Learnings from the Nigerian Experience: Operating GeneXpert® in challenging settings

On July 2nd we hosted a webinar on Lessons Learned from the Nigerian Experience Operating GeneXpert® in Challenging Settings. Jerod Scholten, Technical Officer at KNCV Tuberculosis Foundation, introduced the webinar and highlighted Nigeria’s significant burden of tuberculosis (TB), HIV, and Drug Resistant-TB (DR-TB). Jerod also shared how the country’s TB treatment coverage has dramatically improved from 20% to nearly 70% due to the introduction and scaling up of World Health Organization (WHO) recommended molecular rapid diagnostic tests like GeneXpert®. He emphasized Nigeria’s diverse and vast geography and population, which poses unique challenges to TB service provision. KNCV has been working in Nigeria for over two decades, significantly contributing to the TB diagnostic landscape by supporting the implementation and maintenance of GeneXpert® systems. Jerod also mentioned the increase in diagnostic tools available in Nigeria, with GeneXpert® being the predominant method.

The webinar included participant engagement through polls and a Q&A section, and a keynote speech by Prisca Ajiboye, Director of the Cepheid Authorized Service Provision Project in Nigeria.

After Jerod’s introduction to the current landscape in Nigeria, Prisca continued the discussion on the Nigerian experience with operating GeneXpert® systems in challenging settings.

First, Prisca delved into the diagnostic network in Nigeria. The diagnostic network in the country ensures access to testing through a variety of tools and efficient sample transport systems. Even in areas lacking GeneXpert® machines, there are sample transport systems to transfer specimens to locations where WHO-recommended diagnostics like the TB Lamp and Truenat are available.

In 2022, a diagnostic network optimization revealed that integrating multiple stakeholders is sustainable and cost-effective. In Nigeria, there are 546 GeneXpert® instruments installed across 317 local government areas, covering over 30 different types of tests, from HIV to hepatitis viral load. This integration maximizes utilization and reduces the overall cost per test, significantly improving service delivery and training consistency across various diseases.


“More of this webinars on GeneXpert will educate people on the capacity of the machine as a multi-disease testing machine.” – Comment by webinar participant

Challenges faced include both controllable and uncontrollable factors

Uncontrollable factors like natural disasters, communal clashes, and industrial actions can severely disrupt operations. For instance, flooding in the North Central region in 2022 impeded logistics, and communal clashes often lead to delays in healthcare delivery. An additional challenge has to do with staff attrition due to various reasons including transfers and strikes.

To mitigate these issues, focus is placed on controllable factors. Maintaining air-conditioned rooms to handle high temperatures and conducting regular preventive maintenance to combat dust accumulation. Power availability is another critical factor in the region; transitioning from using UPS systems to inverters and solar panels to ensure consistent power supply has been essential to tackle this issue. Technical support is promptly provided, with repairs often completed within a 24 to 48 hours window.

Despite these efforts, significant challenges are still faced

Facilities have been lost to fire incidents, and natural disasters like floods cause disrupted logistics. Additionally, high staff turnover and industrial actions pose ongoing operational difficulties.

However, effective solutions have been found throughout implementation. Inverters have replaced noisy and costly generators, and standard operating procedures (SOPs) have been modified to address regional specificities like high levels of humidity and dust. The introduction of the Access Care warranty system ensures preventive maintenance is conducted timely. The partners’ community, a local communication tool, allows for immediate issue resolution, and continuous training and retraining for staff, becoming a cornerstone consideration when operating GeneXpert® systems.

Stakeholder collaboration is crucial

The Country GeneXpert® Advisory Team (CEGAT), comprising various programs, implementing partners, and funders, addresses all challenges associated with GeneXpert® use. They provide practical solutions and ensure the effective implementation of the technology.

In conclusion, experiences shared from Nigeria by Prisca and Jerod reveal that while numerous challenges are faced, an integrated approach and stakeholder collaboration has enabled overcoming obstacles and improve the TB diagnostic network in Nigeria.

Click HERE to download a summary of the Q&A session during the webinar.

To know more, you can download the webinar slides HERE and watch the recording of this webinar below.

KNCV has been fighting TB since its establishment in 1903. Over the past 120 years, the organization has acquired indispensable knowledge and experience in the field of effective TB prevention and care, resulting in pre-elimination in the Netherlands and significant contributions to global evidence generation, policy development and TB program implementation worldwide.

Our experts
KNCV governance framework and integrity
Our patroness
Partner with us


De versie van de browser die je gebruikt is verouderd en wordt niet ondersteund.
Upgrade je browser om de website optimaal te gebruiken.