Gender disaggregation of the TB care cascade in Nigeria: a four-year retrospective study 2018-2021.

Background: The global TB burden shows significant gender disparity with men and women facing distinct challenges in accessing comprehensive care for TB. A full understanding of the gender dimensions of the TB epidemic is crucial for appropriate policy interventions and we therefore explored gender differences in the TB service cascade in Nigeria.

Methods: A retrospective gender-based analysis of the TB care cascade was conducted covering the four-year period between 2018-2021. We obtained sex-disaggregated service utilisation data for adults (aged ≥15 years) in 14 states through the monitoring and evaluation systems of the TB control programme. Using a care cascade framework, we present numbers accessing care at each step and gaps for men and women including TB/HIV collaborative services.

Results: Overall, amongst men, 12.3 million visited health facilities, 6 million were screened for TB and 833,483 were identified as presumptive cases, of which 79% were tested for TB. For women, 12.3 million visited facilities, 6.9 million screened and 664,130 identified as presumptive cases, of which 76% were tested. Men exhibited a higher screening gap, whereas women had a higher testing gap, with variations in treatment outcomes across both genders.

Conclusion: The TB surveillance system screened more women and diagnosed more men with the disease, with significant missed opportunities and gaps along the continuum of care for both men and women. Targeted policy interventions are required to strengthen surveillance, data systems and to reduce gender inequity across the TB care cascade in Nigeria.