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The Federal Government of Nigeria through National Agency for the Control of AIDS and KNCV, the technical partner, has successfully deployed and installed 185 GeneXpert machines used in diagnosing Tuberculosis (TB), detect TB multi-drug resistance for Persons Living with HIV and other risk groups, among other functions the Xpert machine is capable of carrying out.

Speaking at the NACA/KNCV Closeout Project meeting, the Director General, Dr. Sani Aliyu who was represented by Dr. Akudo Ikpeazu (Director, Programme Coordination Department (NACA), said the project was initiated in 2013 with funds from Global Fund grant to Nigeria and the implementation began in 2014. The DG NACA told the audience that the NACA/KNCV project is said to be the biggest single rollout project around the world as all the procured machines were successfully installed across selected health facilities providing Anti-Retroviral Therapy (ART) and Directly Observed Treatment (DOT) services.  Dr. Aliyu thanked the KNCV team who provided technical expertise to the project in terms of training, installation and maintenance of the machine throughout the project period.

L-R: Dr. Odume Betrand, representing of Country Director, Centre for Disease Control, Dr. Akudo Ipeazu, representing DG NACA and Mrs. Ineke Huitema, acting Country Director, KNCV TB Foundation, during the NACA-KNCV GeneXpert Project Closeout Meeting held in Abuja.

The Honorable Minister for Health Prof. Isaac Adewole ably represented by Dr. Lawanson Adebola, the National Coordinator of National Tuberculosis and Leprosy Control Programme (NTBLCP) said the Federal Ministry of Health is happy to be part of the success story of the GeneXpert rollout project, the availability of the machines in selected sites across the country has greatly improved the detection of TB especially among person living with HIV in Nigeria. The Health Minster’s representative acknowledged that there were initial challenges when the project commenced but with the help of State TB officers, the challenges were resolved. Dr. Adebola also note that TB case notification, identification and diagnosis is now about 70% which shows a significant improvement in the country’s TB response and with the Government Policy on the GeneXpert machine, the response can only get better. Dr. Adebola went on to make known the intention of the Federal Government plan to deploy more GeneXpert  machines to cover the 110 revitalized Primary Health Care Centres across the senatorial district in the county, she however pointed out that there are challenges that must not be overlooked even as the project come to a close, “an exit strategy must be put in place by KNCV to ensure the machines are maintained, training and retraining of staff who will be handling the machines are routinely carried out and plans to ensure the machines are able to perform maximally all other functions aside TB diagnosis equally put in place. The representatives of the minister for Health concluded by thanking Global Fund for providing funds for the procurement of the GeneXpert machines, and other partners who had in one way or the other contributed to the success of the programme.

Goodwill messages were delivered by representatives of National AIDS and STI Control Programme (NASCP), FHI 360, World Health Organization (WHO), Centre for Disease Control (CDC), United State Agency for International Development (USAID), Country Coordinating Mechanism (CCM) and Joint United State Nations Programme on HIV/AIDS (UNAIDS). They were all full of praises for the execution of such tasking project but admonish NACA not to relent on its effort in ensuring the project continues to work effectively even after the exit of KNCV on the project, they encouraged NACA to partner all relevant agencies that can help in providing further technical, administrative, human resource and financial assistance in order to ensure ownership and sustainability of the project.

Presentations on the achievements, challenges, partnership and collaboration was presented at the close out meeting. The NACA/KNCV partnership was conceived in 2013 with soul aim of increasing TB diagnosis among PLHIV, reduce pool of undetected PLHIV Co-Infection with TB due to low sensitivity of microscopy test, to increase the number PLHIV receiving HIV and TB treatment, and reduce the number of TB related deaths among PLHIV.

The acting Country Coordinator for KNCV, Mrs. Ineke Huitema told the audience that the partnership between NACA and KNCV has yielded positive result and went on to share some of the achievements the project recorded, which includes:

The deployment and installation of GeneXpert machines across the six geo-political zones:

              – North Central 38

               – North East       33

               – North West      28

               – South East        24

               – South South    28

               – South West      34

Training of 58 certified resource persons on GeneXpert MTB/RIF installation available expanding the national pool of trainers. 3 Training of Trainers (ToT) was conducted and 55 ToT resource persons emerged.

Establishment of a maintenance plan for all GX MTB/RIF machines:

               – Five years warranty on 185 machines

               –  Yearly calibration through (ASP) KNCV/Cepheid

               – Number of Calibration kits procured 185

               – Total Calibrations done 96 (52%)

               – Algorithm on the maintenance process

Establishment of a supply management plan for GeneXpert MTB/RIF cartridges:

               – Baseline supply of 150 cartridges 3 kits/site   (27,750 total)

               – IHVN (GF-SR), CGAT and NTBLCP through the states for resupply logistics.

Establishment of supervision and mentoring system integrated within the existing TB/HIV supervision mechanism:

– 185 remote mentoring and supervisory calls 2 weeks post installation 100% done

– 135 onsite mentoring and supervisory visits to sites 73% done

A GeneXpert MTB/RIF M&E system in place including recording and reporting tools:

               – NTP tools supplied to sites by STBLCP

               – Adherence is ensured through mentoring and supervision.

               Tests performed: 54,029

• MTB detected: 9,652  (17.9% positivity rate)
• Rifampicin resistance detected:               2,145 (22.2%) among MTB detected
• Rifampicin resistance indeterminate:  424 (4.4%)
• Invalid/No Result: 1,927 (3.6%),
• Errors: 1,539 (2.96%)
• Number of PLHIV from total number of tests: 19,806
• Total Female PLHIV: 11,918
• Total Male PLHIV: 7,848
• Total Tested HIV status Negative: 23,429
• Total tested HIV status Unknown: 5,685

**NACA GeneXpert results 2015 – 2016 fourth quarter report**

The NTP leadership oversees GeneXpert MTB/RIF implementation at national and at state levels.

An operational research protocol related to the implementation of this GeneXpert MTB/RIF project developed and implemented with a capacity-building approach.

The KNCV Acting Country Coordinator thanked the NACA GeneXpert team which was constituted at the beginning of the project, she said team had worked in collaboration with the KNCV team members to achieve the project goal and objectives. Mrs. Huitema said NACA must ensure this massive investment do not go down the drain, all trainings and experience gathered during the entire project implementation should help NACA in ensuring the project is kept alive and it continues to contribute to the well-being of PLHIV in Nigeria.