By Sola Ogundipe

TOWARDS changing the profile of Nigeria as the country with the 4th largest burden of tuberculosis in the world, and at the same time  checkmate the national menace of HIV & AIDS epidemic, a collaborative venture  involving the National Tuberculosis & Leprosy Control Programme, the Institute of Human Virology, Nigeria (IHVN) and the United States-based Centres for Diseases Control  (CDC)  has established a first rate TB/HIV & AIDS reference laboratory in Zaria, Kaduna State.

Reputed to be one of the  foremost reference TB laboratories in sub-Saharan Africa, the new Centre, based in  Saye,  Zaria, Kaduna State, is set to swing into full action as soon as enough fund is available to fast track its mitgation of the public health burden posed by tuberculosis, which is becoming increasingly important.

From World Health Organisation (WHO) estimates, at least 25 per cent of new tuberculosis patients in Nigeria are living with HIV.  with more than 460,000 estimated new cases in 2007.  The WHO 2009 report on global TB control, notes that 42 percent of the new  TB cases in 2007 were sputum smear-positive (SS+). Lately, there has been concern about the public health burden posed by TB in Nigeria as the country’s HIV &AIDS epidemic unfolds. WHO estimates that more than a quarter of new TB patients are HIV positive. Collaborative TB-HIV/AIDS services are being scaled up and the number of TB patients tested for HIV increased from about 7,500 in 2006 to 27,850 in 2007, or about one-third of all notified cases.

The NTBLCP coordinates and provides strategic direction for TB control activities in Nigeria and it was after the Federal Ministry of Health declared TB a national emergency in April 2006 that it inaugurated the National TBHIV/AIDS Working Group in June 2006.

With this hindsight, the fact that  the new Centre at Saye serves the dual purpose as a collaborative  services provider and  training centre for medical personnel managing TB and HIV & AIDS, is not in doubt. To its credit, the Centre is an affiliate of the University of Maryland, United States of America.

Good Health Weekly gathered that the IHVN project is funded by the United States PEPFAR programme, and actually commenced collaborative work with the NTBLC in Zaria in 2006.

Already, the  state-of-the-art- facilities, are being test-run, and are due to be commissioned soon by  Federal government.

In a chat, the Chief of Party  IHVN, Dr. Patrick Dakum,  noted t hat the initiative was in consonance with Federal government’s determination to tackle HIV & AIDS and tuberculosis together. Dakum said the IHVN began with  activation of the Centre’s existing laboratory facilities and training of its staff in various aspects of good laboratory practices including smear microscopy for TB diagnosis and HIV rapid testing.  This included training on HIV counseling and testing for TB.

Through its PEPFAR funded AIDS Care Treatment in Nigeria (ACTION) project, the Centre has established a comprehensive diagnostic, treatment and care and support programme for HIV & AIDS  to cater for the high number of individuals co-infected with TB and HIV. According to Dakum, “Services at IHVN sites are designed using three structural principles: the hub and spoke model, decentralisation of services and integrated care and treatment. IHVN currently contributes over 70,000 patients on ART to the government of Nigeria AIDS treatment programme.”

The facilities are rated first class and absolutely ultramodern as far as  baseline investigation and follow-up of patients on ART is concerned.  During a visit to the Centre,  Director of the CDC, Dr. Tom Frieden, acknowledged this fact. “From fully equipped laboratories with the most advanced  diagnostic equipment to some of the most respected medical personnel around, this Centre really holds its own.”

In the view of Dr. Alash’le Abimiku, Associate Professor at the University of Maryland and Co-principal Investigator and Executive Director for the laboratory programme for IHVN, there is an ongoing capacity building programme for staff   with capacity for molecular diagnosis of TB and for EID and viral load.

Noting that no less than 1,433 patients have been attended to at the facility,
Abimiku expressed the essence of having in place a good laboratory component if the  menace of the HIV-TB combination is to be effectively tackled.

Through the set up at Saye, collaboration with the NTBLCP to establish laboratories with competence to  better diagnose and treat tuberculosis is to be achieved.  The Centre which provides a suitable training platform for related-fields in Nigeria turns out personnel classified as master trainers. Their number has increasd significantly from the 200 the Centre began with, she noted.

Abimiku stressed that the BSL3 laboratory set up at the Centre is one of its kind in the world that would allow isolation of different types of TB strains in the country.  Already, a  60-bed capacity unit has been proposed to manage detection of multi-drug resistant (MDR) TB  in the facility.

“It will be very comprehensive in terms of managing MDR TB. You have a first class laboratory that can isolate and monitor what is happening in the country because this centre is also part of the TB surveillance in the country.

“The MDR facility is not on ground yet, but I know there are plans to establish as part of the control measures of TB in the country under the Millennium Development Goals (MDGs) programme,” she stated.

Abimiku said the delivery of the reference laboratory was an incredible effort of the government of the country and its donor partners to make the incidence of TB history in the country.  She said it was important to know that if you handle TB very well and you also control HIV as well, it’s really a win-win situation for all stakeholders.

“I think we are making progress. It may not be the end of TB, but we have progressed in managing it appropriately and eventually, we would have the capacity to contain its dangers to lives. Fortunately for us, TB is a disease that can be treated and managed and if we continue on the path we are now with these excellent laboratories and adequate core clinical management support, I am sure Nigeria would be able to handle TB and second line drug regimen successfully,” she said.

Germfree, the US-based firm that built the facility,  would maintain the laboratory for the next five years and train local personnel. It was gatherd that the equipment are designed to work for between 15 to 20 years. “It’s probably going to take a year so that everything will be up and running. Our goal is to completely turn over the laboratories to the staff here to manage on their own.” Coordinator, NTBLCP,  Dr. Mansur Kabir, said the magnitude of  TB incidence in the country was worrisome.

“Tuberculosis is a big problem in this country and every year, we have between 460,000 – 500, 000 cases of the disease. Unfortunately, the national control programme recorded only 94,000 cases of treatment last year. This means that we have been able to take care of only a fraction of the patients and that is why this kind of centre is important for us to accelerate the treatment and to continue to train people to go into the rural areas and the communities to ensure that services are available to the citizenry,” Kabir stated.

In his view Firieden eopined the facility has capability to  train a large number of people to diagnose tuberculosiswhile improving quality of the testing done for people with HIV around the country. “Nigeria, this is a new facility to increase ability to diagnose and treat those with tuberculosis and HIV.”  Officials reckoned that the Centre would go a long way in reducing the burden of the condition.