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. 2024 Jan 17;4(1):e0002018.
doi: 10.1371/journal.pgph.0002018. eCollection 2024.

Iterative evaluation of mobile computer-assisted digital chest x-ray screening for TB improves efficiency, yield, and outcomes in Nigeria

Rupert A Eneogu  1 , Ellen M H Mitchell  2 , Chidubem Ogbudebe  3 , Danjuma Aboki  4 , Victor Anyebe  3 , Chimezie B Dimkpa  3 , Daniel Egbule  4 , Bassey Nsa  5 , Emmy van der Grinten  6 , Festus O Soyinka  7 , Hussein Abdur-Razzaq  8 , Sani Useni  3 , Adebola Lawanson  9 , Simeon Onyemaechi  9 , Emperor Ubochioma  9 , Jerod Scholten  6 , Johan Verhoef  6 , Peter Nwadike  6 , Nkemdilim Chukwueme  10 , Debby Nongo  1 , Mustapha Gidado  6
Affiliations

Iterative evaluation of mobile computer-assisted digital chest x-ray screening for TB improves efficiency, yield, and outcomes in Nigeria

Rupert A Eneogu et al. PLOS Glob Public Health. .

Abstract

Wellness on Wheels (WoW) is a model of mobile systematic tuberculosis (TB) screening of high-risk populations combining digital chest radiography with computer-aided automated detection (CAD) and chronic cough screening to identify presumptive TB clients in communities, health facilities, and prisons in Nigeria. The model evolves to address technical, political, and sustainability challenges. Screening methods were iteratively refined to balance TB yield and feasibility across heterogeneous populations. Performance metrics were compared over time. Screening volumes, risk mix, number needed to screen (NNS), number needed to test (NNT), sample loss, TB treatment initiation and outcomes. Efforts to mitigate losses along the diagnostic cascade were tracked. Persons with high CAD4TB score (≥80), who tested negative on a single spot GeneXpert were followed-up to assess TB status at six months. An experimental calibration method achieved a viable CAD threshold for testing. High risk groups and key stakeholders were engaged. Operations evolved in real time to fix problems. Incremental improvements in mean client volumes (128 to 140/day), target group inclusion (92% to 93%), on-site testing (84% to 86%), TB treatment initiation (87% to 91%), and TB treatment success (71% to 85%) were recorded. Attention to those as highest risk boosted efficiency (the NNT declined from 8.2 ± SD8.2 to 7.6 ± SD7.7). Clinical diagnosis was added after follow-up among those with ≥ 80 CAD scores and initially spot -sputum negative found 11 additional TB cases (6.3%) after 121 person-years of follow-up. Iterative adaptation in response to performance metrics foster feasible, acceptable, and efficient TB case-finding in Nigeria. High CAD scores can identify subclinical TB and those at risk of progression to bacteriologically-confirmed TB disease in the near term.

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Conflict of interest statement

RE and DN are now employed by the funder, but at the time of the study RE worked for KNCV TB Foundation. The funder had a limited role in the review of the manuscript.

Figures

Fig 1
Fig 1. Geographical distribution of the TB screening activities by phase.
Source of base layers: DIVA-GIS (2017) Free Spatial Data by Country http://www.diva-gis.org/gdata.
Fig 2
Fig 2. Client flow and testing algorithm in pilot and scale Up phases.
See this image and copyright information in PMC

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