In Zambia’s high-burden settings, tuberculosis is just one piece of a broader health landscape. At the March 2025 Delft Imaging webinar, Prof. Helen Ayles introduced an ambitious model that combines TB screening with broader wellness services: Ubomi Buandi, or “My Health, My Choice.”
“Although my affiliation is with the London School, I am based full-time in Zambia. We are implementing a project under the Stop TB, TB REACH program called Ubomi Buandi, which focuses on integrating screening and prevention alongside tuberculosis (TB) screening.”
Addressing the global TB emergency
Prof. Ayles began by highlighting the urgency reflected in the latest WHO Global TB Report:
“Many of you on this call are experts in TB, but I want to highlight some key issues from last year’s Global TB Report by the WHO: 8.2 million people were diagnosed with TB in 2023, the highest recorded number. While TB-related deaths are decreasing, incidence is rising. TB is again the leading infectious cause of death worldwide. We are not on track to end TB. More focus is needed on screening and prevention, especially in high-burden settings like Zambia and South Africa.”
A dual burden: TB and NCDs
“Zambia is one of the 30 high TB burden countries, with a national TB incidence of 307 per 100,000 people. Additionally, Zambia has a high incidence of non-communicable diseases (NCDs). Unlike TB, HIV, and malaria, which receive significant external funding, NCDs receive fewer resources, making service provision more challenging. Healthcare services in lower-middle-income countries, like Zambia, are overburdened, focusing mainly on treating the sickest patients. There is little time for preventive screening of other diseases.”
“Given the importance of early diagnosis and treatment, we sought to integrate TB and NCD screening in this project.”
A community hub for wellness screening
“We implemented this project in Chupulukusu, a community in Ndola on the Copper Belt, one of Zambia’s mining regions. This population of 50,000 has high TB prevalence, which was not declining despite previous prevalence surveys over 20 years.”
“A single government health facility serves the entire community but is overwhelmed with sick patients. We developed a Community Hub for wellness screening, separate from treatment facilities.”
“The Community Hub offers annual screenings, including chest X-ray for TB screening. HIV testing. Sexual and reproductive health services. Substance abuse support. Nutritional support. Screening for non-communicable diseases (NCDs) such as: Blood pressure monitoring. Diabetes screening. Cancer awareness (breast, cervical, prostate, and testicular). Healthy living education.”
“Every community member received an Ubomi Buandi Card, a loyalty-style reward system. Individuals earn points for participating in screenings, redeemable for incentives.”
Chest X-rays, CAD4TB and uncovered gaps
“We installed a portable chest X-ray machine, with support from Delft.”
“Out of 40,000 adults, about 25% participated in screening. Most had a chest X-ray for TB screening. Many also underwent HIV testing and blood pressure checks.”
“TB screening was based on: Symptoms. CAD (Computer-Aided Detection) score ≥ 50. This significantly increased the number of TB diagnoses.”
“Many initiated TB treatment without bacteriological confirmation. No alternative algorithms exist for diagnosing other lung diseases.”
Prof. Ayles shared a real case: “A 45-year-old sand miner and smoker had lung abnormalities on X-ray, but his sputum was TB-negative, raising concerns about post-TB lung disease.”
Going further: Expanding lung health under pantanshi
“Applied for TB REACH Wave 11 funding for Ubomi Buandi Pantanshi (‘My Health, My Choice, Going Further’).”
“Expanded lung health screening to include: Pneumonia diagnosis. Post-TB lung disease assessment. Chronic Obstructive Pulmonary Disease (COPD). Industrial lung disease evaluation.”
“Smoking cessation programs to address high smoking rates.”
“Additional funding from Bristol Myers Squibb Foundation for lung cancer awareness.”
From formal to informal work: Reaching the exposed
“Working with Zambia’s Occupational Health Institute to expand screening for: Miners. Informal workers (stone crushers, sand miners, cement workers).”
“A district-level respiratory clinic will offer: Spirometry. Post-TB rehabilitation services.”
“CT scans are available at the teaching hospital but are costly and frequently unavailable. Lung ultrasound is being evaluated as a chest X-ray alternative in remote areas.”
Knowledge in sharing action
Each week, the project team conducts virtual clinical meetings to review cases collaboratively. Prof. Ayles recounted one such example: “A 40-year-old male had a normal X-ray (CAD score: 6) in 2022. In 2023, his X-ray showed consolidation (CAD score: 85) and was confirmed TB-positive.”
A holistic model for TB and beyond
“This integrated approach aims to improve TB screening and broader lung health in Zambia. The project emphasizes early detection, prevention, and community participation.”
