Tuberculosis and Leprosy Control in Nigeria; Interventions and results

1. ADAMAWA STATE TUBERCULOSIS
AND LEPROSY CONTROL
A presentation @ the 1st Quarter Zonal TBL
Review Meeting:
2014
By: Stephen John, MD, MPH/ICHD
Programme Manager

2. Outline…
• Background
• Activities planned & outcome
• TB data presentation & analysis
• EQA
• STOP TB thematic areas
• Leprosy data presentation & analysis
• TB REACH
• Challenges/Recommendations
• Plans for 2nd Qtr, 2014

3. BACKGROUND INFORMATION
• Land Mass 42,000 sq km
• No of LGAs 21
• State population 3.8 million
• Total No of HF >1297
• DOTS Expansion:
• Total # of DOTS Centers 142 (1/27,000 pop:
G=12)
• 118 notified TB cases in Qtr, 1
• 20 HFs detected between >10 TB patients
• Microscopy Center Coverage:
• Total # of Microscopy Centers 44 (1/87,000
pop: G=4)
• Total No of MDT clinics 98

4. Activities Implemented

5. Key activities planned & implemented
Planned Funding Source Outcome Remarks
Supervisions:
State
Team, LGTBLS &
QA Supervisions
NLR, GFATM,
TB CARE
WHO
State Team: 19 LGAs
reported
LGTBLS: 231
QAO: 38 laboratories
supervised
Improved
reporting/feedback
system
Meetings: TB/HIV
TWG, Qtrly Prog.
Review & QA Lab
Meeting
GFATM
IPs
Implemented (except
TB/HIV TWG)
FHI 360 sponsors TB/HIV
TWG
TB REACH: ACF,
ACSM, GX,
Supervision, OR
WHO Yr 1 & 2 successfully
ended, No-cost extension
approved
Improved TB case
notification
Radio Jingles on
TBL
TB REACH On-going
ACF in 2 Districts
of Girei LGA
Janna Health
Foundation
/ATBLCP
Over 600 screened for TB.
HIV & Leprosy: 12 TB
cases detected

6. Adamawa TB Case Notification:
2005 - 2012
2752
2849
2623
2998
2866
2900
2644
3329 3460
1198 1293 1296
1184
984
1314
1122
1812
1667
197 209 178
129 121 92
156 193 291
0
500
1000
1500
2000
2500
3000
3500
4000
2005 2006 2007 2008 2009 2010 2011 2012 2013
All TB SM +ve EPTB
TB Reach

7. TB case notification: Comparing Q4 of ‘12 and ‘13
0
200
400
600
800
1000
Qtr 4 '12 Qtr 4, '13
787
781
441
367
48 65
All Cases Sm +ve EPTB

8. EQA Activities

9. EQA
• 36 Microscopy centers participated
• 29 had >95% concordance
• Rechecking/Panel testing
• Labs with errors identified
• Slide positivity rate among suspects: 11%

10. Trends of Cure Rate: 2006 – 2012
77
83
82 83
77 82 82
73
77 77 78
91
78 75
0
20
40
60
80
100
2006 2007 2008 2009 2010 2011 2012
Cura Rate (CAT I) Cure Rate (CAT 2)

11. STOP-TB Thematic Areas

12. CTBC
• 20 LGAs involved
• Main role is TB suspect identification & referral
• CV activities supported by:
– HAF
– TB Reach
– ADSG
– FHI360

13. CTBC Data: 2010 - 2013
479
515
1560
2225
134
176
257
410
0
500
1000
1500
2000
2500
2010 2011 2012 2013
TB Suspects Refered TB Cases Notified

14. TB/HIV
• Key Partners:
– FHI360, Optimum Initiative, Janna Health Foundation
– WHO/FMOH/NLR, TB CARE 1.
• DOTS/HCT sites:
• 115 of 142 (81%) DOTS centers

15. TB/HIV Data: 2009 - 2013
0
500
1000
1500
2000
2500
3000
3500
2010 2011 2012 2013
2417 2518
3100 3164
1881
1942
2239
2419
487 475
423 426
367 389 384 394
116
176
207 245
Counseled Tested Positive On CPT On ARV

16. TB/HIV Data: Comparing Q4, ‘12 & ‘13
0
100
200
300
400
500
600
700
800
900
1000
Qtr 4, '12 Qtr 4, '13
691
747
501
586
77 90
75
88
39
64
Counseled Tested Positive CPT ART

17. Thematic Areas: Contd..
• PPP:
– 18 facilities: 12 had patients on treatment (9 in 3rd Qtr)
– 58 TB cases notified in the Qtr (37 in 3rdQtr)
• TB in Congregate Settings:
– 2 prisons & 1 barracks
– 3 TB case notified (2 in the Barrack Med Centre)
• ACSM:
– Advocacy on-going
– Training on TB & ACF expected in 7 high endemic LGAs
• DR-TB:
– Suspects have access to preliminary screening (Gx)

18. Leprosy

19. Leprosy Control Interventions…
– Rapid Village Surveys (RVS)
– Intensified Contact Examination (ICE)
– Community Volunteers

20. Trends of Leprosy New Case Detection:
2006 - 2013
257 242 237
196
234
171
234
200
0
50
100
150
200
250
300
2006 2007 2008 2009 2010 2011 2012 2013
Leprosy NCD

21. Trends of MB & Child %:
2008 – 2013
5 5
7
4
0
4
92 91
94
92
98
96
0
20
40
60
80
100
2008 2009 2010 2011 2012 2013
Child % MB%

22. Buruli Ulcer
• Nil Cases in the Quarter

23. Update on TB REACH:
Nomads/Koma Communities (Wave 2 Year 2)

24. Background
• Target Population: 0.5m
• Evaluation Population: 3.7m
• Control Population: 2.6m
• Objective:
– To expand TB services in an innovative and highly
collaborative manner through the involvement of the
Nomadic and Koma leadership to ensure that the
communities have ownership over the
design, implementation and sustainability of the
project
– To determine whether or not the incidence rates of TB
among the target population is higher as compared to
the evaluation population

25. Key Interventions
• Mainly 3:
–ACSM:
• Committee exists; meets, plans and implement activities
quarterly (mainly advocacy & resource mobilization to
sustain the project)
• Radio jingles & TV programmes
–Active Case Search (Rapid surveys & Intensified Contact Examination)
• Community Health Education/Seminars on TB
• Screening of community members for TB
• Transport of TB suspect sputum where necessary
–Use of GeneXpert equipment:
• Transportation of an early morning sputum specimen from
SS- TB suspects for GeneXpert analysis

26. TB Suspect Management: 2013
0
5000
10000
15000
20000
Verbal
Screening
Suspects
Identified
Suspects AFB SS+ Cases
Notified
45100
6790
5287
549
893

27. TB Cases Notified (TB Reach) : 2013
0
200
400
600
800
1000
2013
893
486
45
All SS+ EPTB

28. Data from GeneXpert: 2012 (n = 1031)
115
19
817
6
74
MTB+/Rif- MTB+/Rif+ MTB-/Rif- MTB+/Rifdt Inv/Err
11%7%0.6%
2%
79%

29. TB Reach & the Programme
• Government:
– Improved contribution
• Increased Stakeholder participation/support
• Dissemination:
– National Council on Health
– Union Conferences
– TB Reach meetings
• Other States & TB Control among Nomads
• Sustainability…..

30. Key Challenges
• DOTS:
– Strengthening
– Expanding PPM
• EQA:
– Limited microscopes
• CTBC:
– Attrition
– Incentives
• TB/HIV:
– Test Kits

31. Recommendations
• State Team to ensure strategic expansion
– Mainly private facilities (on-going)
• NTBLCP to provide microscopes (State Gov’t too)
• CV motivation:
– Standardize incentives?
• Continuous advocacy for HIV Test Kits

32. Plans for 2nd Qtr, 2014
• NLR activities:
– Training (low endemic)
– Supervision
• GFATM Activities:
– Meetings
– Supervision
• TB Reach (No-cost extension approved):
– ACF
– Supervision