A high TB-HIV burden country; of the 90 thousand TB patients in Uganda, 12 thousand are children. Additionally, about a quarter of the TB cases are presumed to be missing.
Keeping this in mind, the National Tuberculosis and Leprosy Programme (NTLP) focused on the use of portable digital X-rays with AI software for TB screening. They can help provide diagnostic facilities, not only in high-TB burden districts but also for community outreach.
In 2018, the IDA Foundation procured five Delft Light backpack portable X-ray systems with CAD4TB software. Later, in 2020, 2 more Delft Lighter with CAD4TB software was procured by the DAHW and used in collaboration with the Uganda Catholic Medical Bureau. Witnessing the impact on the field, ten more Delft Light with CAD4TB were procured. While five were acquired under the introducing New Tools Project (iNTP) by the StopTB Partnership, the other five were provided through the Partnership for Supply Chain Management (PFSCM).
Besides portable X-ray systems and CAD4TB software, the NTLP secured two mobile TB screening clinics from Delft Imaging in 2021. Facilitated through the UNOPS, each clinic featured an EasyDR multi-functional X-ray and the CAD4TB software. They secured three more mobile TB screening clinics in the latter half of the year.
The installed base of Delft Imaging solutions in Nigeria covers 17 portable X-ray systems, five mobile OneStopTB clinics (with stationary EasyDR X-ray systems) and 23 CAD4TB installations. For more information on our activities in Uganda, please see our flagship project page.
Making a difference
In collaboration with its in-country partner, Delft Imaging supports all these installations and services through long-term service contracts. We proudly support the Infectious Disease Institute of Makerere University (IDI). Since late 2021, IDI, with the help of the StopTB Partnership’s TB REACH program, has been utilising CAD4TB to investigate the performance of A.I in the rural towns of Uganda.
The CAD4TB installed in the tertiary hospitals of Gulu, Lira and Kitgum served a combined population of more than one million. Each person with presumed TB in the hospital received a digital chest X-ray that CAD4TB reads, trained human readers and a highly sensitive molecular diagnostic test (Xpert). These outcomes were recorded and compared to the molecular test’s to analyse their accuracy and optimal settings. To read more about the project, please see their case study.
In the words of Michael Odit, a Project Radiographer at IDI, “AI has helped us a lot. If you have many patients, you only need to send the images to the AI box. You can work on many patients in the shortest possible time.”
Over the years, various partners have published about the impact of different X-ray systems and CAD solutions for TB screening efforts.
The Delft Light portable backpack X-rays with CAD4TB were used for the TB screenings at health facilities in high TB burden districts and community outreach. Between June 2020 and May 2021, more than a thousand individuals were X-rayed in health facility settings. Of those screened, 21% HAD ABNORMAL X-ray, GeneXpert tested 86%, and the remaining 35% were confirmed with TB. In community settings in March 2021, more than 1400 individuals were X-rayed. Of whom, 13.5% had abnormal X-rays and were tested by GeneXpert. About 6.3% were confirmed with TB.
It was concluded that TB screening by mobile digital X-ray in health facilities had a higher yield of TB when used at health facilities than in community settings, particularly among PLHIV and TB contact. Thus, to improve early case detection, the national TB programs and partners were recommended to scale up the usage of digital X-ray systems with CAD4TB in screening high-risk populations. In the 2022 Union World Conference on Lung Health, the stakeholders in Uganda highlighted the use of dCXR and CAD4TB for systematic TB screening among PLHIV. They concluded this approach led to twice as high TB yield among PLHIV and contacts.
A case study presented in the 8th Webinar of the StopTB Partnerships’ Focus Group on AI-based Imaging for TB showed that Uganda uses about 700,000 Xpert tests annually. Digital chest X-rays with CAD4TB can significantly reduce the number of Xpert tests needed, with minimal reduction of diagnosed TB cases.