Malawi – Improving TB Case-finding in Key Populations with OneStopTB Clinic

The NTLEP’s mobile outreach for TB screening in 28 districts utilized digital X-ray, CAD4TB, and GeneXpert, revealing a high TB incidence among various high-risk groups. Learn about the significant findings from this approach, which underscores the necessity for targeted screening strategies and the effectiveness of combining X-ray and symptom screening in TB detection.

Source: USAID brochure “Mobile Care for TB Screening and Diagnosis – A How-to Guide” // Location: Malawi // Organisation: USAID.

The National Tuberculosis and Leprosy Elimination Program (NTLEP) introduced an outreach TB screening using Mobile Diagnostic Units equipped with digital X-ray, CAD4TB and GeneXpert. The outreach covered 28 districts, targeting inmates, healthcare workers (HCWs), miners/ex-miners and community, IDPs and refugees.

In 2022, 30,225 individuals were screened using symptoms and digital CXR with CAD. 1,993 (7%) were identified as presumptive TB (CAD4TB score >60), and 93% underwent Xpert testing. 165 were diagnosed with TB, representing 546 cases per 100k individuals screened, which is four times higher than the TB incidence in the general population (132/100k).

The highest yield among screened was refugees (957/100k), followed by IDPs (567/100K), miners (535/100K), inmates (523/100k), and HCWs (510/100k). The highest yield among presumptive was refugees (23%), followed by miners (18%), IDPs (10%), HCWs (8%) and inmates (7%). 97.6% of the cases were enrolled to TB treatment.

Further analysis found that 20% of presumptive cases were identified only by chest X-ray (no symptom), which aligns with the findings of the National TB Prevalence Survey. 80% of presumptive cases had symptoms, and 47% had abnormal chest X-rays.

The findings highlight the need for targeted TB screening and diagnostic strategies for each risk group. Also, the parallel CXR and symptom screening approach has proven effective and provides valuable insights that can help scale up more effective TB case-finding.

REFERENCE: Gondol, B. S. (2023, November 15-18). Parallel chest X-ray and symptom screening for TB among marginalised and key populations in Malawi: an effective TB screening and diagnostic strategy [Conference session]. The Union World Conference on Lung Health 2023, Paris, France.