Posted on: Wed 19-02-2025

Dr Olayemi Olupitan is the Project Director of the Global Fund (GF) Grant Cycle 7 Tuberculosis/HIV project of the Institute of Human Virology Nigeria (IHVN). In this interview, she spoke on ways to reduce the TB burden in the country, and tackling mother to child transmission of HIV, among others.

Tuberculosis is still a major public health problem in Nigeria. What do you think should be done to change the narrative?

It is important for the public to know that tuberculosis is preventable and curable. It is real. It is not a spiritual problem.

TB preventive treatment is available for all contacts of tuberculosis patients. So, if you live with someone who has TB, you can be on TB preventive treatment, which is available. It is free of charge and it’s highly tolerable. Early diagnosis cannot be overemphasised. It is the key to avoiding complications and having a better prognosis.

IHVN is doing a lot around this in collaboration with the Government of Nigeria, specifically the National TB and Leprosy Control Programme. IHVN is strongly committed to the fight against TB, HIV, malaria, and other diseases of public health importance, and we have been in this space for two decades.

What is your take on addressing multi-resistant TB?

Multidrug-resistant tuberculosis (MDR-TB) is a form of tuberculosis (TB) infection caused by bacteria that are resistant to treatment with at least two of the most effective first-line anti-TB medications (drugs): isoniazid and rifampicin

MDR-TB is really of great importance because we know that treatment is more challenging, and one needs to be intentional about it.

So, we are not limited to drug-susceptible TB management. TB is TB anywhere. The treatments are different. IHVN works closely with the Government of Nigeria, NTBLCP, to ensure screening, diagnosis, and treatment for all types of TB. If we think it’s TB, we ensure that we provide the necessary support for diagnosis and treatment if they are found to be positive for TB.

There’s contact engagement of these patients on treatment; we track them as needed and provide support as needed. For programme quality, we don’t just track them to enrol them in treatment but work with them to ensure that the treatment is successful.

What can be done to create more awareness on TB?

More can be done through the continuous engagement of the public via different media platforms and the involvement of public/religious figures to transmit correct information about TB. There is a need to engage public health facilities and healthcare workers continuously as well. You know, there’s a high turnover of staff, and the few staff available are overwhelmed with the programming of different disease entities.

Also, with the ‘Japa’ syndrome, some trained ones who are expected to educate clinic attendees on TB and raise awareness continuously have moved on to seemingly greener pastures. As we build the capacity of people in the field, we also need to increase tuberculosis diagnosis and treatment coverage in health facilities.

There are more than 9,000 DOT centres for the treatment of tuberculosis, but there is a plan to activate more DOT centres so that anywhere people go, they are able to access care for tuberculosis.

You must have health facilities close to Nigerians such that in every few kilometres, you have a healthcare post where the staff are knowledgeable about TB services. They are able to link them up with the appropriate investigations and get the results on time. Once the results are out, we should be able to contact the client for more counselling and TB treatment. TB treatment is free, and so are the follow-up investigations.

How important is the prevention of mother-to-child transmission of HIV?

There is this unholy matrimony between HIV and TB where someone with HIV can easily come down with TB.

When we go to communities to screen for tuberculosis, we also test for HIV, particularly the pregnant women, because there are some pregnant women out there that we understand, for one reason or another, are not leaving their homes to public health facilities or even private health facilities for antenatal care. And you see, if you do not leave your home for antenatal care (ANC), how then do you get tested for HIV?

So, we are leveraging the structures that we have put in place over the years for TB active case finding to screen and test any pregnant woman eligible for these services in the community.

We have our teams and our colleagues in the community actively looking for pregnant women and then asking them pertinent questions that will lead us to know whether they need to be tested for HIV or not.

We have a screening tool that we use to ask these women questions because we need to ask the same questions across the board to ensure that we are providing the quality of care and the same set of services to all the women.

These questions; let us know if a woman is registered for ANC or not. Once she is not registered for antenatal care, we focus on that woman, find out why she is not registered and follow her up till she is registered. That person becomes our next best friend.

Protecting an HIV-positive pregnant woman is critical. The child she is carrying is at risk of getting HIV. We don’t just refer to them with a piece of paper, but we have engaged mentor mothers who know what it is to be HIV positive and yet have a negative baby.

Mentor mothers follow up with HIV-positive women, take them to a close health facility in line with the client’s choice for a confirmatory test, and monitor them till they deliver and follow through on the next steps as applicable. They follow through the cascade to ensure the mother and the baby are fine.

There are different socio-cultural reasons why they have opted to stay at home, but when you provide the correct information and they have a peer walk alongside them to access the services, you will see an improvement.

How does IHVN utilise technology to detect TB cases or engage in TB case finding in the community?

We do a lot in the community to identify tuberculosis cases. Our teams have been trained to collect samples. These samples are moved to nearby facilities. However, other things have been brought into play, like you said, technology. So, you know, now there are so many mini x-ray machines across Nigeria.

More are being pushed to the field so that when our colleagues go into the field, they don’t just go with their sputum cups, they also go with these machines to screen for tuberculosis. There are also trucks that we call the Wellness on Wheels (WOW) trucks, which have TB screening capacities, and while these were not procured by us, we are working in collaboration with the providers to support their use.

Apart from these WOW trucks, there are miniature equipment, that is, portable x-ray machines that they move with to the field, and, you know, use them to also screen in the community.

We don’t want a situation where we’ll just be focusing on the cities; we move to the communities, the unreached and seemingly challenging terrains to widen coverage and access.  We’re also flooding the facilities with other highly technical machines that have high sensitivity and specificity for TB, and can easily pick or test for TB. As I said, this is in collaboration with other partners. It is a multi-sectoral, multi-level, multi-organisational collaboration to ensure that we achieve success and we’re able to record the elimination of TB.

Can you briefly tell us about the Nigeria TB/HIV Reach Integration and Impact Project, or N-THRIP project?

It is a Global Fund project referred to as the Grant Cycle 7 TB/HIV Grant, which the Institute of Human Virology Nigeria (IHVN) has labelled the Nigeria TB/HIV Reach Integration and Impact Project (N-THRIP). With IHVN as the Principal Recipient, working in collaboration with sub-recipients, national and sub-national government agencies (including the community), the scope of the project includes nationwide coverage of TB via Public-Private Mix (PPM) to improve access to TB services, enhance the quality of TB care, increase TB case detection and treatment rates, and reduce TB-related morbidity and mortality. Others include community TB testing and community testing of pregnant women towards eliminating Mother-to-Child Transmission of HIV (eMTCT). Additionally, the project encompasses end-to-end HIV programme implementation in four states: Anambra, Ebonyi, Gombe, and Kwara. Other focus areas include Health Systems Strengthening, Resilient and Sustainable Systems for Health (RSSH), and national-level support activities.

How has this project contributed to TB notification or case detection?

The project has notified 70,701 TB cases from January to June 2024 through the PPM intervention. Additionally, within the same period, 42,769 TB patients were identified and referred for treatment, with 41,705 cases notified through community interventions.

These figures represent 34% from PPM and 20% from community contributions to the national TB case notification for 2024 so far. The goal is for PPM to contribute at least 25% and for community efforts to contribute 33% to the national TB case notification.

While we understand that, as an organisation, we are contributing at least 25% through PPM and about 33% through community efforts to the national TB case notification, we do not view it solely as IHVN’s achievement. We are focused on achieving the national-level target, and much work remains to bridge the gap.

Many cases remain undiagnosed due to various issues at present, but significant efforts are being made to address this. We are working with the Government of Nigeria to ensure that diagnosed individuals receive the best care.

How does house-to-house or community involvement help in the detection of TB cases?

The house-to-house community case-finding strategy has been quite instrumental in bringing TB and HIV screening services to people in their homes. You know, some people in Nigeria naturally have poor health-seeking behaviour, and no matter what you do, they will not go to any health facility for one reason or the other. Sometimes, it may be because they can’t even afford the transport fare.

So, we’ve been able to take TB and HIV screening services to these people and identify a lot of cases amongst them through interventions like community outreaches. We carry out hotspot mapping and advocacy to community heads to inform them about the outreach activities.

These outreaches are strategically planned on market days or days we know that they will come together in their numbers. And then after that, when they must have been educated, we’re able to screen them for TB. So, you see, the home-to-home effort has been very instrumental, and it has contributed quite a lot to the successes we have recorded. We are also carrying out public enlightenment to ensure that messages around TB and HIV are out there for people to listen to and then take the right steps.

Lack of knowledge and some beliefs determine health-seeking behaviour. Some people believe that tuberculosis is a spiritual problem or don’t think that it’s a medical issue that can be treated. This is why it’s critical for us to also, with our house-to-house community case finding, build on public enlightenment for people to access these services.

SOURCE: DAILY TRUST NEWSPAPER

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