Control of TB among people with HIV/AIDS in Nigeria

Under the auspices of the National AIDS Control Agency in Nigeria (NACA) we are leading a team that is building a GeneXpert network to support the detection of TB among people living with HIV.

Rolling out the latest TB diagnostics and building capacity to control TB among people living with HIV/AIDS.

The Global Fund has entered into an agreement with Nigeria’s National Agency for the Control of AIDS (NACA) to expand access of rapid TB diagnostic services to people living with HIV by introducing 185 GeneXpert MTB/RIF machines country-wide. KNCV has been commissioned to provide TB expertise and support to NACA during this project, which started in June 2014.

The organization of care for people with HIV/AIDS in Nigeria differs from the way TB control and care is organized: HIV/AIDS services are more centralized, for example, and there are far fewer centers  providing antiretroviral therapy (ART: provided in 491 centers) than there are TB centers providing Directly Observed Therapy (DOTS centers: 5,398). Nigeria is in the process of decentralizing its HIV services but this is a laborious process, given the geographic divides and wide range of living conditions in the country. Nigeria is as diverse a country as it is large.

KNCV has dedicated two technical staff, a finance officer, an IT officer, and an international technical advisor to supporting the NACA Xpert MTB/RIF rollout project. A large component of the work is building local capacity. We provide support by training technicians in maintenance of the machines, creating a pool of trained trainers for installation and on-site training, helping to prepare a supply plan for cartridges, creating systems for supervision and mentoring, and for monitoring and evaluation, as well as developing and implementing an operational research protocol related to the roll out of GeneXpert. Currently (November 2015), 40 trainers have been trained in the use of GeneXpert. More importantly, to date, over 2,000 people living with HIV have been tested for tuberculosis.

Still, challenges remain. The electricity supply can be unreliable, there is a lack of fuel for generators, infrastructure (the hospital laboratory, for example) is not always in good repair and inadequate for GeneXpert installation (hospital laboratories for example). This requires site renovations which are being delayed for several reasons, and the HIV/AIDS services are also busy with other priorities in the battle against HIV/AIDS.

GeneXpert machines are being introduced by around 20 NGOs in Nigeria. NACA has asked KNCV to help with coordination. KNCV has a wealth of experience, and so there is no need to “reinvent the wheel” if any bottlenecks may occur.

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.

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