Boost molecular epidemiology laboratory capacity to detect drug-resistant TB

Africa’s most populous country has the world’s fifth largest TB burden, compounded by a high prevalence of TB-HIV co-infection. The increasing emergence of TB strains that are resistant to multiple TB drugs is severely limiting treatment options and hampering control efforts. 

In 2007, the Nigerian Institute of Medical Research (NIMR) sought funding from IANPHI to develop molecular biology capacity for rapid TB drug sensitivity testing in Nigeria. In just a year and with only a small infusion of funds, NIMR established a national reference laboratory for MDR-TB diagnosis and introduced a new rapid molecular test on sputum that can detect strains resistant to anti-TB drugs isoniazid and rifampin.

NIMR succeeded in developing institutional capacity for use of the rapid GenoType MTBDRplus test (developed by Hain Lifescience with support from the Foundation for Innovative New Diagnostics – FIND). It also has started using it as an important epidemiologic tool for detection and control of MDR-TB in Nigeria. Training and validation support for this effort was provided by two IANPHI member institutes, the US CDC and South Africa’s National Institute of Communicable Diseases, as well as Hain Lifescience and the Harvard School of Public Health.

Since establishing testing capacity, NIMR has been receiving samples from zonal TB labs in the country as well as from clinics in and around Lagos. Results represent the main source of data on MDR-TB in Nigeria for reporting to WHO. Of the total number of tests conducted in project year one, 5% were resistant to isoniazid and rifampin (MDR-TB); 16.7% were resistant to rifampin; and 2.6% were resistant to isoniazid alone.

Routine MDR-TB testing will provide clinicians with information to guide clinical management options for each patient and contribute significantly to the control of MDR-TB in the country. The new Hain assay is also the foundation of the first-ever national TB prevalence survey in Nigeria which began in 2009.

In the third year of IANPHI funding, NIMR will continue to strengthen its public health capacity through collaborative efforts to expand MDR-TB surveillance and training. The project is a model for other developing countries and has attracted the interest of WHO, resulting in Green Light Committee approval for Nigeria to obtain second-line antituberculosis drugs at reduced cost for treatment of MDR-TB.

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