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GLOBAL FUND to Fight AIDS, Tuberculosis and Malaria


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Public-Private Mix

imagesThe Institute of Human Virology Nigeria (IHVN) has been selected by the Country Coordinating Mechanism and the Global Fund as the first Principal Recipient for the scale-up of TB Public-Private Mix (PPM) services in Nigeria. The project will be implemented in 20 States, namely, Edo, Delta, Cross River, Akwa Ibom, Benue, Oyo, Ondo, Osun, Ogun, Kogi, Niger, Sokoto, Plateau, Nasarawa, Kaduna, Anambra, Enugu, Rivers, Imo, Abia.

In Nigeria, private healthcare providers account for more than 60% of care-seeking, yet efforts at engaging the private sector in the provision of TB services have been sporadic, small and short-lived. In 2017, only 2.5% of the private sector health providers were involved. In particular, the focus of this Grant is to scale up TB prevention, diagnostic and treatment services through private sector engagement with the aim of increasing TB PPM coverage from 2.5% in 2017 to 34% in 2020 and the PPM contribution to the National TB case notification from 11% in 2017 to 35% in 2020.

The country adopted GeneXpert as the first point of diagnosis for tuberculosis in 2016 and with support from the grant, it is expected that drug susceptibility testing (DST) coverage will increase from 34% in 2017 to 75% by 2020. IHVN is also to ensure national coverage for maintenance of treatment centers and TB reference laboratories, optimized use of 106 GeneXpert machines and sputum transportation in 36 plus 1 states. Ensuring quality in the provision of TB services through the NigeriaQual TB program across 12 states (Oyo, Ogun, Rivers, Imo, Ebonyi, Benue, Plateau, Kaduna, Kano, Bauchi, Taraba) also falls within the activities that the Institute would be implementing.

This grant also aims to reduce the TB burden by complementing and accelerating the ongoing activities implemented by the Nigerian government, other Implementing Partners and the just concluded Global Fund New Funding Model grant.

In order to achieve the targets outlined above, IHVN, in collaboration with her sub recipients, German Leprosy and Tuberculosis Relief Association, Damien Foundation Belgium, The Leprosy Mission Nigeria, Catholic Caritas Foundation of Nigeria, and KNCV Tuberculosis Foundation, will carry out the following activities within the next two years:

  1. • Engagement of 21,200 Community Pharmacists, Patent Medicine Vendors and Traditional Birth Attendants in identification and referral of presumptive TB cases
  2. • Engagement of 412 Faith-Based Organizations and 1,708 Private-for-Profit Facilities in TB prevention and treatment services
  3. • Capacity building of 540 Health Care Workers from Faith-Based Organizations and Private-for-Profit facilities to provide Drug Resistant Tuberculosis (DR-TB) Out-Patient services
  4. • Scale-up of TB diagnostic services to 421 additional private laboratories
  5. • Deployment of a TB notification application for use by PPM providers nationwide
  6. • Maintenance of DR-TB Treatment centers, TB reference laboratories, NigeriaQual TB and optimization of GeneXpert machines including transportation support for sample shipment for diagnosis and treatment follow up
  7. • Resource mobilization and partnerships for sustainability in collaboration with the NTBLCP

Drug Resistant Tuberculosis

From 2011 to 2018, Institute of Human Virology Nigeria (IHVN) implemented the Global Fund Multi-Drug Resistant (MDR-TB) grant as Principal Recipient. The grant strengthened MDR-TB prevention and control in Nigeria. IHVN partnered with the National Tuberculosis and Leprosy Control Program (NTBLCP) of the Federal Ministry of Health (FMoH) and other stakeholders in the implementation of the scale-up of the Programmatic Management of Drug-Resistant TB (PMDT). On receiving the Grant, the NTBLCP (also a Sub-Recipient to the grant), set up a coordinating mechanism for the MDR-TB program and supported IHVN and other partners in setting up implementation structures for intervention activities. Phase 1 recorded a grant rating of A1, with 168 patients commenced on treatment across seven treatment centres that were activated.

In Phase 2, the activities supported by the grant include infrastructural upgrade, supply of equipment and maintenance of some treatment centres and reference laboratories; and supply of reagents, consumables and data collection tools. The Institute also carried out capacity building for treatment centres, laboratory and state TB staff on service provision and data collection; sputum transportation logistics nationwide to increase case detection; strengthened routine surveillance for Drug-Resistant Tuberculosis at all levels; and established and supported State MDR-TB Teams for strengthening oversight and supervision of patients

In 2015, IHVN was again selected by the Country Coordinating Mechanism of Nigeria as a Principal Recipient to implement the Global Fund New Funding Model (NFM) MDR TB grant. The current grant was to reduce the DR-TB burden by complementing and accelerating the ongoing activities implemented by the Nigerian government and partners, through the Global Fund New Funding Model Grant.

KEY Global Fund DR-TB Grant ACHIEVEMENTS
(From June 2011 till September 2018)

S/No

Indicator

Target

 Achievement

%

1

Percentage of TB patients with DST result for at least Rifampicin among the total number of notified (new and retreatment) cases in the same year.

    60%

      54%

90

2

Number of bacteriologically confirmed, drug resistant TB cases (RR-TB and/or MDR-TB) notified                           

14,546

9,036

62

3

Number of MDR-TB patients enrolled for treatment

5,990

6,515

109

4

Number of service providers trained on DR-TB management      

2,054

3,110

151

Activation and maintenance of 28 treatment centers to provide DR-TB services and 10 TB reference laboratories for DR-TB diagnosis

Major task included scaling up the activities in the Round 9 Grant to improve accessibility to DR-TB diagnosis, care and treatment services. Activities in the NFM DR-TB grant included; LGA team trainings, decentralization of outpatient services for the DR-TB patients, development of structured adherence program for DR-TB, development of Logistic Management Information Systems for laboratories, support for electronic data management through the e-TB manager and GX Alert Software, maintenance of 106 GeneXpert machines, procurement and distribution of GeneXpert cartridges, procurement of basic equipment for emergency care for treatment centers to manage critically ill patients and improve treatment outcome, provision of solar-powered refrigerators for sample storage to reduce sample wastage.

Malaria

The Institute of Human Virology Nigeria (IHVN) implemented the Global Fund Malaria program, as a Sub-Recipient to the National Malaria Elimination Program (NMEP) between 2009 and 2016. Grant implementation covered the 4 components of malaria control interventions;

  • Vector Control
  • Case Management
  • Program Monitoring and Evaluation
  • Program Management

These malaria control interventions were supported through selected public health facilities in 13 States - Katsina, Ogun, Kwara, Gombe, Akwa-Ibom, Kano, Kaduna, Borno, Kebbi, Plateau, Kogi, Benue and Jigawa States. Cumulatively, 417 public health facilities across 291 Local Government Areas (LGAs) were supported to deliver free prompt and effective malaria services in their various communities. The Institute distributed Long Lasting Insecticide Treated nets to over 5 million people through campaigns and routine distribution channels, about 9.8 million persons were treated with Artemisinin-based combination therapies (ACTs) and over 7 million parasitological diagnosis done before treatment. With the inclusion of support for provision intermittent Preventive Therapy for women receiving ANC from 2015 to 2017, 730,271 pregnant women benefited from IPTp and 30,162 health care workers were trained on malaria management.

HIV

IHVN commenced the implementation of the GF Round 8 HSS Grant as Sub-Recipient (SR) to NACA in 2009; this was later consolidated into the Round 9 HIV Grant which ran from July 2011 – December 2016. In 2017 IHVN continued as Sub Recipient to FHI360 the Principal Recipient implementing the Global Fund Investing For Impact Against TB/ HIV grant. The grant focused on providing services in the areas of HIV Testing Services (HTS), prevention of mother-to-child transmission (PMTCT), anti-retroviral treatment (ART) and TB/HIV services in 10 States: Adamawa, Bauchi, Benue, Kano, Nasarawa, Ogun, Plateau, Taraba and Yobe states and the Federal Capital Territory. These services are provided through support to 69 secondary health facilities for comprehensive ART care and 348 primary health facilities to provide PMTCT services.

From 2009 till date, 2,130,963 individuals and 1,409,250 pregnant women have received HIV testing and counselling services. 99,168 HIV positive patients have been placed on treatment and 16,701 HIV positive pregnant women have received ARV prophylaxis while 2,860 HIV positive incident TB cases have received treatment for TB and HIV. Over 5,773 health care workers have been trained on HIV management.

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:: Support and Funding

 The Institute of Human Virology, Nigeria AITRP Training     Programmes are supported and funded by the Fogarty International Center.
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