Nigeria

The National Tuberculosis and Leprosy Control Programme (NTBLCP) of Nigeria was established in 1989. Tuberculosis (TB) is a serious public health problem in Nigeria with an estimated prevalence of all forms of TB of 772,000 cases. WHO estimates that 460,000 new TB cases (all forms) and 195,000 smear positive cases occurred in 2007 and that incidence is still increasing as a result of the HIV epidemic (4.6% of the population infected, 2008 National HIV sentinel survey report). Nigeria is the highest TB disease burden country in Africa and 4th among 22 high TB burden countries in the world.

Nigeria adopted the WHO recommended DOTS strategy in 1994, which was just gradually implemented, also as a result of lack of domestic funding. By 2002, 21 of the 36 states and 350 of the 774 Local Government Areas (LGAs) in the country were implementing DOTS with support of the ILEP organizations (Damien Foundation, GLRA, NLR) and some bilateral donors (DFID, CIDA). While enhancing TA by WHO, USAID and CIDA jointly supported the expansion of DOTS services to 17 states in the north that had no services prior to 2002. From 2006 Nigeria also received a grant from The Global Fund (GF R5). As a result of this support, DOTS expansion further increased. By the end of 2008, DOTS services were available in all 36 states and the Federal Capital Territory (FCT) and all 774 LGAs had at least one facility providing DOTS services.

According to NTBLCP data on 2008, a total of 90,311 new TB cases were reported, of which 44,132 (48%) were pulmonary new smear-positive cases, a case detection rate of 131/100,000. The national case detection rate (CDR) increased from 16.1% of the WHO estimate at end of 2002 to 31% by the end of 2008. After 14 years of DOTS implementation, Nigeria has achieved a treatment success rate of 82% at national level. 7% Failure occurred among all re-treatment cases (320 among 4,605 in 2006), possibly an indicator of MDR-TB.

Role of KNCV Tuberculosis Foundation

KNCV through TBCTA’s PMU is the coordinating partner for the TB CAP Nigeria project. The main responsibilities of KNCV/TB CAP Nigeria include coordinating all TB CAP activities among the three partners - FHI, MSH and WHO, also vis-à-vis the NTBLCP, with the goal to keep all supported activities well coordinated.

Beyond coordination, KNCV is responsible for the planning and implementation of TB/HIV scaling up activities in collaboration with three ILEP partners - GLRA, TLMN and NLR, to increase coverage of TB treatment and TB/HIV services in the 73 LGAs across the country that did not have DOTS services or TB/HIV services before. KNCV provides technical assistance and support to these ILEP NGOs. Furthermore, KNCV provides support for the development of an HRD strategic plan and MIS system and TA for the National TB and Leprosy Training Centre at Zaria.

Achievements

After the difficulties experienced in the first year of the TB CAP Nigeria project were overcome, the level of implementation improved a lot. The Country Representative, Dr. Emmy van der Grinten and her KNCV/TB CAP office team, including the WHO team members, established a close working relationship with the TB program and the newly appointed NTBCLP Coordinator. As a result the activity implementation increased tremendously.

• Nigeria joined the list of countries globally fighting to STOP TB with its official launch of the Nigeria STOP TB Partnership in 2009
• When the Global Fund Round 5 Phase 2 was put on hold in January 2009, the NTBLCP requested TBCAP for technical assistance to rewrite the proposal. Two consultants joined an in-country team and their hard work resulted in the final approval of Round 5 Phase 2, with the Global Fund grant restarted on October 1st 2009
• To strengthen NTP leadership and management at the national level, the WHO training course “Management of TB/HIV Collaborative Activities” from Sondalo, Italy was conducted in Nigeria with the assistance of external facilitators from Italy. TB CAP supported the training of 28 core national facilitators with a view to cascade the trainings in-country. The step down mentored training on the NTP leadership and management training has not taken place yet. This was rolled over to COP 09 from COP08 plan
• The TB management training at district level, a TBCAP activity implemented by WHO in collaboration with the FmoH, was cascaded to other zones of the country through a step down training organized for 56 participants, using the pool of technically competent and knowledgeable management staff
• To improve prevention and management of MDR-TB, Nigeria started a Drug Resistance Survey under CDC guidance, with increasing logistic support through TBCAP. The NTP planned for the treatment of at least 80 MDR-TB patients identified in the course of the survey and sought the assistance of the GLC which approved the request. The drugs have been ordered and are expected to arrive in country before the end of the year
• To scale-up TB Infection Control (IC) measures, TB CAP is executing the TB/HIV collaborative activities together with the ILEP (International Federation of Anti Leprosy Organizations) organizations in Nigeria. The following activities at state level were supported: training clinic staff on TB/HIV, training lab staff on TB/HIV, quarterly meetings of TB/HIV working groups at State and LGA level. Also a one day workshop on TB-IC at facility level: 417 facility staff were trained (M=205 and F212)
• Regarding TB/HIV coordination and TB/HIV M&E activities, a major achievement was the integration of TB/HIV indicators and reporting formats in the existing national recording and reporting formats. A workshop was organized for 25 TB stakeholders to review TB/HIV recording and reporting guidelines for IC, IPT guidelines, SOPs for IC and joint checklist for TB/HIV supervision. TB CAP also supported development, printing and distribution of job aids for TB/HIV collaborative activities to the ILEP partners. 32 laboratory staff was trained on HIV rapid testing and supervision. TB CAP also assisted 32 health facilities in the 4 states to develop/implement TB-IC Plans
• TB activities implemented in HIV care settings: the Workers Manual of the NTBLCP states that IPT should be given to all eligible PLWHAs. In the work plan of TBCAP was provision for the purchase of Isoniazid for 1500 patients and the NTBLCP provided funding for an additional 1000 patients. In March 2009 TB CAP procured Isoniazid for a total of 2500 patients. After arrival of the drugs two stakeholders meetings (in April and July 2009) were organized under leadership of the NTBLCP, NASCP and TBCAP
• Supporting Human Resource Development, training of members of the Nigerian Medical and Dental Council was organized as a follow up of a review of the curriculum of medical schools. The training was attended by 25 participants from 19 universities. Further collaboration of NTBLCP with the national institutions on the integration of the reviewed documents will be pursued.

Technical assistance provided:

• Two KNCV staff (JvdB, SV) conducted a GLC assessment in April
• One staff (YK) participated and provided support in the “COP09 country work plan development, April 21-24, Abuja”
• Four KNCV staff (MvC, SM, YK, SV) participated in May in the mid-term review of the NTBLCP
• One staff (SM) field tested the TB Quote Light tool
• Two KNCV staff (IL, IH) provided technical support to the National TB and Leprosy Training Centre in Zaria, Nigeria in facilitation of a Leadership and Management Course for TB and HIV/AIDS Managers in September, 2009
• Backstopping of KNCV/TBCAP staff as defined in APA5 took place during a mission in November (RV)
• One KNCV staff (RvH) traveled to Nigeria to implement the Exact financial system at KNCV/TBCAP office
• In December KNCV staff (JvdB) facilitated a training in MDR-TB for 30 staff from various organizations engaged in guiding or implementing MDR-TB care and treatment.

Next steps

KNCV will continue to implement the approved TB CAP activities, including those for TB/HIV in collaboration with the ILEP partners. The main focus is to continue the scaling-up of interventions that have started in the past, to consolidate the capacity that has been developed and to guarantee a smooth closing of TBCAP and (if possible) continuation – in whatever form- in a follow-up project, while at the same time increasing the absorption capacity to spend the available funds in a timely manner.