Implementation of the Active TB Case Finding in Nigeria; Processes, Lessons Learnt and Recommendations

Abstract

Introduction: Tuberculosis remains a major public health issue in Nigeria with the country ranking seventh among the 30 high TB burden countries. Nigeria is among the three countries that account for half of the 4.3 million "missing" TB cases globally. One untreated TB case is able to infect about 10 -20 people annually. Hence, it is pertinent that TB is controlled effectively through the use of active case finding strategies to find the missing TB cases. Objective: This article highlights the best practices and key lessons learnt during the implementation of the active house to house TB case finding strategy in Nigeria. Lessons Learnt and Recommendations: Strategic community engagement, massive awareness creation using mass media and local means of communication, mapping of locations where registered TB cases live, to inform home visits for contact tracing and strengthening of laboratory systems, are viable mechanisms to improve TB case finding. Conclusion: Active TB case finding interventions should be implemented in the context of a strengthened diagnostics system, strategic community engagement and media involvement.

Evaluation of House-to House Active Tuberculosis Case Finding Contribution to TB Case Notification in 10 States in Nigeria

“…Table 3b shows contribution of ACF to individual State TB notification for both presumptive and positive cases. There was a contribution of 24-74% to the states positive TB cases across the ten (10) states and a very significant contribution of 52-74% to the overall TB cases in three (3) out of the ten (10) states. Sex disaggregation of TB cases notified from the community ACF intervention.…”

“…Table 1 shows the cascade and yield of the community TB intervention in the ten states ranging from number of households visited by the CTWs, presumptive TB cases identified, positives TB cases out of the identified presumptive and the number of patients placed on treatment. The table shows that a total of five hundred and eleven thousand, one hundred and eighty-one (511,181) households were visited in the ten (10) states where house to house active TB case search was implemented. In these households visited, three hundred and sixty-three thousand, seven hundred and fifty-eight (363,758) presumptive TB cases were identified out of which three hundred and fifty-three thousand, nine hundred and ninety-two (353,992) were tested for TB.…”

Capitalizing on facilitators and addressing barriers when implementing active tuberculosis case-finding in six districts of Ho Chi Minh City, Vietnam: a qualitative study with key stakeholders

“…In terms of progressing beyond describing what the facilitators and barriers are, our data also provide examples and ideas of how to address them. Studies from Nigeria [ 41 ] and India [ 42 ] are among the few studies that also elaborate on the “how-to” of ACF implementation: Shamenewadi and colleagues [ 42 ] mentioned involving local leaders, training employees, and volunteers in counseling TB patients and supporting patients financially for ACF implementation. Based on our results, “how-to” examples and ideas included close collaboration between employees and volunteers and staff from District TB Units to overcome challenges with preparation and logistics for ACF in the community.…”

Operationalizing Mobile Computer-assisted TB Screening and Diagnosis With Wellness on Wheels (WoW)) in Nigeria: Balancing Feasibility and Iterative Efficiency

“…Home to 9% of the world's missing TB patients, Nigeria has experimented with many models of TB active case-finding (ACF) and results have varied widely. [12][13][14][15][16][17][18] However, while referring chronic coughers is often feasible due to specificity of 94%, the sensitivity of the classical chronic cough screen has recently been downgraded from 56 to 38%. [19] Nigeria has tried to increase the sensitivity of screening efforts, moving from a three-week chronic cough threshold policy to a two-week cough threshold in 2014, but pulmonary TB (PTB) case notification did not increase significantly.…”