Increasing detection of individuals with tuberculosis through engagement of informal health care providers in Northeastern Nigeria

Patent and proprietary medicine vendors (PPMVs) and traditional healers (THs) are informal healthcare providers with a significant presence in Nigeria and many parts of Africa. They have established partnerships and trust with community stakeholders and are often the first point of contact for health-seeking, especially in rural communities. Disease programs like malaria have engaged PPMVs, but documentation on efforts to engage these informal providers for tuberculosis (TB) care in Africa is limited. We evaluated the impact of an intervention engaging informal health providers to increase linkages of people with presumptive TB to testing and treatment in Adamawa and Yobe States between October 2020 and December 2022. Four local government areas (LGAs) were included as intervention areas and four others as control areas. PPMVs and THs’ leadership were engaged, and providers were mapped. Community health volunteers were linked to PPMVs and TH and supported the intervention. TB screening was conducted among clients of PPMVs and THs, and people with presumptive TB had sputum samples collected and transported for diagnostic testing and treatment. In the intervention area, 344 PPMVs and 142 THs were mapped, and 120 PPMVs (35%) and 60 THs (42%) were successfully engaged. Informal providers identified 7,553 individuals with presumptive TB and linked 6,920 (92%) to testing. A total of 1,014 individuals with TB (926 with bacteriological confirmation) were detected. All forms of TB notifications increased by 16.5% (13% in control areas) while bacteriologically confirmed TB increased by 16.7% (14.3% in control areas) compared to the baseline, fuelled by a 97.1% increase in diagnostic testing. A substantial proportion of people with TB seek care from informal providers like PPMVs and THs in Nigeria. Properly engaging these providers at scale could improve TB detection.