Improving indicators of tuberculosis program cascades by leveraging HIV program strategies

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Health Systems Strengthening

Background:

• The Nigerian Ministry of Defense Health Implementation Program and US Army Medical Directorate-Africa/Nigeria introduced a human immunodeficiency virus (HIV) standard of care (SOC) package to boost HIV case detection and treatment.
• Integration of tuberculosis (TB) and HIV programs necessitates evaluating the impact of updated HIV care strategies on TB program performance indicators.

Purpose of the Study:

• To assess the effect of implementing an updated HIV standard of care (SOC) package on key tuberculosis (TB) program indicators within Nigerian military healthcare facilities.

Main Methods:

• Analysis of routine, de-identified program data from 27 Nigerian military hospitals.
• Comparison of TB program indicators from 12 months before and after the implementation of the HIV SOC package using Wilcoxon signed-rank test and bivariate analyses.

Main Results:

• Significant improvements were observed post-implementation, including increased antiretroviral therapy (ART) clients screened for TB (14,530 to 29,467), presumptive TB identification (803 to 1800), and TB testing among ART clients (746 to 1717).
• Treatment rates for TB among ART clients increased (152 to 282), alongside a rise in newly registered or relapsed TB cases (436 to 906).
• Key indicators for TB-HIV co-infection also improved, with more TB cases having known HIV status (437 to 837), increased co-infected cases identified (182 to 301), and a higher proportion starting ART (101 to 176).

Conclusions:

• The updated HIV SOC package implementation demonstrably enhanced critical TB diagnosis and treatment metrics.
• This strategy holds potential for replication and could significantly improve TB program outcomes in other countries beyond Nigeria.