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Engaging the private sector in the fight to end tuberculosis SHOPS Plus in Nigeria has established networks of private providers who screen and test for tuberculosis (TB) and then refer or treat patients with confirmed TB.

Nigeria has one of the lowest case detection rates among high-burden TB countries. According to the WHO, only a quarter of the country's estimated 418,000 TB cases in 2017 reportedly received treatment. Strengthening the private sector’s capacity to detect and treat tuberculosis is vital to increasing the TB case detection rate in Nigeria, as over half of the country’s total health expenditure is in the private sector. In Lagos and Kanos states, the USAID-funded SHOPS Plus project creates community networks of private providers and builds their capacity to screen patients, detect cases, confirm diagnosis, and see patients through treatment. Through the networks, patients can interact with private businesses, network officers, physicians, labs, and others throughout their experience with TB. SHOPS Plus is dedicated to facilitating positive interactions in all of the pathways to care—one patient at a time.

Network officers help patients navigate testing, treatment, and follow-up. Ayodeji (Ayo) Bamgboye finds great fulfillment in his work as a network officer.

Finding cases through unconventional means

When network officer Ayo received a call from a patent and proprietary medicine vendor (PPMV) about a woman who presented with symptoms of TB, he sprang into action. Many Nigerians go to PPMVs before seeking care at a hospital or clinic when they feel sick. This makes PPMVs an important first line of defense in detecting TB cases. After recognizing symptoms of TB in customers, PPMVs refer the client to a clinical facility within their network and call designated network officers to notify them of a potential case.

SHOPS Plus trains employees of participating PPMVs, such as this one, to recognize potential cases of TB and, if necessary, refer the client to a clinical facility and alert a network officer.

Encouraging treatment through support

Within the SHOPS Plus networks of private providers, network officers connect clients with presumptive TB to clinical facilities and encourage them to seek testing and treatment. After coordinating with the PPMV to locate the woman, Ayo quickly arranged for her to meet with Dr. Thomas of MediPlus Hospital, a private clinical facility in Ikorodu, Lagos. He accompanied her to the appointment to provide guidance and support.

“She came with her mother and her three-month-old baby. I was shocked at her look compared to her beautiful baby.” -Ayo
MediPlus Hospital in Ikorodu, Lagos, and the MediPlus team including Ayo (second from the left) and Dr. Thomas (center).

At MediPlus, Dr. Thomas first performed a standard HIV test on the woman before sending her sputum sample to a local public hospital for testing by a GeneXpert machine. These machines are the preferred method of testing a patient for TB. They are more accurate than other methods and are available in labs and public hospitals. Ayo worked with the lab to get the test results as soon as possible in order to inform Dr. Thomas.

Sputum samples are delivered to be tested by a GeneXpert machine.

A positive test result

Three days later, Ayo received news that the woman’s sputum sample tested positive for TB. As TB can be spread between people who are in close contact, the woman’s mother and baby, with whom she lives, were also at risk.

“I informed [Dr. Thomas] immediately and then he called [the woman and asked] her to come the following day with her mother and baby. She came and was placed on TB treatment. Her mother's sputum sample was collected and so was the gastric aspirate of the child for contact tracing. I did the GeneXpert test, which showed negative for [the woman's] mother but her 3-month-old baby tested positive for TB.” - Ayo

Ayo’s ability to arrange TB tests for the patient's close relatives relieves some responsibility from physicians so they can focus on providing quality care.

Patients must begin treatment as soon as possible

Both the woman and her baby completed the six months of treatment under Dr. Thomas’s instruction and have tested negative for TB.

“I had much fulfillment and joy that I could save the life of this nursing mother and [her] 3-month-old baby," Ayo said.

Since partnering with SHOPS Plus, MediPlus hospital has conducted more TB screenings than before. PPMVs, network officers, community pharmacies, clinics, and labs all play a critical role in increasing TB detection in the private sector.

A happy patient and her provider.
"It is important to involve the private sector in TB treatment, as private sector doctors are often closer to the patient," said Dr. Thomas. "The patient also has more time with the doctor in the private sector."

Private sector providers within SHOPS Plus networks have diagnosed 3,160 cases of TB in Nigeria since their work began. More than 50 percent of the clients diagnosed have also been treated in the private sector by network members in Lagos and Kano.

About SHOPS Plus

Sustaining Health Outcomes through the Private Sector (SHOPS) Plus is USAID’s flagship initiative in private sector health. The project seeks to harness the full potential of the private sector and catalyze public-private engagement to improve health outcomes in family planning, HIV, TB, child health, and other health areas. SHOPS Plus in Nigeria aims to increase the availability of and access to TB services in the private sector in Lagos and Kano states, the two states with the highest TB burden and levels of private sector activity. The project’s approach aligns with both international standards and the country’s national plan for tuberculosis control.

Credits:

Photos by KC Nwakalor .

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