Progress with intensified TB Case Finding in Nigeria. Dr. E.B.A. Coker MD, MPH Coordinator National HIV/AIDS Programme

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1 Progress with intensified TB Case Finding in Nigeria Dr. E.B.A. Coker MD, MPH Coordinator National HIV/AIDS Programme

2 Presentation outline. Country information. HIV/AIDS profile. TB burden. Progress with intensifying TB case findings Challenges. Conclusion.

3 Country Information ADMINISTRATIVE MAP OF NIGERIA Situated in West Africa. Sokoto Pop 140M. (2006 census) Kebbi Zamfara Katsina Kano Jigawa Yobe Borno Federation of 36 states and FCT. Kaduna Bauchi Gombe 774 LGAs. Oyo Ogun Lagos Osun Kwara Ekiti Ondo Niger Edo Delta Bayeisa Kogi FCT Enugu Ebonyi Anambra Imo Rivers Abia Nassarawa Akwa Ibom Benue Cross River Plateau Taraba Adamawa 6 Geo Political zones 927,000 sq m - Area Presidential system of government Health is on concurrent legislative list (NCH)

4 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 ,030 (15,104 - children) Cumulative No of Deaths m.

5 Nigerian HIV Prevalence Trend ( )

6 BENUE AKWA IBOM NASARAWA ENUGU FCT CROSS TARABA KADUNA KOGI RIVERS NIGER GOMBE PLATEAU EDO EBONYI ADAMAWA ANAMBRA KEBBI ABIA IMO BAYELSA YOBE DELTA OGUN BORNO BAUCHI KANO LAGOS ONDO SOKOTO ZAMFARA KWARA KATSINA OSUN OYO JIGAWA EKITI Ranked State HIV Prevalence (2005) Prevalence (%)

7 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%

8 Progress with intensified TB Case Finding in Nigeria

9 National target relating to Intensifying TB case findings Proportion of PLWHA screened for TB 68.7% 80% 90% 100%

10 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.

11 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

12 No of PLWHAs Screening for TB among PLWHAs No of PLWHAs screened for TB No with Active TB st & 2nd Qt 2008 No of PLWHAs screened for TB No with Active TB

13 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.

14 Linking Intensifying case finding to IPT in No on IPT 76 No with Active TB No of PLWHAs screened for TB 86897

15 Linking Intensifying case finding to IPT (1 st and 2 nd quarter 2008) 1st & 2nd Qt 2008 No on IPT 1189 No with Active TB st & 2nd Qt 2008 No of PLWHAs screened for TB 57695

16 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

17 Proportion Progress access to HCT among TB patients Proportion of TB patients tested for HIV (Q 1-3) Year Target achieved

18 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.

19 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

20 Appreciation ILEP(GLRA, DFB, NLR, TLMN) USG (USAID, CDC, IHVN, MSH, AIDS relief, ICAP-Columbia, APIN) CIDA GFATM WHO. NEPHWAN.

NIGERIA ROUTINE IMMUNIZATION IN NIGERIA. 31% of children who received the 1st dose of pentavalent vaccine did not get all 3 doses

NIGERIA ROUTINE IMMUNIZATION IN NIGERIA. 31% of children who received the 1st dose of pentavalent vaccine did not get all 3 doses MICS/NICS 206/7 NIGERIA 206 207 PROGRESS TOWARD GVAP GOALS Penta3 coverage 00% goal 90% goal States with 80% penta3 coverage NATIONAL IMMUNIZATION COVERAGE SURVEY (NICS): National Brief ROUTINE IMMUNIZATION