Early experience in implementation of an integrated COVID-19 and TB community-based active case finding in Nigeria

Background: Nearly all countries around the world have felt the great impact of COVID-19, resulting in a global health crisis. The KNCV TB foundation Nigeria-funded by USAID for comprehensive TB care leveraged on existing structure and resources to partner with Kaduna state government to roll out an integrated COVID-19 and TB case-finding intervention. This was implemented using a mobile diagnostic van equipped with GeneXpert and digital X-ray from June to July 2020 in Kaduna State. The community-based strategy also integrated screening for HIV, HBsAg, and Malaria. Screening algorithm, recording tools and SOPs were developed that guided the intervention. Of 1,931 persons enrolled and 1,928 (99.8%) screened using CAD4TB x-ray, 83 presumptive TB were identified;11 (13%) cases of TB diagnosed with GeneXpert. Among persons screened, 1,252 nasopharyngeal swabs were collected and tested with SARS COV-2, and all screened for HIV with 183 (15%) COVID-19 and 12 (1.0%) HIV cases diagnosed. COVID-19/HIV co-infection rate was 0.5% and COVID TB co-infection rate was 0%.. The integrated approach to COVID-19 testing was built on existing TB structure and successfully implemented through a multi-stakeholder collaboration backed by a strong political commitment at the sub-national level. Key lessons from this early intervention are informing scale-up across other states in Nigeria.