Programmatic Management of Drug Resistant Tuberculosis

Case Finding

The adoption of the Gene Xpert as a point of entry in the diagnosis of drug resistant Tuberculosis in Nigeria has propelled the increase in the detection of RIF resistance TB cases. The NTBLCP algorithm has been expanded to include other priority group aside DR-TB presumptive TB cases and PLHIVs. This has resulted in a commensurate increased in the number of presumptive TB cases screened and TB cases diagnosed in 2014. A total of 24,313 persons were tested using the Xpert machine in 2014 out of which 783 isolates were resistant to the anti-TB drug Rifampicin. 

The clinical and programmatic Management of Drug Resistant Tuberculosis has assumed another dimension since the unrelenting efforts of all stakeholders to ensure that the community management of Drug Resistant Tuberculosis is commenced in Nigeria. This model of care was introduced in order to scale up enrollment of diagnosed DR-TB cases and to provide access to care and support for patients while on treatment across the country. In 2014, 10 states of the federation commenced community PMDT through the support of TBCARE 1 project. These states are Kano, Kaduna, Gombe, Benue, Abia, Lagos, Ogun, Akwa Ibom, Oyo and Osun.. 

While intensifying efforts to increase the number of treatment centres in the country with a target of ensuring that each state has a treatment center, the introduction of community PMDT has also ensure that patients can have access to DOTs on ambulation during intensive phase of their treatment and prevent or reduce the socio economic impact experienced by patients who have to be admitted in treatment centres for 8 month of their intensive phase treatment. A total of 423 DR-TB cases were enrolled on treatment both at the community and in the treatment centres across the country. 

 

Case Holding 

Although much has been achieved in the areas of case finding for DR-TB cases with the scale up of GeneXpert and culture services, not much improvement has been achieved in the area of case holding (both the interim outcome and preliminary outcome results for PMDT). The percentage of DR-TB cases who converted to culture negative at 8 month of their treatment (interim assessment outcome) reduced from 73.9% among cases enrolled on treatment in 2010 to 70.0% among cases enrolled on treatment in 2013. Similarly, the cure rate and treatment success rate among DR-TB cases enrolled in 2010 has reduced from 43.0% and 57.0% respectively to 13.6% and 37.7% respectively in 2012.