VZCZCXRO9537
PP RUEHMA RUEHPA
DE RUEHUJA #0618/01 1041638
ZNR UUUUU ZZH
P 141638Z APR 09
FM AMEMBASSY ABUJA
TO RUEHC/SECSTATE WASHDC PRIORITY 5728
INFO RUEHOS/AMCONSUL LAGOS 1116
RUEHZK/ECOWAS COLLECTIVE
RUEHPH/CDC ATLANTA GA
RUEAUSA/DEPT OF HHS WASHDC

UNCLAS SECTION 01 OF 02 ABUJA 000618 
 
SENSITIVE 
SIPDIS 
 
DEPARTMENT FOR OES/IHA DANO WILUSZ 
USAID FOR GH/HIDN CHERI VINCENT, IRENE KOEK, RICHARD GREENE 
USAID FOR AFR/SD MARY HARVEY 
CDC FOR CCID/NCHHSTP/GAP DEBORAH BIRX 
 
TAGS: TBIO EAID AMED SOCI KPAO NI
SUBJECT:  NIGERIA USES WORLD TUBERCULOSIS DAY TO BRING FOCUS TO THE 
DISEASE 
 
REF: STATE 026078 
 
¶1. (U) Post provides the following response per reftel request. 
 
¶2. (U) Summary:  In commemoration of World Tuberculosis (TB) Day, 
the Nigeria Federal Ministry of Health (FMOH) held a press 
conference on March 24, 2009 and briefed the media on Nigeria's TB 
challenges, efforts underway to combat the disease, and future plans 
to achieve better results.  At the press event, the FMOH announced 
that it will, in collaboration with partners, launch a campaign 
under the banner "Nigeria Stop TB Partnership" on April 27, 2009 to 
drum up support for the TB campaign.  Representatives from the USG, 
World Health Organization (WHO), implementing partners, and advocacy 
groups highlighted their commitment to help the Government of 
Nigeria (GON) attain its objective of halting and reversing the 
incidence of TB by 2015; such as, by enhancing GON's TB intervention 
capabilities.  According to the Minister of Health, TB is a major 
public health problem in Nigeria with an estimated 460,000 cases per 
year, ranking the country fifth among 22 high TB burden countries. 
The TB burden is further complicated by an HIV/AIDS prevalence rate 
of 3.1%, which contributes to the TB caseload and the emergence of 
drug-resistant TB.  U.S. assistance is helping improve Nigeria's low 
case detection and treatment success rates.  In order to achieve its 
MDG target for the prevention and control of TB, Nigeria needs to 
improve its detection and treatment success rates and prevent the 
emergence of drug-resistant TB by providing quality TB care.  End 
Summary. 
 
TB in Nigeria 
------------- 
 
¶3. (U) Nigeria has a high tuberculosis burden with an estimated 
460,000 new cases per annum and a very low tuberculosis detection 
rate of 30% (compared to the global rate of 70%), according to WHO 
figures.  In 1993, Nigeria adopted the WHO-recommended Directly 
Observed Short-Course Treatment Strategy (DOTS) for the control of 
TB and declared the disease a public health emergency.  The TB 
burden is further complicated by the high HIV prevalence rate (3.1%) 
and the emergence of drug-resistant TB (MDR-TB).  (Note:  Although 
Nigeria's HIV prevalence rate is low compared to many other 
countries, the sheer size of its population - close to 150 million - 
means a large number of cases.  TB often occurs in conjunction with 
HIV.  End note.).  In order to reduce the threat created by the 
interaction between TB and HIV, the FMOH has instituted a policy of 
screening HIV patents for TB and vice versa.  In 2008, the Nigerian 
Ministry of Health screened 58,942 TB positive patients for HIV/AIDS 
out of which 14,698 were found to be HIV positive.  (Note:  In 2008, 
the USG -- through the President's Emergency Plan for AIDS Relief 
(PEPFAR) program -- screened nearly 122,321 TB patients for 
HIV/AIDS, of which 25% were found to be co-infected). 
 
U.S. Assistance 
--------------- 
 
¶4. (U) The core objective of the U.S. TB program in Nigeria is to 
strengthen and scale up interventions to prevent and control 
tuberculosis in the country.  USG support is provided through PEPFAR 
as well as the Infectious Disease (ID) Account of the United States 
Agency for International Development (USAID).  Some of the specific 
USG PEPFAR contributions are as follows: 
 
- Over $44 million dedicated to TB-HIV programs from 2005 through 
2009; 
- Working with 17 implementing partners on TB-HIV co- infections in 
36 states of Nigeria; 
- Supporting over 420 TB-HIV treatment outlets in Nigeria. 
- Screening more than 122,321 TB patients and suspects for HIV by 
the end of 2008; 
- Providing 32,192 HIV patients with TB treatment by the end of 
2008; 
- Providing seven mini X-ray equipment and technical support for the 
National MDR-TB prevalence survey that will commence in June 2009; 
- Providing technical assistance to the TB National Reference 
Culture Laboratory in Lagos, Lagos State and the National TB and 
Leprosy Training Center in Zaria, Kaduna State; and 
- Providing technical assistance and building the capacity of 
Nigerian program officers on TB infection control. 
 
¶5. (U) Since 2003, USAID ID program funds have been used to support 
the establishment and phased expansion of TB control programs, 
Directly Observed Short-Course Treatment (DOTS) centers, and 
microscopy laboratories in 17 northern states, Lagos, and the 
Federal Capital Territory (FCT), where there were no such services 
before.  In 2008, a total of 84 facilities consisting of 42 DOTS 
 
ABUJA 00000618  002 OF 002 
 
 
treatment centers and 42 microscopy centers were established, 
resulting in close to 100% DOTS treatment coverage in all Local 
Government Areas in USAID-supported states.  This has boosted 
Nigeria's capacity towards achieving the WHO-set target of halting 
and reversing the incidence of TB by 2015. 
 
¶6. (U) With USG support the Nigerian National Tuberculosis and 
Leprosy Control Program (NTBLCP) has, over the years, increased its 
case notification rate for new smear positive TB cases and its 
treatment success rate to 79%.  However, this is still short of the 
WHO global target of an 85% treatment success rate.  USG assistance 
has also strengthened the NTBLCP's diagnostic capacity of MDR-TB and 
its drug distribution and logistics system, and encouraged private 
health sector and community participation in TB prevention and 
control.  With technical assistance provided by the USG, the NTBLCP 
has established a reference TB laboratory to provide TB culture 
services in Zaria, Kaduna State. 
 
¶7. (U) USG support also addresses serious co-infection 
vulnerabilities between TB and HIV.  Most recently, in collaboration 
with the NTBLCP, the State TB and Leprosy Control Program (STBLCP), 
and the National Expert Committee for MDR-TB, the USG, via the 
PEPFAR program, supported the establishment of a state level TB 
culture and drug sensitivity testing reference laboratory at the Dr. 
Lawrence Henshaw Memorial Hospital in Cross River State (Note:  The 
laboratory is scheduled to open at a public ceremony on April 24. 
End Note).  This is the first such laboratory at the state level in 
Nigeria and the first laboratory of its technical standard in the 
country.  The laboratory will act as the reference laboratory to 
satellite centers offering microscopy services, enhancing the GON's 
response to TB in Nigeria.  USG support is also enabling the 
integration of TB and HIV programs by enhancing the capacity of 
Global Fund recipients. 
 
Comments: 
-------- 
 
¶8. (SBU) Nigeria's high TB burden, complicated by its HIV prevalence 
rate and emergence of drug-resistant TB, continues to pose a serious 
public health challenge to the country.  USG assistance is 
strengthening and scaling up Nigeria's intervention capacity and 
helping improve its very low TB detection and treatment success 
rates.  The U.S. funded and soon-to-be-inaugurated state-of-the-art 
TB laboratory in Cross River State is expected to raise 
significantly Nigeria's TB diagnostic ability.  The April 27, 2009 
kick-off of the "Nigeria Stop TB Partnership" campaign will help 
raise needed awareness about the disease and availability of free 
medical care.  However, without addressing the broader problem of 
Nigeria's weak health infrastructure and strengthening standards of 
patient care in a sustained manner, the government's intention of 
preventing and controlling TB by 2015 will not be realized.  The GON 
also needs to significantly budget for the purchase of TB drugs and 
setting up the logistical system for their distribution.  (Note: 
virtually all TB drugs and diagnostic reagents are provided by 
donors, including the USG and Geneva-based Global Drug Facility. 
End Note).  Post sees the need for stronger advocacy here and in 
Geneva for a much more robust GON commitment to TB diagnosis, 
control and treatment.  End Comments. 
 
SANDERS