Tuberculosis: WHO, Nigeria’s efforts in scaling-up PMDT

Tuberculosis (TB) control and prevention efforts in Nigeria has progressed relatively well over almost two decades since the introduction of the Directly Observed Treatment Short Course (DOTS) Strategy.
However, it still constitutes a public health challenge.
AJUMA EDWINA OGIRI, with agencies, writes on WHO and Nigeria’s support for the rapid scaling-up of Programmatic Management of Drug-Resistant Tubercloisis (PMDT) in Nigeria.

World Health Organisation (WHO) report indicates that every hour, 47 Nigerians develop active Tuberculosis (TB).
It also states that seven of these cases are children, and is therefore ranked 15th among the 27 High Burden Countries for Multidrug Resistant TB (MDR-TB).
The emergence of drug resistant TB and relatively high burden of HIV/AIDS have impacted negatively on TB control and prevention efforts.
A 2011 WHO report also states that Nigeria has an estimated MDR-TB rate of 2.2 per cent and 9.4 per cent among new and re-treatment TB cases, respectively.
In response to the threat of MDRTB to effective control and prevention of TB, the Federal Ministry of Health in collaboration with WHO and other partners have put in place structures for the initiation and expansion of the programmatic management of drugresistant TB (PMDT) in the country.
The enrolment of MDR-TB for treatment with second-line anti-TB drugs started in July 2010, at the only functional MDR-TB treatment centre at University College Hospital, Ibadan.
The model of care involves an initial hospitalization until sputum culture conversion, followed by ambulatory phase of treatment in the nearest DOTS facility.
The National TB and Leprosy Control Programme (NTBLCP) is now set to expand the implementation of PMDT.
Milestones in implementation, funding and policy As a major technical partner of the NTBLCP, WHO has continued to play key roles in many critical aspects of PMDT implementation in Nigeria.
The Global Funds to Fight AIDS, Tuberculosis and Malaria (GFATM) grant, was signed to support the National Scale plan for the programmatic management of drug-resistant TB (PMDT).
The grant was signed in July 2011 between the Global Fund and the Institute of Human Virology of Nigeria (IHVN) as the Principal Recipient (PR); development and finalization of the National Guidelines for the Clinical and Control of Drug Resistant TB in Nigeria.
The NTBLCP leveraged funds from WHO to develop and finalise DR-TB training guidelines to ensure the TB Patients receiving treatment Tuberculosis: WHO, Nigeria’s efforts in scaling-up PMDT standardization of training for all facilities and field health workers providing DR-TB management services.
Infrastructural Development With support from KNCV/TBCARE 1, the Xpert MTB/RIF technology has been deployed in 9 facilities namely, National Reference Laboratories in Lagos and Zaria, Chest Hospital JerichoIbadan, Infectious Disease Hospital (IDH) Kano, Specialist Hospital Gombe, Mile 4 Mission Hospital, Abakilike, Central Hospital Benin-City and Zankli Medical Centre Abuja.
This is already improving access to rapid and early diagnosis.
WHO participated actively in the planning meetings for the selection and assessment of the facilities for the deployment of the Xpert machines.
Five additional DR-TB Treatment Centres are now ready and began the enrolment of confirmed MDR-TB patients for treatment on Second Line Anti-TB Drugs (SLDs) in the first week of March 2012.
These facilities are located at Dr Lawrence Henshaw Memorial Infectious Disease Hospital, Calabar; Lagos Mainland Hospital; Jericho Chest Hospital, Ibadan; National TB and Leprosy Training Centre and Infectious Disease Hospital, Kano.
Human resource development WHO provided technical support for the training on DR-TB management for 27 medical and health workers from three of the newly established DR-TB treatment Centres at Calabar, Ibadan, and Lagos.
Plans to train the medical and health workers from the other centres at Kano and Zaria have been concluded.
Plans are also in place to train the programme staff at all levels on PMDT.
These training activities will facilitate the effective and systematic decentralization of PMDT in the country.
Programme monitoring and routine surveillance Working in collaboration with the NTBLCP and other partners, WHO supported the adaptation of the recording and reporting formats for DRTB, which have been printed and available for use in the field.
Technical support is also provided in the development and establishment of routine surveillance system for DR-TB.
As part of the scale up plan, a system of routine culture for all identified re-treatment cases is now place.
From both the conceptual and operational points of view, routine culture/ DST will be expanded to other risk groups over the next few years as more resources become available.
NTBLCP in collaboration with MSH, leading other partners, including WHO, have customized the E-TB manager for documentation and monitoring purposes.
Operational Research Through funding support from WHO Geneva, the NTBLCP in collaboration with other partners conducted an operational research on operationalizing Community-based DR-TB care in the country.
The findings are insightful and provide operational contexts to guide the development of models for communitybased DR-TB control and prevention in the country.
Launch of paediatric anti-TB formulation Commemorating the 2018 World Tuberculosis Day, Nigeria launched the new paediatric anti-TB formulations for treatment of ‘drug susceptible’ TB in children.
The minister of health, Prof.
Isaac Adewole, said the new drug is both dispersible and flavoured and meets the WHO “optimal dosing recommendations for all children”.
In his speech, Prof.
Adewole said the major drawback of TB programme in Nigeria is low TB case finding for both adult and children “as there are lot of missing TB cases that were either not diagnosed or reported”.
He said in 2017, only 104,904 TB cases were detected out of an estimated 407,000 of all forms of TB cases expected to be detected in 2017.
According to him, this signifies treatment coverage of 25.8 percent, leaving a gap of 302,096 comprising undetected or detected but not notified cases especially “in non-DOTS sites”.
“In the same year, the proportion of Childhood TB was 7 per cent of all forms of TB cases compared to 10 per cent recommended by the World Health Organization.
In addition, a total of 1783 DR-TB cases were notified out of the estimated 5200 DR-TB cases,” he explained.
The minister said in order to accelerate TB case finding, the country has moved from passive to active case-finding in key affected populations.

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