Taking tuberculosis preventive therapy implementation to national scale: the Nigerian PEPFAR Program experience

• Published in: Public health action Vol. 10; no. 1; pp. 7 - 10
• Main Authors: Odume, B., Meribe, S. C., Odusote, T., Ifunanya, M., Debem, H., Amazue-Ezeuko, I., Ogbanufe, O., Adamu, Y., Onotu, D.
• Format: Journal Article
• Language: English
• Published: France International Union Against Tuberculosis and Lung Disease 21-03-2020
• Subjects: Human Immunodeficiency Virus; isoniazid preventive therapy; Original; people living with HIV; Tb Preventive Therapy; Tuberculosis; human immunodeficiency virus; isoniazid preventive therapy; people living with HIV; TB preventive therapy; tuberculosis
• ISSN: 2220-8372; 2220-8372
• DOI: 10.5588/pha.19.0033

Background: Tuberculosis (TB) preventive therapy (TPT), including isoniazid preventive therapy (IPT), has been implemented within the Nigerian human immunodeficiency virus (HIV) programme since 2014. However, drug procurement and logistic support has remained the responsibility
of the National Tuberculosis and Leprosy Control Programme. The US President's Emergency Plan for AIDS Relief-Nigeria (PEPFAR Nigeria) reviewed the key bottlenecks to TPT implementation in 2016.Method: The logistics of delivery of isoniazid (INH) were integrated with the antiretroviral
(ARV) logistics management and information system (LMIS). Drug order and requisition forms at the facility level were revised to include INH, along with training on appropriate quantification and requisition of INH with ARVs. Support was provided for last mile delivery of INH directly to every
implementing site, alongside ARV.Reults: We observed an increasing trend in TPT uptake between the pre-and-post intervention periods: 6% in fiscal year (FY) 2015, 7% in FY2016 and 12% in FY2017. Overall, the logistical changes in the LMIS to include INH in 2016 led to a 69% increase
in TPT by the end of FY2017; this was statistically significant.Conclusion: Addressing logistical challenges to TPT implementation will ensure that the TB and HIV programmes can tackle the increasing burden of TB infection in people living with HIV. We recommended that the provider-to-client
stage of TPT implementation be driven by the HIV programme and that cross-communication between the two programmes be improved.