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SETTING: This study is a retrospective review of a large-scale systematic TB screening project conducted in six states of Nigeria. OBJECTIVE: To determine the magnitude and characteristics of subclinical TB and the relative contributions of bacteriological versus clinical diagnosis in its identification in Nigeria. DESIGN: Data were retrospectively analysed from six states of Nigeria, where parallel screening with any TB symptoms and chest X-ray (CXR) with artificial intelligence (AI) was used for active case finding. Diagnosis of TB among presumptive was confirmed using either bacteriological tests or clinical review of CXR. RESULTS: Out of 8,516 presumptive identified during the project, 172 (2.0%) had no TB symptoms (males: 73.8%, females: 26.2%). The overall prevalence of TB among all presumptive was 21.9% (n = 1,867), including 62 (3.3%) subclinical TB and 1,805 (97.3%) active TB cases. The proportion of clinical diagnosis using CXR was significantly higher in the subclinical TB group than in the active TB group (79.0% vs. 63.5%; P = 0.012, OR = 2.2, 95% CI 1.17–4.03). CONCLUSION: Subclinical TB contributed 3.3% of the large TB burden in this study (22 per 100 presumptive). These cases would have been missed if only symptom-based TB screening had been employed.

OBJECTIVE: To evaluate the impact of Truenat assays on the diagnosis of TB at peripheral facilities in Nigeria. METHODS: This was a retrospective cross-sectional study across 34 out of 38 Truenat-implementing facilities in Nigeria. These facilities offer DOTS services. Information on turnaround time (TAT) for TB diagnosis and time to commencement of treatment was obtained. Also, trends in TB case notifications at the facilities 9 months prior to and 9 months during Truenat implementation were compared. RESULTS: Of 2,335 entries, 70.1% (1,636) were used to determine TAT, while 45.8% (n = 1,070) were used for time to treatment initiation. The median time to diagnosis was

INTRODUCTION: Successful treatment of TB requires high levels of adherence to treatment. This has been found to be below optimal with directly observed therapy (DOT), and digital adherence technologies (DATs) offer a promising approach to non-adherence to medication and improving treatment outcomes. This study explores the perception, acceptability, and challenges of DATs among healthcare workers (HCWs). METHODS: The study was conducted in eight states in Nigeria among Health Care workers involved in treating patients with TB. This was a descriptive cross-sectional study using an open questionnaire and analysed using IBM SPSS v25. RESULTS: Twenty-three HCWs (95.8%) agreed that DATs helped them provide better support and counselling to their patients. All of them would recommend DATs to their patients and found it easy to explain them. Eleven (45.8%) of them were not able to use DATs on a few occasions; their reasons were poor network (n = 9, 37.5%) and (n = 1, 4.2%) power failure. CONCLUSION: DATs help HCWs provide better support and care regarding real-time tracking of their patients’ adherence to treatment and possibly reduction of attrition. This implies that DATs are a suitable alternative to DOT to help HCWs provide the best care and support to their patients towards achieving the End TB targets.

INTRODUCTION: Poor adherence to TB treatment poses a significant public health threat to TB control programmes. The sustainability of directly observed treatment has been questioned because of its non-patient-centred approach and resource-intensive nature, and Digital Adherence Technologies (DATs) provide a suitable alternative. This study assessed the feasibility and acceptability of DATs among patients with TB. METHODS: This descriptive study was conducted in eight states in Nigeria among all patients with drug-susceptible TB. RESULT: A total of 230 patients (89.1%) own a phone that no one else uses, and 18 (7.0%) use a family phone. A higher proportion of 189 (73.3%) have airtime credit and 119 (46.1%) have internet credit on their phone. In addition, 216 (83.7%) stated that the reminders they received on their phone helped them remember to take their medicine. Only 11 (4.3%) patients missed a dose of the TB medicine. Equally, 11 (4.3%) patients had taken their TB medicine without using DAT. Of these, 7 (63.3%) did not use DATs because they forgot to text medication labels, and 3 (27.6%) did so because of poor network. Only four (1.6%) purchased additional items to support the use of DATs. CONCLUSION: DATs are acceptable in a wide variety of settings, even with reported challenges. Implementation efforts should ensure access, address technical challenges, and minimise additional cost to patients.

Background: Proficiency testing (PT) is a means of verifying the reliability of laboratory results, but such programmes are not readily available to laboratories in developing countries. This project provided PT to laboratories in Nigeria. Objectives: To assess the proficiency of laboratories in the diagnosis of HIV, tuberculosis and malaria. Methods: This was a prospective study carried out between 2009 and 2011. A structured questionnaire was administered to 106 randomly-selected laboratories. Forty-four indicated their interest in participation and were enrolled. Four rounds of pre-characterised plasma panels for HIV, sputum films for tuberculosis and blood films for malaria were distributed quarterly by courier over the course of one year. The results were returned within two weeks and scores of ≥ 80% were reported as satisfactory. Mentoring was offered after the first and second PT rounds. Results: Average HIV PT scores increased from 74% to 95% from the first round to the third round, but decreased in the fourth round. For diagnosis of tuberculosis, average scores increased from 42% in the first round to 78% in the second round; but a decrease to 34% was observed in the fourth round. Malaria PT performance was 2% at first, but average scores increased between the second and fourth rounds, culminating in a fourth-round score of 39%. Many participants requested training and mentoring. Conclusions: There were gross deficiencies in the quality of laboratory services rendered across Nigeria. In-country PT programmes, implemented in conjunction with mentoring, will improve coverage and diagnosis of HIV, tuberculosis and malaria.

Background: The Nigerian Institute of Medical Research houses two reference laboratories: the virology and tuberculosis laboratories. Both were enrolled in the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme. Objective: To describe the impact of SLMTA and discuss factors affecting the results, with an emphasis on mentorship. Methods: The SLMTA programme was implemented from April 2010 through November 2012. Participants attended three workshops and executed quality improvement projects; laboratory auditors evaluated performance using a standard checklist. The virology laboratory did not receive mentorship; however, the tuberculosis laboratory had an international mentor who visited the laboratory four times during the programme, spending two to four weeks embedded within the laboratory during each visit. Results: There was an overall improvement in the performance of both laboratories, with the virology laboratory increasing 13% (from 80% at baseline to 93% at exit audit) and the tuberculosis laboratory increasing 29% (from 66% to 95%). These scores were maintained nine months later at the surveillance audit. Conclusion: The SLMTA programme resulted in improved and sustained quality management performance for both laboratories. Mentoring was a possible factor in the substantial improvement made by the tuberculosis laboratory and should be considered in order to augment the training received from the SLMTA workshops.

Vascular pathologies are prevalent in a broad spectrum of diseases, necessitating a deeper understanding of vascular biology, particularly in overcoming the oxygen and nutrient diffusion limit in tissue constructs. The evolution of vascularized tissues signifies a convergence of multiple scientific disciplines, encompassing the differentiation of human pluripotent stem cells (hPSCs) into vascular cells, the development of advanced three-dimensional (3D) bioprinting techniques, and the refinement of bioinks. These technologies are instrumental in creating intricate vascular networks essential for tissue viability, especially in thick, complex constructs. This review provides broad perspectives on the past, current state, and advancements in key areas, including the differentiation of hPSCs into specific vascular lineages, the potential and challenges of 3D bioprinting methods, and the role of innovative bioinks mimicking the native extracellular matrix. We also explore the integration of biophysical cues in vascularized tissues in vitro, highlighting their importance in stimulating vessel maturation and functionality. In this review, we aim to synthesize these diverse yet interconnected domains, offering a broad, multidisciplinary perspective on tissue vascularization. Advancements in this field will help address the global organ shortage and transform patient care.

Setting: This study is a retrospective review of a large-scale systematic TB screening project conducted in six states of Nigeria., Objective: To determine the magnitude and characteristics of subclinical TB and the relative contributions of bacteriological versus clinical diagnosis in its identification in Nigeria., Design: Data were retrospectively analysed from six states of Nigeria, where parallel screening with any TB symptoms and chest X-ray (CXR) with artificial intelligence (AI) was used for active case finding. Diagnosis of TB among presumptive was confirmed using either bacteriological tests or clinical review of CXR., Results: Out of 8,516 presumptive identified during the project, 172 (2.0%) had no TB symptoms (males: 73.8%, females: 26.2%). The overall prevalence of TB among all presumptive was 21.9% ( n = 1,867), including 62 (3.3%) subclinical TB and 1,805 (97.3%) active TB cases. The proportion of clinical diagnosis using CXR was significantly higher in the subclinical TB group than in the active TB group (79.0% vs. 63.5%; P = 0.012, OR = 2.2, 95% CI 1.17-4.03)., Conclusion: Subclinical TB contributed 3.3% of the large TB burden in this study (22 per 100 presumptive). These cases would have been missed if only symptom-based TB screening had been employed., (© 2024 The Authors.)

In January 2020, WHO released a rapid communication on use of molecular assays as initial tests for diagnosis of tuberculosis, recommending Truenat as a replacement for smear microscopy in TB diagnosis. This study was designed to assess perceived ease of use of Truenat among Laboratory staff as a new diagnostic tool for TB in Nigeria. This study used a cross-sectional design. All trained Laboratory personnel operating the Truenat Duo equipment in 38 Truenat sites in the country were included. Information was obtained using a pre-tested self-administered questionnaire. Ease of use of Truenat was assessed using twenty-three variables on a five-point Likert scale of 1-5. The variables were analyzed quantitatively and qualitatively. Good Ease of use of Truenat was determined by proportion of respondents who answered ≥70% of the variables in the positive. All 50 Truenat Laboratory staff participated in the study. (Response rate 100%). Majority, (58%) were male. The median estimated number of tests before Laboratory staff became proficient with Truenat machine was 9 (IQR, 4-20), median number of tests to be analyzed within eight working hours was 10, (IQR = 8-15) and median time to conduct a Truelab MTBPlus test from start to finish was 60 minutes (IQR = 60-80). The commonest operational challenge that required Molbio service support was Trueprep errors/blockage, 47.4%. Overall, mean ease of use score was 4.0±0.4. Majority, (76%) had Good Ease of use of Truenat. No factor significantly influenced Ease of use of Truenat. Truenat machine is easy to use for a trained laboratory staff with minimal technical support and hence could be rolled out easily and successfully by various National TB Programs. Considering the high Trueprep challenges reported, there is need for further studies into the common errors/challenges, the contexts surrounding them and the programmatic intervention to address the high rate of Trueprep equipment faults., Competing Interests: The authors have declared that no competing interest exist., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

Objective: To evaluate the impact of Truenat assays on the diagnosis of TB at peripheral facilities in Nigeria., Methods: This was a retrospective cross-sectional study across 34 out of 38 Truenat-implementing facilities in Nigeria. These facilities offer DOTS services. Information on turnaround time (TAT) for TB diagnosis and time to commencement of treatment was obtained. Also, trends in TB case notifications at the facilities 9 months prior to and 9 months during Truenat implementation were compared., Results: Of 2,335 entries, 70.1% (1,636) were used to determine TAT, while 45.8% ( n = 1,070) were used for time to treatment initiation. The median time to diagnosis was <24 hours (IQR 0-1 days). The majority (57.9%) were diagnosed in <24 hours. The median time to treatment initiation was 1.5 days (IQR 0-3). In 9 months before the introduction of Truenat, 8% of 20,424 presumptives evaluated were positive for TB, while during the implementation, 9% of 37,087 presumptives were positive for TB., Conclusion: Truenat deployment led to an increase in TB and DR-TB case detection in peripheral facilities in Nigeria. It also decreased TAT and time to TB treatment initiation. These have positive implications in the fight against TB, and Truenat is relevant in finding missing TB cases in Nigeria., (© 2024 The Authors.)

Introduction: Successful treatment of TB requires high levels of adherence to treatment. This has been found to be below optimal with directly observed therapy (DOT), and digital adherence technologies (DATs) offer a promising approach to non-adherence to medication and improving treatment outcomes. This study explores the perception, acceptability, and challenges of DATs among healthcare workers (HCWs)., Methods: The study was conducted in eight states in Nigeria among Health Care workers involved in treating patients with TB. This was a descriptive cross-sectional study using an open questionnaire and analysed using IBM SPSS v25., Results: Twenty-three HCWs (95.8%) agreed that DATs helped them provide better support and counselling to their patients. All of them would recommend DATs to their patients and found it easy to explain them. Eleven (45.8%) of them were not able to use DATs on a few occasions; their reasons were poor network ( n = 9, 37.5%) and ( n = 1, 4.2%) power failure., Conclusion: DATs help HCWs provide better support and care regarding real-time tracking of their patients' adherence to treatment and possibly reduction of attrition. This implies that DATs are a suitable alternative to DOT to help HCWs provide the best care and support to their patients towards achieving the End TB targets., (© 2024 The Authors.)

Introduction: Poor adherence to TB treatment poses a significant public health threat to TB control programmes. The sustainability of directly observed treatment has been questioned because of its non-patient-centred approach and resource-intensive nature, and Digital Adherence Technologies (DATs) provide a suitable alternative. This study assessed the feasibility and acceptability of DATs among patients with TB., Methods: This descriptive study was conducted in eight states in Nigeria among all patients with drug-susceptible TB., Result: A total of 230 patients (89.1%) own a phone that no one else uses, and 18 (7.0%) use a family phone. A higher proportion of 189 (73.3%) have airtime credit and 119 (46.1%) have internet credit on their phone. In addition, 216 (83.7%) stated that the reminders they received on their phone helped them remember to take their medicine. Only 11 (4.3%) patients missed a dose of the TB medicine. Equally, 11 (4.3%) patients had taken their TB medicine without using DAT. Of these, 7 (63.3%) did not use DATs because they forgot to text medication labels, and 3 (27.6%) did so because of poor network. Only four (1.6%) purchased additional items to support the use of DATs., Conclusion: DATs are acceptable in a wide variety of settings, even with reported challenges. Implementation efforts should ensure access, address technical challenges, and minimise additional cost to patients., Competing Interests: Conflicts of interest: none declared., (© 2024 The Authors.)

Background: In Nigeria, most children with tuberculosis (TB) present at primary health clinics where there are limited personnel skilled in collecting appropriate respiratory specimens from those who cannot produce sputum. KNCV Nigeria, in collaboration with the National Tuberculosis Control Program, implemented a modified simple, one-step (SOS), stool-based Xpert MTB/RIF method for diagnosis of TB in children who cannot expectorate sputum. We evaluated the impact of its implementation on childhood TB diagnosis., Method: A cross-sectional study was conducted across 14 selected states using secondary data of children presumed to have TB. Stool was collected from children presumed to have TB and processed using Xpert., Result: Out of 52,117 presumptive TB cases, 52% were male and 59.7% were under 5 years old. A total of 2440 (5%) cases were diagnosed with TB, and 2307 (95%) were placed on treatment. Annual TB notifications increased significantly after the introduction of the stool-based Xpert test when compared to those in the pre-implementation period. Increasing contributions from stool testing were observed throughout the implementation period, except in 2020 during the COVID-19 era. Overall, stool Xpert testing improved childhood TB notification in the studied states. Interventions aimed at awareness creation, capacity building, and active case finding improved the performance of the test.

Setting: KNCV Nigeria implements seven key TB case-finding interventions. It was critical to evaluate the efficiency of these interventions in terms of TB yield to direct future prioritisation in the country., Objectives: To compare the efficiency of active case-finding (ACF) interventions for TB in Nigeria., Design: Data from the 2020-2022 implementing period were analysed retrospectively. Intervention efficiencies were analysed using the number needed to screen (NNS), the number needed to test (NNT) and the true screen-positive (TSP) rate., Results: Across the interventions, 21,704,669 persons were screened for TB, 1,834,447 (8.5%) were presumed to have TB (7.7% pre-diagnostic drop-out rate) and 122,452 were diagnosed with TB (TSP rate of 7.2%). The average TSP rate of interventions that used both the WHO four-symptom screen (W4SS) and portable digital X-ray (PDX) screening algorithm was significantly higher (22.6%) than those that employed the former alone (7.0%; OR 3.9, 95% CI 3.74-3.98; P < 0.001). The average NNT for interventions with W4SS/PDX screening was 4 (range: 4-5), while that of W4SS-only screening was 14 (range: 11-22)., Conclusions: Interventions using the PDX in addition to W4SS for TB screening were more efficient in terms of TB case yield than interventions that used symptom-based TB screening only., (© 2023 The Union.)

Background: Undiagnosed tuberculosis (TB) cases are the major challenge to TB control in Nigeria. An early warning outbreak recognition system (EWORS) is a system that is primarily used to detect infectious disease outbreaks; this system can be used as a case-based geospatial tool for the real-time identification of hot spot areas with clusters of TB patients. TB screening targeted at such hot spots should yield more TB cases than screening targeted at non-hot spots., Objective: We aimed to demonstrate the effectiveness of an EWORS for TB hot spot mapping as a tool for detecting areas with increased TB case yields in high TB-burden states of Nigeria., Methods: KNCV Tuberculosis Foundation Nigeria deployed an EWORS to 14 high-burden states in Nigeria. The system used an advanced surveillance mechanism to identify TB patients' residences in clusters, enabling it to predict areas with elevated disease spread (ie, hot spots) at the ward level. TB screening outreach using the World Health Organization 4-symptom screening method was conducted in 121 hot spot wards and 213 non-hot spot wards selected from the same communities. Presumptive cases identified were evaluated for TB using the GeneXpert instrument or chest X-ray. Confirmed TB cases from both areas were linked to treatment. Data from the hot spot and non-hot spot wards were analyzed retrospectively for this study., Results: During the 16-month intervention, a total of 1,962,042 persons (n=734,384, 37.4% male, n=1,227,658, 62.6% female) and 2,025,286 persons (n=701,103, 34.6% male, n=1,324,183, 65.4% female) participated in the community TB screening outreaches in the hot spot and non-hot spot areas, respectively. Presumptive cases among all patients screened were 268,264 (N=3,987,328, 6.7%) and confirmed TB cases were 22,618 (N=222,270, 10.1%). The number needed to screen to diagnose a TB case in the hot spot and non-hot spot areas was 146 and 193 per 10,000 people, respectively., Conclusions: Active TB case finding in EWORS-mapped hot spot areas yielded higher TB cases than the non-hot spot areas in the 14 high-burden states of Nigeria. With the application of EWORS, the precision of diagnosing TB among presumptive cases increased from 0.077 to 0.103, and the number of presumptive cases needed to diagnose a TB case decreased from 14.047 to 10.255 per 10,000 people., (©Chidubem Ogbudebe, Dohyo Jeong, Bethrand Odume, Ogoamaka Chukwuogo, Cyril Dim, Sani Useni, Okey Okuzu, Chenchita Malolan, Dohyeong Kim, Fiemu Nwariaku, Nkiru Nwokoye, Stephanie Gande, Debby Nongo, Rupert Eneogu, Temitayo Odusote, Salewa Oyelaran, Obioma Chijioke-Akaniro, Nrip Nihalani, Chukwuma Anyaike, Mustapha Gidado. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 08.02.2023.)

Setting: This pilot project was conducted in hard-to-reach communities of two Niger Delta States in the South-South Region of Nigeria., Objective: To assess the usefulness of portable digital X-ray, the Delft-Light Backpack (DLB) for TB active case-finding (ACF) in hard-to-reach Niger Delta communities using the WHO 3B TB screening/diagnosis algorithm., Design: DLB X-ray was used to screen all consenting eligible participants during community TB screening out-reaches in all hard-to-reach communities of Akwa Ibom and Cross River States in the Niger Delta, Nigeria. Participants with a CAD4TB (computer-aided detection for TB score) ⩾60 had Xpert (sputum) and/or clinical (radiograph) assessment for TB diagnosis. Data from the project were analysed for this study., Results: A total of 8,230 participants (males: 47.2%, females: 52.8%) underwent TB screening and 1,140 (13.9%) presumptive TB cases were identified. The TB prevalence among all participants and among those with presumptive TB were respectively 1.2% and 8.6%. The number needed to screen was 84. Among people with presumptive TB, the proportion of males and females with confirmed TB was respectively 12.0% and 5.6% ( P < 0.001)., Conclusion: TB screening using DLB X-ray during community-based ACF in hard-to-reach Niger Delta communities of Nigeria showed a high TB prevalence among participants. Nationwide deployment of the instrument in hard-to-reach areas is recommended., (© 2022 The Union.)

Background: Active TB case finding (ACF) is a key strategy employed by the National Tuberculosis and Leprosy Control Programme (NTBLCP) to address the increasing gap in TB case finding in Nigeria. KNCV TB foundation Nigeria rolled out two high-impact ACF interventions; TB Surge and the Wellness on Wheels (WoW) campaigns from January 2020., Method: The TB Surge intervention supports the engagement of ad hoc staff for TB ACF. The WoW campaign employs a mobile diagnostic unit to deliver care to the doorstep of people at risk of TB. Data along the TB cascade are recorded for all clients using the CommCare app. Cochran-Armitage χ 2 test for linear trend was used to assess the significance declining trends along the TB cascade., Results: There was a progressive decrease of respectively 63%, 64%, 73% and 72% in clinic attendance, presumptive TB identification, TB cases detected and treatment initiation for the TB Surge ACF intervention since the emergence of coronavirus; a similar decrease was noted for the WoW intervention. Trend analysis showed a significant decline in trends for both interventions for all variables ( P < 0.001)., Conclusion: The COVID-19 epidemic has impacted negatively on TB services in Nigeria. The TB programme could leverage some resources used to combat the epidemic such as digital health technology and funds, and work towards strengthening patient-centred approach to care to limit the challenges that COVID-19 presents to TB control., Competing Interests: Conflicts of interest: none declared., (© 2020 The Union.)

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., Competing Interests: There are no conflicts of interest.

Setting: Nigeria, a high tuberculosis (TB) burden country. Objective: To study the rate, distribution and causes of unsuccessful Xpert ® MTB/RIF test outcomes, with the aim of identifying key areas that need to be strengthened for optimal performance of the assay. Design: This was a retrospective analysis of data uploaded between January and December 2015 from Xpert facilities to the central server using GXAlert. Result: Of 52 219 test results uploaded from 176 Xpert machines, 22.5% were positive for Mycobacterium tuberculosis, 10.8% of which were rifampicin-resistant; 4.7% of the total number of results were invalid, 4.2% had error results and 2.1% no result outcomes. Technical errors were most frequent (69%); these were non-seasonal and occurred in all geopolitical regions and at all health facility levels. Temperature-related errors were more prevalent in the North-West Region, with peaks in April to June. Peak periods for temperature and machine malfunction errors coincided with the periods of low utilisation of the assay. Conclusion: The key challenge affecting performance was poor adherence to standard operating procedures. Periodic refresher training courses, regular supervision, preventive maintenance of Xpert machines and proper storage of cartridges are strategies that could improve Xpert performance., Competing Interests: The authors thank the Nigerian National Tuberculosis Programme and all partners investing in Xpert implementation for their support, including the US Agency for International Development (Washington DC, USA) and AB Associate (Paris, France) for GXAlert. Conflicts of interest: none declared.

Tuberculosis (TB) is the most common opportunistic infection in human immunodeficiency virus (HIV)-infected patients and the emergence of drug-resistant tuberculosis (DR-TB) is a growing problem in resource-limited settings. Adequate infrastructure for testing drug sensitivity and sufficient evidence of first-line resistance are currently unavailable in Nigeria. We collected sputum samples from HIV-infected patients enrolled in the Harvard PEPFAR/APIN Plus program over 12 months at two PEPFAR antiretroviral therapy (ART) clinics in the southwest and north central regions in Nigeria. Smear-positive sputum samples were submitted for GenoType MTBDRplus testing (n = 415); mutations were confirmed through sequencing. Our results show high rates of DR-TB in Nigerian HIV-infected individuals (7.0% for rifampin [RIF] and 9.3% for RIF or isoniazid [INH]). Total RIF resistance indicative of MDR-TB in treatment-naive patients was 5.52%, far exceeding the World Health Organization predictions (0 to 4.3%). RIF resistance was found in 6/213 (2.8%) cases, INH resistance was found in 3/215 (1.4%) cases, and MDR-TB was found in 8/223 (3.6%) cases. We found significantly different amounts of DR-TB by location (18.18% in the south of the country versus 3.91% in the north central region [P < 0.01]). Furthermore, RIF resistance was genetically distinct, suggesting possible location-specific strains are responsible for the transmission of drug resistance (P < 0.04). Finally, GenoType MTBDRplus correctly identified the drug-resistant samples compared to sequencing in 96.8% of cases. We found that total DR-TB in HIV-infection is high and that transmission of drug-resistant TB in HIV-infected patients in Nigeria is higher than predicted.