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Setting: Nigeria adopted GeneXpert MTB Rif as a primary diagnostic tool were available and accessible since 2016. The current geographical coverage of GeneXpert machines by LGAs stands at 48%, with a varied access and utilization. Objectives: To assess the association between the type and level of health facilities implementing GeneXpert MTB/Rif and performance outcome of the machines in Nigeria. Study Design: Retrospective secondary data analysis of GeneXpert performance for 2017 from GXAlert database. The independent variables were type and levels of health care facilities, and dependent variables were GeneXpert performance (utilization, successful test, error rates, MTB detected, and Rifampicin resistance detected). Results: Only 366 health care facilities are currently implementing and reporting GeneXpert performance, the distribution is 86.9% and 13.1% public and private health care facilities respectively, and only 6.3% of the facilities are primary health care. Of 354,321 test conducted in 2017, 91.5% were successful, and among unsuccessful test 6.8% were errors. The yield was 16.8% MTB detected (54,713) among which 6.8% had Rif resistance. The GeneXpert utilization rate was higher among private health care facilities (55.8%) compared to 33.3% among public health care facilities. There was a statistically significant difference in the number of successful test between public and private health facility-based machines as determined by one-way ANOVA (F(1,2) = 21.81, P = 0.02) and between primary, secondary and tertiary level health facility-based machines (F(1,2) = 41.24, P < 0.01). Conclusion: Nigeria with very low TB coverage should rapidly scale-up and decentralize GeneXpert services to the private sector.

Wellness on Wheels (WoW) provided mobile systematic TB screening of high-risk populations combining digital chest radiography with computer-aided automated interpretation and chronic cough screening to identify beneficiaries of GeneXpert MTB/RIF testing in communities and prisons. We piloted and refined approaches in phased evaluations, recalibrating CAD4TB thresholds adjusting to balance TB yield and feasibility. Iterative data monitoring of screening volumes, risk mix, number needed to screen (NNS), number needed to test (NNT), sample loss, TB treatment initiation and HIV testing are required. Given pre-selection of highest risk individuals via an accurate screening test, inability to collect or test samples impacts yield and cost-per-case. Linkage to care and treatment outcomes improved overtime. Short conclusion: Mobile computer-assisted digital chest x-ray and chronic cough screening with GeneXpert MTB/RIF testing is feasible, acceptable, efficient and high-yield when highest risk groups are engaged, and operations evolve in response to monitoring data.