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Using a standardised patient (SP) survey approach, we assessed how management of presumptive TB in the private sector aligns with national guidelines and whether this differed from a study conducted before the start of the COVID-19 pandemic. 13 SPs presented a presumptive TB case to 511 private providers in urban areas of Lagos and Kano states in May and June 2021. Private provider case management was compared with national guidelines divided into three main steps: SP questioned about cough duration; sputum collection attempted for TB testing; and non-prescription of anti-TB medications, antibiotics and steroids. SP visits conducted in May\u2013June 2021 were directly compared to SP visits conducted in the same areas in June\u2013July 2019. Overall, 28% of interactions (145 of 511, 95% CI 24.5% to 32.5%) were correctly managed according to Nigerian guidelines, as few providers completed all three necessary steps. Providers in 71% of visits asked about cough duration (362 of 511, 95% CI 66.7% to 74.7%), 35% tested or recommended a sputum test (181 of 511, 95% CI 31.3% to 39.8%) and 79% avoided prescribing or dispensing unnecessary medications (406 of 511, 95% CI 75.6% to 82.8%). COVID-19 related questions were asked in only 2.4% (12 of 511, 95% CI 1.3% to 4.2%) of visits. During the COVID-19 pandemic, few providers completed all steps of the national guidelines. Providers performed better on individual steps, particularly asking about symptoms and avoiding prescription of harmful medications. Comparing visits conducted before and during the COVID-19 pandemic showed that COVID-19 did not significantly change the quality of TB care.<\/jats:p>","DOI":"10.1136\/bmjgh-2024-015474","type":"journal-article","created":{"date-parts":[[2024,11,14]],"date-time":"2024-11-14T09:25:30Z","timestamp":1731576330000},"page":"e015474","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Private sector tuberculosis care quality during the COVID-19 pandemic: a repeated cross-sectional standardised patients study of adherence to national TB guidelines in urban Nigeria"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5807-6388","authenticated-orcid":false,"given":"Angelina","family":"Sassi","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Biostatistics, and Occupational Health, McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada"},{"name":"McGill International TB Centre, McGill University, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8475-9388","authenticated-orcid":false,"given":"Lauren","family":"Rosapep","sequence":"additional","affiliation":[{"name":"Sustaining Health Outcomes through the Private Sector (SHOPS) Plus\/Abt Associates, Rockville, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bolanle Olusola","family":"Faleye","sequence":"additional","affiliation":[{"name":"Sustaining Health Outcomes through the Private Sector (SHOPS) Plus\/Abt Associates, Lagos, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine","family":"Baruwa","sequence":"additional","affiliation":[{"name":"Sustaining Health Outcomes through the Private Sector (SHOPS) Plus\/Abt Associates, Rockville, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Johns","sequence":"additional","affiliation":[{"name":"Sustaining Health Outcomes through the Private Sector (SHOPS) Plus\/Abt Associates, Rockville, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md. Abdullah Heel","family":"Kafi","sequence":"additional","affiliation":[{"name":"McGill International TB Centre, McGill University, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lavanya","family":"Huria","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Biostatistics, and Occupational Health, McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada"},{"name":"McGill International TB Centre, McGill University, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1019-8597","authenticated-orcid":false,"given":"Nathaly","family":"Aguilera Vasquez","sequence":"additional","affiliation":[{"name":"McGill International Tuberculosis Centre, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Daniels","sequence":"additional","affiliation":[{"name":"Georgetown University McCourt School of Public Policy, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5909-3585","authenticated-orcid":false,"given":"Jishnu","family":"Das","sequence":"additional","affiliation":[{"name":"Georgetown University McCourt School of Public Policy, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chukwuma","family":"Anyaike","sequence":"additional","affiliation":[{"name":"National Tuberculosis, Leprosy and Buruli Ulcer Control Programme, Nigeria Federal Ministry of Health, Abuja, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Obioma","family":"Chijioke-Akaniro","sequence":"additional","affiliation":[{"name":"National Tuberculosis, Leprosy and Buruli Ulcer Control Programme, Nigeria Federal Ministry of Health, Abuja, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3667-4536","authenticated-orcid":false,"given":"Madhukar","family":"Pai","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Biostatistics, and Occupational Health, McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada"},{"name":"McGill International TB Centre, McGill University, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0779-570X","authenticated-orcid":false,"given":"Charity","family":"Oga-Omenka","sequence":"additional","affiliation":[{"name":"McGill International TB Centre, McGill University, Montreal, Quebec, Canada"},{"name":"University of Waterloo, Waterloo, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,11,14]]},"reference":[{"key":"2025072913410698000_9.11.e015474.1","unstructured":"World Health Organization . 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