Indonesia, the world’s third-highest TB burden country, has made remarkable progress against TB. Yet, over the last decade, the infectious disease has remained among the top causes of death in the nation. In a country of over 250 million, more than 950,000 are estimated to have developed TB. In addition, more than 50,000 people are considered missing people with TB. Of these, a little over 47,000 are children.
In 2018, an MoU was signed between the Ministry of Health of the Republic of Indonesia and the MoH of the Kingdom of the Netherlands. It included a collaboration on infectious diseases – the aim to, together, combat the rise of TB. This became the ground on which Delft Imaging joined the country’s effort against TB.
In 2020, Delft Imaging signed a Letter of Intent with the Ministry of Health of the Republic of Indonesia using the Computer-Aided Detection for Tuberculosis (CAD4TB) software. CAD4TB uses artificial intelligence to detect TB-related abnormalities on a chest X-ray automatically. The CAD4TBbox hosts the CAD4TB software, allowing offline use with the data stored locally instead of being dependent on internet availability. The World Health Organization endorses CAD4TB (meets the Target Product Profile of the WHO of 90% sensitivity and 70% specificity), has been scientifically validated in over 65 publications and has been implemented in over 50 countries around the world, impacting the lives of over 14 million people to date.
In the same year, we registered the CAD4TB software with the Ministry of Health of the Republic of Indonesia to support the further roll-out of this TB screening solution. In that same year, in collaboration with Fullerton Health, e-Tirta medical centres and the Ministry of Health, CAD4TB was installed in several prisons and a factory in Jakarta. If any symptoms were found among the prisoners screened, the chest X-ray was taken to a mobile van equipped with CAD4TB. This initial pilot, screening approximately 1000 people, paved the way for the further utilisation of CAD4TB in Indonesia. The pilot showed that the software helped to find more cases, reduced the time and cost of TB diagnosis, and could be particularly helpful in hard-to-reach areas where it could help to optimise TB-detection results in support of the radiologists. During the project, users referred to CAD4TB as the ‘super assistant’ to radiologists in Indonesia in their efforts to eliminate TB.
In 2021, we supported a COVID-19 screening project funded by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), utilising CAD4COVID, a software solution built upon the existing technical infrastructure of CAD4TB, yet optimised for the detection of COVID-19 related abnormalities.
In the latter half of 2021, we signed three Memorandums of Understanding (MoU) as part of a collaboration with the Faculty of Medicine of Universitas Indonesia to research the use of AI in the nation. The MoUs were on CAD4TB, CAD4COVID and RetCAD (utilising artificial intelligence on fundus imaging to detect Diabetic Retinopathy, Age-Related Macular Degeneration and Glaucoma).
In its efforts to further support its projects in Indonesia, Delft Imaging started a local office in Indonesia (Delft Imaging Indonesia) at the end of 2021, hosting IT specialists and local personnel to aid in installation, training and service support.
In early 2022, the TB efforts were scaled up in collaboration with e-Tirta medical centres and the Ministry of Health. In the first quarter of the year, over 80,000 prisoners were screened. Later that year, the efforts were scaled up further in collaboration with the partners. CAD4TB was set up in 16 mobile clinics, covering 25 public health centres and supported the screening of an additional 110,000 people.
In the same year, we started collaborating with International SOS, a global health and security service firm that provides healthcare services to mining companies and their employees across Indonesia. CAD4TB was set up in a mobile van and used to screen 10,000 employees in the mining industry for TB. Early 2023, another 15,000 employees were screened.
In 2023, we extended our collaboration with e-Tirta Medical Centres and the Ministry of Health of Indonesia to screen an additional 206,000 prisoners across 374 prisons in 33 provinces using CAD4TB.
The above figure shows H.E. Budi Gunadi Sadikin, Minister of Health of Indonesia, discussing the utilisation of CAD4TB during the kick-off of the Active Case Finding project to screen 200,000 people with CAD4TB as part of the High Level Tuberculosis Meeting on in Surabaya on November 8th, 2022.
Making a difference
For more information on how CAD4TB is used throughout Indonesia, please view the story of ‘Utilization of CAD4TB for Mass and Remote TB-Screening in Indonesia, ‘ presented by Dr Lituhayu B. Putri of Fullerton Health in Indonesia. The story was presented during the 2021 Q3 Delft webinar.
Moreover, as a long-time partner to Indonesia’s TB screening efforts, researchers studied the use of CAD4TB among Indonesians living with Diabetes Mellitus (PLWD). This was particularly important as Diabetes Mellitus is a significant risk factor for TB. The study, already published in 2018, showed the potential use of CAD4TB as a triage tool for TB screening in PLWD, significantly reducing the need for microbiological examination.
Finally, Delft Imaging supported several events in Indonesia. Amongst those, we supported the World TB Event at Universitas Indonesia and collaborate actively with Kadin (the Chamber of Commerce) to utilize CAD4TB in workplaces and schools.