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

Background: 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 efforts to engage these informal providers for tuberculosis (TB) care in Africa are limited. Methods: We evaluated the impact of intervention to engage informal health providers to increase TB linkages to treatment in Adamawa and Yobe States between October 2020 and December 2022. Four local government areas (LGA) were included as intervention areas and four others as control areas. PPMVs and THs leadership were engaged, and providers were mapped. Community 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. Results: In the intervention area, 344 PMVs 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 TB notifications increased by 16.5% while bacteriologically confirmed TB increased by 16.7% compared to the baseline fuelled by a 97.1% increase in diagnostic testing. Conclusion: Many people with TB seek care from informal providers like PMVs and THs in Nigeria. Properly engaging these providers at scale could improve TB detection.