 3 project is sited in regions 1, 2 and 3.
Region 1 covers North Central and North East, while Region 2 covers South East and South South, and Region 3 covers the South-Western states of Lagos, Oyo, Ogun and Osun states.
The project’s focuses on finding the missing tuberculosis cases, the annual cases that are expected to be found and the specific strategy that was adopted for the facility and community interventions across the zones.
Daniel said that historically, up until 2020, the country’s case finding had been staggering around 24 to 25 per cent, “which is about 100,000 or 105,000 cases.
“In 2019, we increased to about 116,000/120,000 cases, and thereafter we had an increase in 2020 to about 130,000 cases. All these are out of the expected 432,000,” he said.
He added that all the findings were due to the concerted effort of both the public facility intervention, the private facility intervention as well as communities across the zones.
“So, this boils down to the fact that we still have over 300,000 TB cases annually that are yet to be diagnosed and another insight to that is that one positive index TB patient infects 15 people annually.
“If you do the geometric progression of that, knowing the number of people that will be infected annually by undiagnosed TB cases, truly if you look at it critically it is an emergency.
“For the facility intervention, basically what we have done is to ensure 100 percent of the patients that visit the facility are screened for TB and when we say screened for TB we are talking about the clinical screening, asking questions and identifying those that are presumed to have TB,” he explained.
Daniel noted that these people were subsequently sent for further investigation and the cases identified were placed on treatment.
“For the facility, we have the private and public facility interventions.
The public facilities are majorly the general hospitals, teaching hospitals. For the private facilities, we have private-for-profit facilities, individually-owned facilities that are supported for TB and we also engage some faith-based facilities.
“But, be that as it may, these are formal health providers. We have the informal sector, the traditional birth attendants, traditional medicine healers and the community pharmacies,” he explained.
He stressed that 50 percent of hospital attendees were found to visit these facilities first, before visiting the formal health care facilities.
“In that regard, we equally engage some traditional medicine healers, to support them, to ensure that 100 percent of the people that visit their facilities are screened for TB.
”These people are there, as well as the community pharmacies where patients just visit just to get drugs for back pain or maybe cough that started just yesterday, not knowing that it is actually more grievous than what they are expecting,” he added.
Facility intervention had really helped in improving the case findings across the four supported states, he said, adding that based on community strategies, the 300,000 people who are out there annually, that were yet to be identified, were found to be in the community.
Community transmission was ongoing every day, Daniel said, while stressing that if TB services were not taken to them, a number of them might not actually visit the facilities.
“So, what are we doing about that? We have hotspot and when I say hotspot, I mean we have a platform that we use that uses different parameters, age distribution, sex distribution, the HIV prevalence, the financial status and other various strategies, to identify areas with high prevalence of TB.
“This is now used to determine the area that our active case search, house-to-house search intervention, as well as Advocacy Communication and Social Mobilization (ACSM) meetings will be targeting.
“It is a targeted intervention as against just visiting the community blindly and doing the general screening which, over time, has been found to be very ineffective. We’ve also been able to drive more patients to the facility and link them for treatment,” he said.
Daniel added that TB was known to be a disease that was diagnosed in the laboratory, noting that only presumptive cases were identified on the field, at the facility, or the clinic, but the most definitive diagnostics was done at the laboratory.
“Therefore, all of the interventions that you’re putting in place, if there is no top notch diagnostic capacity installed across the service points, at the end of the day, the program will not be as effective as expected.
“So, one of the strategies that we also put in place as a program for the TB LON 3 project is to ensure that we expand the diagnostic capacity of the supported facilities across the targeted states, which has really helped to equally improve the case finding in the supported states,” he said.
The director stressed that to bring facts and figures out, all the states that the IHVN was currently supporting have recorded an increase in case findings since the project began in April 2020, and despite the impact of COVID-19.
“For quarter 2, we had some case finding drop compared with quarter 1 but in quarter 4, this picked up.
“To round up the first response for the TB LON 3 projects, we have been able to expand the coverage of facilities that are providing TB services across the four states, by instituting the Out Patient Department screening strategy for both the public facility and then the private facilities, and then the high burden LGAs,” he said.
Daniel noted that the IHVN had also improved on the community strategies of the ACSM, hotspots mapping and contact investigation as well as house-to-house search and Outpatient Department (OPD), diagnostic capacity for testing or finding TB cases.
