Abstract
Nigeria has the second largest share of missing tuberculosis (TB) cases according to WHO estimates. In response, stakeholders are implementing public-private-mix approaches to bolster provision of high-quality services and prevent losses in the TB care cascade. Considering the COVID-19-related health care disruptions observed on a global scale, the goal of this study is to understand private providers鈥� adherence to TB service guidelines in Nigeria since the onset of the pandemic. The study uses standardized patient (SP) surveys conducted in May and June 2021 to assess quality of TB care before and after pandemic onset. SPs completed 514 interactions in Lagos and Kano state, Nigeria. All visits were conducted using a 鈥渢extbook鈥� case of presumptive TB, which describes a patient with three weeks of cough, mild fever, and some weight loss. Provider interactions were recorded using exit surveys and assessed against a composite measure of patient management that aligns with guidelines and standards of care established by Nigeria鈥檚 National TB Program. Initial data analysis showed a minority of providers (23%) correctly managed presumptive TB SPs by screening, initiating an appropriate diagnostic, and refraining from prescribing unnecessary/inappropriate drugs. Results from a previous SP survey in 2019 already demonstrate a need for increased quality of TB care. Examining if and how the pandemic has further affected quality will help providers, implementers, and policymakers adapt and iterate ongoing efforts to improve services and build back better after the pandemic subsides.
