Advances, Challenges, and Research Gaps in the Diagnosis of Drug-Resistant Tuberculosis in Nigeria: A Review

Background. Nigeria is one of eight countries that together account for two- thirds of the global tuberculosis (TB) burden and is on the WHO high-burden list for multidrug- and rifampicin-resistant TB (MDR/RR-TB). Timely detection of drug resistance is the entry point to effective treatment, yet many people with drug-resistant TB (DR-TB) in Nigeria are never diagnosed or never start treatment. Materials and Methods. This narrative review synthesised published studies, programme evaluations and WHO documents on DR-TB diagnosis in Nigeria, identified through targeted searches of PubMed/PubMed Central, publisher repositories and WHO repositories in October 2026. Results. Nigeria has moved from smear microscopy and culture to a molecular-first algorithm based on Xpert MTB/RIF, with line probe assays (LPAs) and culture-based drug susceptibility testing (DST) at reference laboratories. Advances include whole-genome sequencing studies that identified extensively drug-resistant strains, a pilot sequencing surveillance network, public–private referral networks and decentralised DR-TB care. Challenges include uneven GeneXpert access, weak sample transport and result return, pre-treatment attrition, reliance on rifampicin resistance as a proxy for MDR-TB, limited second-line and new-drug DST, and the lack of a nationally representative drug-resistance survey in the sources identified. Evidence on newer WHO-endorsed tools (Xpert MTB/XDR, Truenat, targeted next-generation sequencing) in Nigeria is essentially absent. Conclusions. Research priorities include a national drug-resistance survey, field evaluation of newer tests, local genotype–phenotype studies, implementation research on the diagnosis-to-treatment cascade, and quality-assurance data for molecular DST.