Optimizing Tuberculosis Case Detection in Nigeria: A Task Shifting Approach in Gombe State, Northeast, Nigeria
Abstract:
Background: Nigeria continues to face significant challenges in tuberculosis (TB) detection and control, espe cially in resource-limited settings. Innovative strategies, such as task shifting, have been proposed to improve case finding.
Objective: To evaluate the impact of a taskshifting approach on TB case detection and management in Gombe State, Nigeria.
Methods: This mixed-methods case study assessed the implementation of a task-shifting intervention involving the training of community health workers (CHWs) to perform TB screening, sputum collection, and referral. Quantitative analysis involved a pre-post comparison of TB case notification data using chi-square tests, interrupted time-series analysis to model monthly detection trends, and multivariable logistic regression to identify factors associated with treatment adherence. These data were supplemented with qualitative analysis of thematic content from focus group discussions and in-depth interviews with key stakeholders, including CHWs, patients, and healthcare providers.
Results: The intervention markedly improved all measured outcomes. Case detection increased substantially, with confirmed TB cases more than doubling (131.5% increase, from 127 to 294). Bacteriologically confirmed cases nearly tripled, showing a 187.6% increase. The diagnostic turnaround time was drastically reduced from an average of 14 days to under 48 hours (p<0.001). Treatment outcomes also improved significantly. The rate of treatment initiation within 48 hours rose to 90.2%. Conversely, the default rate fell sharply by 71% (from 20.2% to 5.8%). Stakeholder interviews corroborated these quantitative findings, highlighting enhanced com munity trust and the critical role of CHWs in outreach.
Conclusion: Task shifting is an effective strategy to improve TB case detection and can serve as a scalable model for Nigeria’s TB control efforts. Sustained policy support and capacity-building are vital for long-term success.
