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

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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
Original languageEnglish
JournalPLoS Global Public Health
ISSN2767-3375
Publication statusPublished - 17-Jan-2024

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