Despite a high incidence of tuberculosis (TB), Nigeria has one of the lowest case detection rates among high TB burden countries. With an estimated 429,000 new cases in 2018 according to the World Health Organization, only a quarter of this number was reported as receiving treatment. Strengthening the private sector’s capacity to detect, treat, and educate communities about TB is vital to reducing the incidence rate of the disease. Stigma and misconceptions about TB are significant challenges for the detection and treatment of TB in Nigeria, as they discourage people from seeking care.
In Nigeria, SHOPS Plus works to scale up TB testing, treatment and prevention in the private sector through provider networks in Lagos and Kano states, two states with high TB burdens and high levels of private sector activity. Private providers are grouped into networks of clinicians, patent and proprietary medicine vendors, community pharmacists, and lab scientists who work together to screen, test, refer, and treat patients for TB. With the inclusion of behavior change campaigns and the mobilization of community members, the SHOPS Plus project aims to increase the number of clients who seek TB screening and treatment by reducing stigma and providing communities with accurate information about TB.
James Onu, the director of the Jimac Laboratory in Ikorodu, Lagos, often sees clients that test positive for TB but do not seek follow-up treatment. Onu explains that due to widespread stigma and fear, patients may either refuse treatment or simply not return to receive it if tested positive. To fight this pattern and increase treatment uptake, Onu educates his clients about TB with the help of SHOPS Plus’s educational material and outreach events. Onu displays a SHOPS Plus poster in his waiting room that communicates the hopeful message that TB is curable and that patients can return to good health with the right medication. In addition to Onu’s lab, the program partners with other networked facilities to educate community leaders and increase awareness through TB outreach events. Through these efforts, community leaders are encouraged to refer presumptive patients to providers and community members are screened in local markets or places of worship.
Engaging communities in stigma reduction
Sadiq Ozovehe is a medical doctor and the owner of Al Sadiq Hospital located in Kosofe, Lagos. Like Onu, he witnesses the effects that widespread TB stigma and misconceptions have on his community. To Ozovehe, one of the most detrimental misconceptions he sees is the belief that TB is not a critical health issue. Ozovehe recognizes that while it can be difficult to shift beliefs and attitudes about the disease, outreach events provide ample opportunity to spread awareness and share facts about TB to a large audience. Ozovehe has held successful outreach events in his community, the most recent of which was located in the local government area of Kosofe in Lagos. The turnout of this outreach event was particularly high, which has encouraged Ozovehe to organize future outreach events where more community members can be educated about and tested for TB.
A vital component to increasing TB case detection and treatment is reducing stigma and inaccurate information associated with the disease. As part of supporting awareness and outreach events, SHOPS Plus created brochures, educational flipcharts, and posters to help providers change pre-existing attitudes and disseminate accurate information about TB. By implementing behavior change campaigns and supporting provider engagement and outreach events, SHOPS Plus is helping its networked providers overcome the stigma barrier and improve TB case detection and treatment outcomes.