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49 th Union World Conference on Lung Health;

Learn about the successful implementation of integrated TB and HIV services among IDPs in Nigeria by GomSACA, overcoming challenges and sharing lessons for future work in this informative presentation from the 49th Union World Conference on Lung Health.

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49 th Union World Conference on Lung Health;

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  1. Integrated Provider Initiated TB and HIV Services among Internally Displaced Persons in North-eastern Nigeria 49thUnion World Conference on Lung Health; The Hague, Netherlands 26th October, 2018 Dr Suraj Abdulkarim, Gombe State Agency For Control of AIDS (GomSACA)

  2. Outline • Background • Objectives • Intervention • Results • Challenges • Lesson Learnt and Next Steps

  3. Background GomSACA: • An Agency under the office of the Governor • Established to coordinate HIV/AIDS Response • Experienced working with multiple Stakeholders at all levels (Government & Non Governmental) • Successfully implemented World Bank Projects (HPDP 1 & 2) in the past • TB REACH Wave 5 Grantee; now scaling up • In consortium with Janna Health Foundation (JHF) and SUFABEL Community Development Initiative (SCDI) in NE Nigeria

  4. Background • Total Pop:7,143,989 • Evaluation Pop: 3,362,345 • Target Pop: 307,585 • Control Pop: 2,461,374 • No. of LGAs: 12 • DOTS centers: 91 • Xpert Sites: 12 • AFB Sites: 31 • ART Sites: 17

  5. Objectives • Primary: • To detect & notify additional TB cases among IDPs camps & IDPs Host communities in Adamawa, Gombe & Yobe States, North-Eastern Nigeria • Secondary (OR): • To assess knowledge and patient perceptions of TB and treatment seeking behavioramong IDPs • To estimate the prevalence of TB, HIV and TB/HIV coinfection among IDPs

  6. Stakeholders

  7. Key Approaches • Screening of IDP Camps & Host Communities for TB by CVs • Identification of Presumptive TB cases • Sputum collection and transportation for GeneXpert analysis • Childhood TB screening • & Transportation • TB Diagnosis & Linkage to treatment • TB Contact Examination

  8. Medical Officer

  9. Project Activity Pictures from IDP Camps & Host Communities

  10. Trends of TB Notifications (June 2017-June 2018): Bac +

  11. Trend of TB Notifications (June 2017-June 2018): : TB All Forms

  12. Key achievements • Case Finding • No of IDPs screened: 283,556 • No of Drug Sensitive TB: 1,253 • No of Drug Resistance TB: 38 • Contact Investigation • No. of Contacts Screened: 2025 • No of TB cases detected: 56 (2.3%) • HIV Screening • No of clients screened: 48,341 • No of HIV+ Detected: 223 • 2 LGAs re-activated in Yobe State • 3 (25%) non-functional GeneXpert equipment were reactivated • Increased utilization of GeneXpert equipment in the project area

  13. Operational Research- Why OR: • TB among IDPs is about twice higher than in the general population. • Low case detection in Nigeria • How has the experience of mass displacement affected the health-seeking behaviour of IDPs in the region? • What is the perception of the quality of TB and HIV services by IDPs • Data analysis is ongoing

  14. Preliminary Findings: • Knowledge gaps; Delays in accessing services (due to Social stigma)  • Alternative Health Care (often the first point of contact) • Poor access to Health Services including TB • Quality of Health (including TB) services (facility & Community based) from the client perspective was encouraging • Most TB patients were satisfied with services provided through CVs (especially House-to-House) • Household heads were more satisfied with female CVs screening their spouses rather than male CVs • The second OR question still being analyzed

  15. Challenges • Keeping up with new host communities • Identification of key stakeholders: • Stakeholder analysis is valuable • Initial compliance issues during House-to-House TB screening • Childhood TB diagnosis (<5s) • Distribution of CVs • Low capacity for HCT (among CVs) • Shortages of HIV Rapid Testing Kits

  16. Lessons Learnt and Next step • Collaboration/information sharing with camp managers/NGOs • IDP preference for Host Communities (90%) • The influence of Incentives • Ward Development Committees (WDCs): A potential for ownership. • Distribution of CV/Impact • IDP trans-border movement • Monthly data collection • More Host Communities identified by Project • More Targeting of HCs • New innovations include; • leveraging on the existing Ward Development Committees (WDCs • the provision of transport support for presumptive <5 childhood TB cases, • strategic distribution of CVs • Going Forward: • Scale Up • Multi-Country Project

  17. Acknowledgements – Project, ideas, input, (and ppt slides) Adamawa, Gombe and Yobe States Government NTBLCP McGill International TB Centre TB REACH / Stop TB Partnership Global Affairs Canada Jacob Creswell Marina Smelyanskaya Dr Stephen John 17

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