Location: Malawi // Organization: Delft Imaging

Introduction

The latest TB survey revealed that 35% of active TB cases did not seek care, with urban areas having a much higher prevalence than rural areas. Since 2018, Malawi has used Delft Imaging’s Mobile Clinics with digital X-ray, CAD4TB, and GeneXpert for urban community-based active case finding.

Intervention
  • While the rates of prsumptive TB cases were comparable (6.3% vs 6.1%), parallel screening had a higher Xpert testing uptake (94% vs 75%) and a greater Xpert positivity rate (9.3% vs 3.5%) compared to W4S screening only.
  • A total of 1,164 TB cases were diagnosed, with 52% (600) Bac+ TB and 48% (559) clinically diagnosed. This represents 6% of all notified TB cases nationally in 2023.
  • When compared to W4S screening only, parallel screening yielded 4.4. times more Tb cases of all forms (1,089/100k vs 247/100k) and 3.4 times more Bac+ TB cases (552/100k vs 161/100k).
Conclusion
  • Combining digital chest X-ray with CAD/AI and symptom screening has significantly increased the yield of TB cases by 4.4 times compared to symptom screening along, as evidenced over the past 5 to 6 years in Malawi.
  • Mobile Clinics continuously screen over 100 people daily, contributing to up to 6% of all notified TB cases. Scaling this intervention at facilities and including X-rays with CAD/AI as screening tools is essentials

REFERENCE: Gondol, B. et al (2024, November 12-16). Bridging the gap: Enhanced TB detection using mobile digital X-ray and AI as screening tool surpasses W4S-based screening in community-based intervention – Insights from Malawi [Presentation]. The Union World Conference on Lung Health, Bali, Indonesia.