Nigeria has a population of 213 million people and is among the countries with the highest TB burden and among the 10 countries accounting for over 70% of the global gap in TB case detection and notification. This gap in TB case identification is a major area of focus for the National TB Program. In 2021, the TB incidence was estimated to a total of 467,000 persons who have active TB disease. The National TB, Leprosy and Buruli Ulcer Control Program (NTBLCP) notified 207,785 having a gap of 56% of the estimated cases unidentified and about 2,975 DR-TB cases were diagnosed out of an estimated 21,000 cases in the country, leaving out more than 80% of the resistant cases missing.

Nigeria conducted the BpaL operational research (OR) in 8 States, supported by the SMT Endowment funds from the Netherlands. A nationwide roll out was planned in the first half of 2023. However there have been delays in drugs delivery and review and approval of national guidelines. In 2023, the lack of funding allocation for the dissemination of these guidelines and the capacity building required for this scale-up, delayed the roll out plan. Support is then needed for the finalization of the guideline and its dissemination.

The partner landscape for the support of new drugs and regimens in 2024 includes the USAID LON project and funding for capacity building under the approved Global Fund budget. The establishment of a joint roadmap will help to align efforts across the different partners.

As Nigeria moves towards the nationwide scale-up of the BPaLM/BPaL regimen, the country will benefit from technical and financial support to ensure success of this scale-up. Following the BpaL pilot carried by KNCV Nigeria, several modalities need to be put in place, including the development of a roadmap for transition to the BPaLM/BPaL regimen, review, and dissemination of the National DR-TB guidelines, laboratory upgrades for drug susceptibility testing (DST) of new drugs, drug logistic management system, active drug-safety monitoring and management (aDSM), drug intake monitoring and capacity building of resource persons.

With support from the ASCENT DR-TB project, identified gaps will be addressed, to ensure seamless transition into the BPaLM/BPaL regimen and prompt national scale.