Tuberculosis (TB) remains a significant public health challenge in Nigeria, which ranks sixth among high TB burden countries and first in Africa for TB, MDR-TB, and TB/HIV cases. With an estimated 499,000 TB cases in 2023 but only 74% of them detected, a substantial gap persists in case identification and treatment. Addressing this challenge requires innovative screening solutions, including AI-powered X-ray systems, which have played a transformative role in strengthening Nigeria’s TB detection efforts.
Addressing the screening gap with AI
Dr. Emperor Ubochioma, the Global Fund Grant Program Management Unit Team Lead at Nigeria’s National Tuberculosis and Leprosy Control Program, emphasized that while TB case detection has improved, there is still a 24% gap between the estimated TB burden and notified cases. A major challenge has been the limited use of clinical diagnosis, with only 18% of TB cases being clinically diagnosed while the rest rely on bacteriological confirmation. “If you look at other countries closing the gap, clinical diagnosis plays a significant role, but in Nigeria, it remains minimal,” Dr. Ubochioma noted.
Scaling digital X-ray systems across Nigeria
Introducing portable digital X-rays (PDX), Delft Light with CAD4TB was a milestone in Nigeria’s TB control strategy. Initially deployed through the USAID-funded New Tools Project (2020-2023), the program introduced 10 PDX units, with seven allocated to KNCV and 3 to IHVN. Since then, the number of AI-enabled X-ray units in the country has grown to 73, including 18 fixed units, 10 mobile van-based units, and 45 portable units.
Dr. Olayemi Olupitan, Project Director of the Global Fund Grant Cycle 7 Tuberculosis/HIV project at the Institute of Human Virology Nigeria (IHVN), emphasized the importance of Wellness on Wheels (WoW) Clinics in expanding TB detection. “The WoW Clinics have been instrumental in reaching remote communities with portable X-ray machines and AI-powered diagnostics. These mobile clinics ensure that people in hard-to-reach areas have access to quality TB screening and diagnosis,” he stated. This initiative aligns with the country’s commitment to early and widespread TB case detection, particularly among vulnerable populations.
This expansion has enabled community-based TB screenings, reducing reliance on static healthcare facilities. Dr. Ubochioma highlighted the importance of early and widespread screening, stating: “If we want to meet the 2030 global TB targets, we must integrate new innovations that facilitate early detection and improve case notification in-country.”
Innovations in AI-driven TB screening
Beyond increasing access to X-ray screening, Nigeria has pioneered two transformative innovations in its TB screening approach:
- Wellness on Keke (WOK): A miniature version of the traditional mobile screening truck, the WOK integrates PDX platforms with TB LAMP or Truenat molecular testing, allowing screenings in hard-to-reach areas with poor road networks.
- Portable Digital X-ray with AI (PDX): AI-powered portable X-ray machines have enabled early TB detection in both community and facility settings, supporting faster diagnosis and case management.
Strengthening healthcare systems with AI
A major concern in TB screening is the shortage of radiographers and imaging technicians. To address this, electronic reporting mechanisms have been integrated into the national TB program, allowing radiologists to review X-ray images remotely. Additionally, Nigeria has developed implementation guidelines, standard operating procedures (SOPs), and maintenance plans to ensure the sustainability of AI-driven TB screening. “Our priority is to integrate all PDX units under the national TB program, ensuring consistent monitoring and cross-sector collaboration,” Dr. Ubochioma added.
The Future of AI-powered TB detection in Nigeria
Looking ahead, Nigeria is set to procure 370 additional AI-enabled portable digital X-ray systems to expand screening coverage across all 36 states and the Federal Capital Territory. These units will be deployed across public and private health facilities and community screening programs, ensuring wider accessibility and early detection of TB cases.
Dr. Ubochioma emphasized the potential impact of these advancements: “With these innovations, we are moving towards becoming one of the leading countries in AI-powered TB screening. This is a game-changer in Nigeria’s fight against TB.”
Conclusion
AI-enabled X-ray technology is revolutionizing TB detection in Nigeria, bridging diagnostic gaps, and increasing case notifications. Through mobile screening programs, digital reporting systems, and integration with broader healthcare services, Nigeria is setting a benchmark for TB control in Africa. As more AI-powered X-ray units are deployed, the country is taking significant strides toward achieving the global goal of ending TB by 2030.
