The document summarizes findings from a review of Nigeria's 2023 TB Programme. It covers several thematic areas: TB/HIV services, infection prevention and control (IPC), key populations like those in correctional centers, and patient interviews. Some achievements noted include high rates of TB screening, linkage to treatment, and TPT coverage for PLHIV. Challenges include diagnostic delays and lack of IEC materials. Recommendations focus on improving diagnostics, implementing IPC protocols, engaging key populations, and strengthening community education and support for TB patients.

1. 2023 Nigeria TB Programme Review
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2. Findings by thematic areas
◦ TB/HIV
 Observations:
 Integrated TB/HIV services are provided across facilities in the state, with coordination by the leadership of TB and ART units.
 HIV testing is offered to all presumptive and confirmed TB cases, and coinfected patients receive TB treatment with cotrimoxazole, then
ART is commenced two weeks after initiation of TB treatment.
 Average time to TB diagnosis is 2-4 days. GeneXpert is the main diagnostic modality, accounting for over 90% of all TB tests among PLHIV,
while TB LF-LAM is used for diagnosis among newly diagnosed patients with Advanced HIV disease.
 The ART electronic medical records adequately captures patient-level TB/HIV services, from TB screening to evaluation, diagnosis and
treatment, as well as TPT initiation and completion.
 Achievements:
 Routine TB screened for patients attending ART clinics was 100%
 Linkage to TB treatment averaged over 90%
 TPT coverage and completion among PLHIV were above 90% for all facilities visited

3. Findings by thematic areas
◦ TB/HIV
 Challenges:
 Extended time to TB diagnosis due to recurrent Xpert module failures, stock out of LF-LAM kits, and limited number of X-ray equipment.
 Non-implementation of universal clinical diagnostic evaluation of all newly enrolled PLHIV and presumptive PLHIV on follow up visit using
chest x-ray
 Best practice(s):
 Patient-level documentation of TB services on the Electronic Medical Records enables adequate monitoring of TB services, and adherence
support for TPT completion.
 Support by a dedicated TB surge staff and ad-hoc ART staff for routine screening for TB at every clinic day at the ART Site contributes to
the 100% screening at the ART clinics.
 Recommendations: Address facility specific root cause of module failures, and engage with NTP for access to Chest X-ray

4. Findings by thematic areas
◦ IPC
Observations:
Facility IPC committees hold regular meetings to strengthen capacity and review performance,
though there is no dedicated IPC budget, there are designated TBIC focal persons.
Written IC plans were not available
Staff have been trained on, and implement IPC measures.
TB staff are not screened annually for TB as recommended.
Environmental controls are implemented in the OPDs and waiting areas
PPEs are available, and disposable masks provided to coughing patients at the waiting areas.

5. Findings by thematic areas
◦ IPC
Challenges:
Lack of IECs, SOPs and job aids on TBIC
Best practice(s):
Cough champions at OPD implement the FAST strategy effec
Recommendations:
State program should provide TBIC IECs and job aids at DOTS and OPD clinics.
Recommended annual TB screening for DOTS staff should be implemented

6. Findings by thematic areas
◦ Key populations (Persons in Correctional Centres)
Observations:
Active TB case finding in correctional facilities has high case finding potential.
Collaboration with KNCV for TB screening and diagnosis using innovative solutions like Portrable Digital X-
ray, TrueNat and XMAP have been effective in optimizing TB case finding.
Achievements:
20% TB diagnostic yield among presumptives in 2022, and 100% linkage to TB treatment.
Cure rate was 97% in 2021.
Results from KNCV outreach to the prison on January 27th 2023, during the MTR visit:
77 screened, 14% presumptive yield, 3 bacteriologically confirmed.

7. Findings by thematic areas
◦ Key populations (Persons in Correctional Centres)
Challenges:
Active TB case finding is limited by the absence of dedicated TB diagnostic equipment at the facility
Inadequate ancillary support – food, toiletries – for patients receiving treatment at the facility
Best practice(s):
All new inmates are routinely offered HIV testing and TB symptom screening
Outreaches are coordinated with LGTBLS to ensure proper follow up of presumptive and confirmed cases

8. Findings by thematic areas
◦ Key populations (Persons in Correctional Centres)
Areas for possible operational research: Change in TB diagnostic yield among persons in correctional centres with
the use of modern diagnostic technologies
Recommendations :
Engage with NTP to deploy PDX to the facility
Mobile TB LAMP should be coupled with the PDX to further shorten time to diagnosis for presumptives identified
via X-ray
Engage with partners to attach solar power source to TrueNat, to extend hours of functionality when deployed
Engage with state TB program on provision of IECs, and with CSOs for provision of toiletries and food for inmates
attending the clinic

9. Findings by thematic areas
◦ Patient interviews
Observations
Patients are adequately educated on TB prevention and control measures, but are not sure about the
cause of TB. Their knowledge that TB can be cured possibly provides a goal that they aim for, which
may strengthen their adherence to treatment. Patients still experience delays between presentation
and diagnosis, but counseling by healthcare staff may be instrumental in allaying their initial fears
following diagnosis, and enable them keep their clinic appointments despite the significant transport
costs. All patients interviewed would like to have more information about TB and health provided to
them either via IECs in English or a local language, or via technology: texts or radio. The provision of
free TB services appears to cushion the effects of loss of livelihood that very often occurs when they
are ill with TB.

10. Findings by thematic areas
◦ Patient interviews
Recommendations:
SBCC activities should be implemented actively in the community to improve knowledge about
causes of TB and preventive measures.
Use of virtual communication platforms should be explored, to reduce the time to TB diagnosis and
treatment
Family members who have been disclosed to, can be educated on provision of adequate home-based
treatment support for patients receiving TB treatment.
Patients on TB treatment should be linked with CSOs/CBOs that provide economic
strengthening/livelihood support, especially when there is loss of livelihood.