Lessons learned in implementing community tb prevention programme in south west n igeria

1Bako J.C, 1Kehinde D., 1Faloye A, 1Ojoye K, 2Itodo G.

1The Society For Family Health Akure, Nigeria, 2Centre for Women and Children Development, Akure Nigeria

Lessons Learned in Implementing a Community TB prevention programme in

South West Nigeria

The Society for Family Health

Background

•Tuberculosis has been identified as one of the major threats to People living with HIV (PLWH) accounting for the highest reported cases of illness and death.

•Nigeria is 4th among the twenty two high TB burden countries with cases of TB infection.

•The infection rate in the country increased from 31,264 in 2002 to 90,307 in 2009.

The Society for Family Health

• The TB burden in Nigeria is further compounded by the re-emergence of Multi-drug Resistant Tuberculosis (MDR-TB).

• This calls for the need to improve interventions preventing TB HIV co infection among PLWH and the general population.

Background cont’d.

The Society for Family Health

• Society for Family Health, an indigenous non governmental organisation received funding from United State Agency for International Development (USAID) in 2008 to implement the STOP TB strategy.

• The project aimed at improving access to TB prevention interventions for the poor and vulnerable Nigerians with major interest in Ogun, Ondo, Oyo, Lagos, Benue and Adamawa states.

SFH’s Response

• The intervention commenced with TB DOTS centres assessment to identify functional centres for referrals

• IPC Guides were developed to educate and sensitise the general population and PLWHA on basic facts about Tuberculosis prevention, detection, treatment and control

• Advocacy visits were paid to key stakeholders and community sensitisation and mobilisation programmes were carried out

SFH Response cont’d.

Intervention Strategies

Baseline assessments using In-depth Interviews/FGDs with health workers at the DOTS centers

Community Mobilisation/Sensitisation through the State TBL coordinators – TBL Supervisors - Nursing officers of PHC – CDA Chairmen.

Monthly tracking of referrals.

Training/review meeting with IPC conductors.

Production/distribution of IEC materials.

Participation in Special events and Community TB outreach programmes using IPC conductors.

Findings/Results

• DOTS centres assessment revealed that -

There are functional TB DOTS centres in Lagos, Ogun, Ondo and Oyo states.

Insufficient staff (Some DOTS have 1 to 3 staff who attends to an average of 15 to 20 clients).

Providers reported limited knowledge and skills to diagnose active and extra pulmonary TB and manage co-infected patients.

Acute shortages of TB drugs (especially for children) and delays in drug supply and resupply.

• Many people still do not know that TB is curable and treatable

• IPC conductors reached 13,060 persons (5,395 males and 7,665 females) with TB prevention messages

• Defaulters were followed up to ensure they re-establish contact with DOTS

• IPC conductors referred 129 suspects out of which 47 were confirmed Acid Fast Bacteria (AFB) positive

• All positive clients are currently on treatment in various DOTS centers

Findings/Results cont’d

Lessons Learned

• Community TB - IPC interventions showed high levels of acceptance by community members

• Attrition rates for conductors are lower if conductors come from the community, are identified and selected by the community, and are resident within the community

The Society for Family Health

• Poor awareness about TB symptoms and stock out of essential commodities including laboratory materials contributes to low TB case detected in Nigeria

• Stigma particularly from health workers threatens treatment effectiveness and control and could increase the possibility of MDR-TB

Lessons Learned cont’d

The Society for Family Health

Possible Future Interventions

• It is necessary that Nigeria scales up collaborative TB/HIV activities

• Efforts should be made to empower people with TB and communities and encourage partnerships, through advocacy, communication and social mobilisation

• Staff training is an urgent requirement

The Society for Family Health

• Thank you for your attention

• For further information, contact

The Society for Family Health

P O Box 5116, Wuse, Abuja

www.sfhnigeria.org, [email protected]

The Society for Family Health