Background
The high tuberculosis (TB) burden in Nigeria, particularly in hard-to-reach and underserved areas, has called for innovative approaches to enhance case-finding. The portable digital X-ray (PDX) machines offer an opportunity to improve TB detection in regions with limited resources and access to more complex diagnostic tools. This paper presents the effectiveness of PDX machines in TB case-finding in Nigeria under the USAID-funded TB-LON 3 project.
Methods
This PDX intervention was carried out in purposively selected two (Oyo and Osun) States, Nigeria, from January 2022 to March 2024. The AI-enhanced Fujifilm’s Xair and Delft Light Backpack PDX machines were deployed to screen the population of people in communities, schools, correctional centres and orphanages. Presumptive were evaluated using bacteriological laboratory tests and clinical radiology reviews. Data on screening coverage, presumptive TB identification, confirmed diagnoses and treatment initiation were collected and analysed.
Results
Overall, 98,863 people were screened within the implementing period, and 52.57% of those screened were from Osun state. Oyo State, however, had a higher presumptive identification (53.07%) and TB diagnoses (53.17%) rate. The PDX machine identified 13.79% (13,630) of those screened as TB presumptive, and almost all (99.4%) were evaluated with other TB diagnostic methods. TB was diagnosed in 14.91% (2,020) of those evaluated, and 94.11% of them were started on treatment. Although more females (57.51%) were screened, the males had a higher proportion (54.11%) of TB diagnosed. Almost all clients screened were relatively distributed among those aged 5 to 65+ years; nonetheless, presumptive identification and case-finding were highest among those aged 65+.
Conclusions
Implementing PDX machines significantly improved TB case identification and diagnoses in Osun and Oyo States. The machines effectively identified presumptive TB cases and enhanced TB diagnostic yield. Although AI-enhanced PDX machines have not shown effectiveness in this location as a diagnostic tool, the findings support that it should be adopted as a screening tool on a large scale, especially in resource-limited settings.
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