Progress with intensified TB Case Finding in Nigeria · Taraba Borno Adamawa Oyo Ogun Lagos Osun...
Transcript of Progress with intensified TB Case Finding in Nigeria · Taraba Borno Adamawa Oyo Ogun Lagos Osun...
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.