Abstract

Nigeria is among the fourteen countries with the highest MDR-TB burden, and accounts for 12% of the global gap in DRTB diagnosis. Several control strategies have been put in place to ensure that all DRTB patients are diagnosed and placed on treatment, but this has not significantly closed this diagnostic gap. This study seeks to identify the drug resistant TB treatment service alignment with health seeking behavior of patients. The cross-sectional study under program implementation was carried out in 14 states among public and private healthcare facilities across different levels of care from June 2020 to December 2021. Data collection was carried out using an open-ended questionnaire and analyzed using Tableau 15 (version 2021.4 Germany). In public sector primary facilities only 14% facilities provide DR-TB services. States with highest availability of DRTB services do not have patients who first sought care at this level. In the secondary facilities, 14% of states have about 50% of their facilities providing DR-TB treatment services, and this aligns with where patients are seeking care in these states. For tertiary facilities, 28% of states have ≥ 50% facilities with DR-TB treatment services, but most patients do not first seek care at this level. The DRTB service availability in the private sector is low across all levels of care. There is a misalignment of availability of DR-TB services with facilities where patients first seek care. This insufficient and inequitable distribution should be a priority for TB control in order to close the DRTB notification and enrolment gap in Nigeria.

Key words: Patient pathway analysis, drug resistant tuberculosis, treatment service analysis, health seeking behavior.