The document discusses the roles of medical laboratory scientists in controlling multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) in Nigeria. It notes that Nigeria has a high burden of TB cases and faces several gaps in controlling MDR-TB and XDR-TB. Medical laboratory scientists can help fill these gaps by improving diagnosis of drug-resistant TB, monitoring treatment efficacy, strengthening surveillance systems, scaling up molecular drug resistance testing, contributing to epidemiological research, and participating in clinical trials. Filling these roles is important for accelerating Nigeria's response to the growing problems of MDR-TB and XDR-TB.
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1. The Role of Medical Laboratory
Scientists in the Control of MDR-TB
and XDR-TB in Nigeria
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and XDR-TB in Nigeria
Dr. Iwalokun B.A
NIMR, Lagos
2. Presentation Outlay
• TB, MDR TB, XDR-TB Global Burden
– Nigeria’s Contribution to these burden
– Case definitions: MD-TB, XDR-TB and others
• Nigeria’s MDR-TB and XDR-TB Control situation
– Gaps to be filled and the role of Med Lab Scientists in Nigeria.
• Organisation, training, diagnostics, treatment follow-up,
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• Organisation, training, diagnostics, treatment follow-up,
surveillance, mapping and emergency response.
• Conclusion
• Aknowledgment
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In 2016, 10.4 m cases and 1.8 m deaths, including
400,000 deaths in HIV patients.
TB remains a formidable treat to global health. No
country of the world that is TB free.
5. Nigeria TB Score card in 2016
• Nigeria is ranked 3rd (behind India and
China) among the 22 high TB burden
countries of the world
• 1st in Africa-60% of total with 5 others
• Every year 245,000 Nigerians die of
TB
• 590,000 new cases (140,000 are also
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• 590,000 new cases (140,000 are also
HIV positive)
Every hour 30 people die of TB
• Only 90,584 cases are notified to
NTLCP
% bacteriologically confirmed = 68%
– % tested using RDT = 58%
– Treatment coverage = 16%
TB Situation in 2006-WHO
17. Nigeria Score card MDR/RR TB, 2016
• Incidence = 29,000 (15,000 – 43,000)
– 16 (8.2 – 24)/100,000
– Notified = 4,700
• % Notified tested for Rifampicin resistance
– 40% new cases; 60% Re-treatment cases
% of cases with MDR TB
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• % of cases with MDR TB
– 4.3% (2.2% in 2010) for new cases
– 25% (9.4% in 2010) for re-treatment cases
• HIV + TB = 100,000 (56,000-155,000)
– 5 (31-55)/100,000
18. Treatment Success Rate and Cohort Size: Nigeria
Treatment Sus/Cohort size Success Cohort
New and Relapse case reported in 2014 87% 86464
Previously treated cases excluding relapse of
2014
83% 4890
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2014
HIV pos TB cases registered in 2014 79% 17014
MDR/RR TB cases stated on second line
since 2013
77% 339
XDR-TB cases started on second line
treatment since 2013
0% 2
19. Targets & Financing
• 90% reduction in TB death
• 80% reduction in new cases by 2030
• 81 billion per year must be spent (13% domestic; 55% unfunded)
– Increase CDR
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– Increase CDR
– Strengthen PHC
– Scale up treatment (First line)
• Benefits
– 22 years extra life spent by a TB patients
– 2.8 million additional years of life
27. A medical laboratory scientist (MLS), clinical
laboratory scientist (CLS), medical laboratory
technician and medical laboratory
technologist (MLT), is a healthcare
professional who
performs chemical, hematological, immunologic,
histopathological,cytopathological, microscopic,
and bacteriological diagnostic analyses on body
Who is a Medical Laboratory Scientist?
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and bacteriological diagnostic analyses on body
fluids such
as blood, urine, sputum, stool,cerebrospinal
fluid (CSF), peritoneal fluid, pericardial fluid,
and synovial fluid, as well as other specimens.
Medical laboratory scientists work in clinical
laboratories at hospitals, reference
labs, biotechnology labs and non-clinical
industrial labs.
Certified, Can have a PhD, can become a lecturer, and a Professor
28. With multiple gaps in TB control in Nigeria, Med Lab scientists would
play key roles in filling these gaps.
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29. Improved diagnosis of
MDR TB Treatment Efficacy Monitoring
Community-based
Case Management of TB
Improved diagnosis of
MDR TB
Community education and Engagement
BCC + Milk pasteurisation promotion
The Roles
One head many caps.
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MDR TB Treatment Efficacy Monitoring
Sputum conversion +
DST/GeneXpert
Molecular Typing of TB
TB Surveillance
Clinical Trial
Operational Research TB Case Investigation
33. Help in building capacity for accurate diagnosis of Latent TB and
stratification of HIV positive patients for INH prophylaxis
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38. Contribute to the identification of novel DR associated mutations for
MDR-TB in the country-for a sustainable drug resistance testing
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39. Facilitate molecular epidemiology information about MDR-TB
for better prevention and control tools development
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41. Participate in clinical trials
(superiority of the 9-mo Bangladesh Regimen
vs. 24 mo standrrd second line regimen.
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Recommended by WHO in May 2016 plus MDR TB treatment for RR-TB
42. Evidence of effectiveness of the Bangladesh regimen in Asia
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43. Nine Francophon
Benin, Burkina F
Cameroun, Cote
Niger, CAR, DRC
Evidence of effectiveness of the Bangladesh regimen in Africa
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Niger, CAR, DRC
44. MDR-TB can be caused by M. bovis
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45. M bovis transmission pathway and BCC for prevention and control
Education is key
Promoting milk pasteurisation
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Promoting milk pasteurisation
46. Stop TB Partnership : 2016 – 2020
Targets
Targets reminder of the global strategy
End TB vs. Stop TB
END TB 2016 -2035
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WHO Ending TB is defined as an
incidence rate of 10 per 100,000
per year
Targets
Reduce TB deaths by 95%
Cut new cases between 2016 –
2035 by 90%
Ensure zero catastrophic cost
95:90:0
Targets
Reach 90% all TB people
Reach at least 90% of key populations
Achieve treatment success rate of 90%:
90:90:90 Treatment>adherence>support
END TB 2016 -2035
47. Conclusion
• MDT-TB is on the rise in Nigeria with no state exception.
• XDR-TB has emerged and may spread like MDR-TB.
• Nigeria should accelerate the implementation of the short
regimen (9 mo) treatment of MDR-TB to improve adherence and
tolerance as well as averting the rise in XDR-TB incidence.
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tolerance as well as averting the rise in XDR-TB incidence.
• Laboratory Medical Scientists from Public and Private health
system provide the needed opportunity to strengthen national
response to MDR-TB and XDR-TB in Nigeria.
• Stop TB Partnership Nigeria should provide the framework and
motivation for the present TB control gaps in the country to be
filled.
