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 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 HIV Prevalence (2005) 4.4% Estimated Total PLWHAs 3m PLWHAs Needing Treatment over 500,000 Number of PLWHAs on ARV by June 2008 234,030 (15,104 - children) Cumulative No of Deaths 1. 45 m.

Nigerian HIV Prevalence Trend (1991-2005) This is the first time ever that Nigeria is noticing a fall in the HIV prevalence. This should be taken positively but with a note of caution. First the fall in HIV prevalence is not significant. An analysis of the trend line shows no pattern of falling; in fact the trendline shows a steady rise. Secondly UNAIDS recommends that countries should only consider a steady reduction to occur after 2 (two) consecutive falls in HIV prevalence, and third it is preferable to look at the individual communities where the results from and monitor the trend in these communities over time. This we will now do.

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

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

Linking Intensifying case finding to IPT (1st and 2nd quarter 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”

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.

TB HIV collaboration will lead us to beneficial health outcomes Thank you! for listening TB HIV collaboration will lead us to beneficial health outcomes