The Expanding Access to Lung Health and Tuberculosis Coverage (EXALT) TB REACH Project, implemented by Project HOPE Nigeria, has screened 113,935 people in Niger State, Nigeria, and uncovered significant gaps in the response to tuberculosis (TB), asthma, and pneumonia. The 22-month project, which took place in Paikoro, Gurara, and Suleja Local Government Areas, integrated screening, diagnosis, treatment, and referral for these respiratory diseases through primary healthcare facilities and community platforms. This initiative aimed to bridge the gap between people with respiratory symptoms and timely access to care.
The project led to the diagnosis of 263 TB cases, 468 asthma cases, and 805 pneumonia cases. Of the TB cases, 233 were bacteriologically diagnosed, and 259 patients were linked to treatment. The project recorded a 91 percent treatment success rate among 82 TB patients who commenced treatment between January and June 2025, exceeding the project's 80 percent benchmark. These results demonstrate the effectiveness of integrated lung health services in primary healthcare settings.
Stakeholders at the dissemination event in Abuja emphasized the need for stronger government ownership, financing, and integration of lung health services into Nigeria's primary healthcare system. Dr. Chidimma Anyanwu, Country Representative, Project HOPE Nigeria, said the project demonstrated that integrated lung health services could be delivered closer to communities through existing primary healthcare structures. However, she stressed that government ownership and financing were crucial for sustaining these services.
Dr. Inua Junaidu, Executive Director, Niger State Primary Health Care Development Agency, described the project's approach as "advanced integrated care," where patients presenting with respiratory symptoms could be assessed for TB, pneumonia, and asthma rather than being managed through separate disease-specific services. He urged Nigerians to seek medical attention when experiencing persistent cough, particularly if it lasts for more than two weeks.
The project identified persistent challenges, including long distances to molecular diagnostic centers, transportation costs, intermittent diagnostic commodity stock-outs, staffing shortages, incomplete referrals and follow-up, and limited availability and affordability of asthma and pneumonia medicines. Cultural beliefs also delayed healthcare-seeking, and health workers required continued mentoring in spirometry use and interpretation.
To sustain the gains, the project developed an Integrated Service Delivery Handbook for TB, asthma, and pneumonia in Nigeria, providing guidance on prevention, screening, diagnosis, treatment, referral, patient education, reporting, and monitoring. The handbook is expected to be published after technical review, and stakeholders will consider how lessons from the Niger State intervention can inform broader efforts to strengthen integrated lung health services across Nigeria.
The EXALT Project Reference Guide was launched to support health workers in the integrated management of TB, asthma, and pneumonia at primary healthcare and community levels. The guide provides practical direction on prevention, screening, diagnosis, treatment, referral, patient education, reporting, and monitoring. Project HOPE aims to support the continued strengthening and expansion of integrated lung health services beyond the project's life.
Key points
- The EXALT Project screened 113,935 people in Niger State, Nigeria, and diagnosed 263 TB cases, 468 asthma cases, and 805 pneumonia cases.
- Stakeholders stress the need for government ownership, financing, and integration of lung health services into Nigeria's primary healthcare system.
- The project developed an Integrated Service Delivery Handbook and a Reference Guide to support sustained integrated lung health services.
