With nearly half a million people developing tuberculosis in 2023 and more than 70,000 losing their lives to the disease, Nigeria remains one of the countries most affected by TB worldwide. While the country has made progress in detection and care, over 131,000 people with TB were still missed last year. An estimated 9,400 individuals developed drug-resistant TB, and around 25,000 were affected by both TB and HIV, placing additional strain on public health services.

To address these challenges, we have partnered with the National Tuberculosis, Leprosy and Buruli Ulcer Control Programme (NTBLCP) and a range of local stakeholders to expand access to digital X-ray and AI-supported diagnostics across the country.

Our work in Nigeria began in 2017 through the Challenge TB Program, in collaboration with the KNCV Tuberculosis Foundation. That same year, 2 Delft OneStopTB X-ray Trucks were introduced in Nasarawa and Ogun States. Known as “Wellness on Wheels,” these trucks were equipped with EasyDR X-ray systems, CAD4TB, and onboard GeneXpert testing facilities. In 2019, 3 more Delft OneStopTB X-ray Clinics, each equipped with EasyDR and CAD4TB, were delivered to the Damien Foundation.

In 2021, we supported the Lagos State Ministry of Health by installing 21 digital X-ray units, comprising 8 semi-mobile X-ray clinics, 10 room-based units, and 3 mobile TB screening vans. All systems were delivered with EasyDR, MAC, or Delft Light X-ray systems and supported by CAD4TB. That same year, 5 Delft OneStopTB X-ray Clinics with EasyDR and CAD4TB were delivered to Kaduna State. Additionally, 10 Delft Light systems with CAD4TB were supplied through the USAID-funded iNTP project, in collaboration with the Stop TB Partnership. Seven of these systems were allocated to KNCV, and 3 to the Institute of Human Virology Nigeria (IHVN).

The expansion continued in 2022. We delivered 20 Delft Light systems with CAD4TB to KNCV Nigeria. An additional 4 Delft Light systems were delivered to the Heartland Alliance. Twelve EasyDR systems, each supported by CAD4TB, were also installed for the National Agency for the Control of AIDS (NACA).

In 2024, Nigeria witnessed one of the largest rollouts of Delft Light and CAD4TB technology to date. Four Delft Light systems with CAD4TB were delivered to the Heartland Alliance, and another 4 of this combination were delivered to Achieving Health Nigeria Initiative. Georgetown Global Health Nigeria received 3 Delft Lights with CAD4TB, while the Association for Reproductive and Family Health acquired 2 Delft Lights with CAD4TB.

In the same year, we also delivered 8 Delft Light systems, each equipped with its own CAD4TB, to the Heartland Alliance. The Centre for Clinical Care and Clinical Research deployed 2 Delft Lights with CAD4TB, and the Excellence Community Education Welfare Scheme recieved 4 Delft Lights and CAD4TB. The Health System Consult Ltd received a Delft Light and a CAD4TB. Seventeen Delft Light systems and seventeen CAD4TB were supplied to the APIN Public Health Initiative, while 10 Delft Light and 10 CAD4TB were deployed for the Society for Family Health. Later in the year, the Centre for Clinical Care and Clinical Research received an additional 4 Delft Lights with CAD4TB.

Last, but not least, Nigeria also deployed over 200 additional Delft Lights, with CAD4TB, for the National Tuberculosis, Leprosy & Buruli-Ulcer Control Programme. Through these collaborations, TB screening has become more accessible across Nigeria.

Making a Difference

Research paper

To eradicate TB, it is critical to ensure TB screening in marginalized and remote sections of the nation. In 2019, the OneStopTB Clinics (called Wow trucks in Nigeria)enrolled more than 45000 people from rural and suburban community settings. These include motor parks, markets, health facilities and mosques in 16 local government areas within the Kano State. In addition to 920 new cases, 3,380 clients were presumptive of TB. While 31 cases were drug-resistant TB, 889 were drug-susceptible TB with a linkage to treatment rate of 97 %.

KNCV Nigeria used the Delft Light for active TB case findings in communities living in the hard-to-reach Delta Region. Within four months, more than 6000 adults and children (ages 4+) were enrolled. Of the 6218 people whom Delft Light, with CAD4TB, screened, 778 presumptive TB and 757 cases were found. These were then further evaluated by Xperts. The program found 70 cases diagnosed with TB. A study found that Number Needed to Screen (NNS) with this approach was more effective than the intervention with the Wow mobile clinics, particularly among the hard-to-reach populations in rural areas.

In the 2022 Union Conference on Lung Health, the KNCV Foundation in Nigeria extensively shared the results of their projects:

Their studies discussed the importance of Wellness on Wheels mobile TB clinics (WoW) and Delft Light played in the increased use of digital X-ray with CAD for active TB case-finding. While their screening efficiency was found similar, their impact, however, was different. The approach with Delft Light led to a higher clinical diagnosis and the WoW clinic had more impactful advocacy.

One of their studies compared various TB case-finding interventions and assessed their numbers needed to screen (%NNS) and test (%NNT). It was found that the portable digital X-ray with AI and a real-time referring/reporting digital platform has shown the best yields in a resource-limited setting.

Another study compared various TB case-finding approaches. It concluded that TB screening using CXR-CAD showed a higher screening yield than the WHO 4-symptom screen. Also, CXR-CAD combined with the WHO 4-symptom screen and GeneXpert as a single diagnostic algorithm yield TB far superior to CXR and GeneXpert alone.

A study exploring the use of artificial intelligence software-aided chest X-ray screening for community active case-finding in Kano, Nigeria, showed the added value of using CXR screening with CAD compared to WHO symptom screen for an efficient community active TB case-finding intervention in Kano state, Nigeria.

Studying the interim result of AI-powered portable CXR in boosting TB case-finding in Katsina State, Nigeria, it was found that the use of Delft Light with CAD4TB at prisons and marginalized communities led to increased TB case notifications. It also doubled case contribution at prisons.

A comparison of yield from symptomatic W4SS screening and mass mobile X-ray in schoolchildren in Lagos, Nigeria concluded that active case-finding based on CXR with CAD was preferable as the yield was better than 4-symptom screening.

Similarly, a study exploring the potential of existing artificial intelligence to improve TB case-finding at the Nigeria Correctional Centre Lafia, Nasarawa State, north- central Nigeria, concludes that the use of digital X-rays with CAD4TB to improve TB screening of most at-risk populations can be efficient in finding missing TB cases, especially in high TB burden countries.

A 2023 Stop TB Partnership Report detailed the implementation of Delft Light and CAD4TB software in Nigeria. As part of the introducing New Tools Project (iNTP), supported by USAID, Institute of Human Virology Nigeria (IHVN) and KNCV deployed 10 Delft Light with CAD4TB software across eight states, facilitating TB screening in remote areas and among high-risk populations. It has significantly improved case detection rates, with over 130,000 individuals been screened so far, of which 10% were detected with abnormal CXR, and 3,200+ diagnosed with TB through this intervention.

KNCV’s Executive Director, Dr. Bethrand Odume, also spoke about CAD4TB in an interview in 2023. He spoke how portable x-ray systems with CAD4TB has not only contributed to advancing TB screening, but has also reduced the cost of x-rays, minimised transportation time and expenses incurred by patients, thus significantly enhancing access to TB services.

In the beginning of 2024, a study evaluated the Wellness on Wheels for TB improves efficiency, yield, and outcomes in Nigeria. The mobile TB clinic combines digital chest radiography with computer-aided automated detection (CAD) and chronic cough screening to identify presumptive TB cases among high-risk populations in communities, health facilities, and prisons.

The study lauded the “Wellness on Wheels” (WoW) for its efficiency and the effectiveness of its team, noting significant operational improvements and high engagement from all involved. Specifically, it mentions the evolution of operations in real-time to address issues, and incremental improvements in client volumes, target group inclusion, on-site testing, TB treatment initiation, and TB treatment success. These findings suggested that “the return on investment from CAD may be doubled by following up clients with high CAD scores and/or provision of an early intervention regimen or vaccine.”

In 2025, released by KNCV Nigeria, a newly published study assessed the use of ultra-portable digital X-ray (UPDX) systems integrated with CAD4TB software for active case finding across eight Nigerian states.

Between January and September 2022, over 94,000 individuals aged 4 years and above were screened. The study reported a 10 percent TB confirmation rate, with notable detection of subclinical TB – including 3.4 percent of confirmed cases showing no symptoms. Notably, over half of the patients received same-day diagnosis, and more than a third began treatment the same day, underscoring the efficiency of the intervention.

These findings reinforce the value of deploying portable, AI-supported screening tools in hard-to-reach settings and demonstrate the importance of CAD threshold adjustments for both pediatric and adult populations.

Webinar insights

For more information about how the Delft Light portable X-ray and CAD4TB solutions are used in Nigeria, please view the story of “Finding the Missing TB Cases Using DX with AI” The KNCV Nigeria Experience,’ as presented by Dr. Odume Bethrand, Executive Director of the KNCV Foundation in Nigeria. The story with presented during the 2022 Delft Imaging webinar. Dr. Bethrand also presented on “Using CAD in Bi-Directional Screening” during the 2021 webinar.

During the webinar, Dr. Odume noted: “Since 2018, KNCV Nigeria has pioneered the chest X-ray with CAD4TB in Nigeria with the ‘Wellness on Wheels’ Trucks. It has been pivotal in our targeted TB case finding and advocacy, especially within rural communities and hard-to-reach locations.

Thanks to the introduction and pilot of the Delft Light Backpack, we are scaling up digital X-ray with AI for TB case finding. The pilot helped us generated local evidence and experience, which informed country-wide scale-up by other TB partners with the National TB Program to help bridge the gap in TB case-finding in Nigeria, Digital X-ray with AI has shown efficiency in TB case finding as the number needed to screen and the test ad reduced significantly.”

The story of the iNTP project using the Delft Light X-ray and CAD4TB was also covered in a video made by Delft Imaging in collaboration with the KNCV Foundation in Nigeria.

In 2024, during the webinar “Strengthening TB Screening: Innovation, Evidence and Safety,” Dr. Emperor Ubochioma, Team Lead at Nigeria’s National Tuberculosis and Leprosy Control Program, highlighted the country’s progress and remaining challenges in TB detection. Nigeria reported an estimated 499,000 TB cases in 2023, yet only 74 percent were detected, leaving a 24 percent gap. To address this, the deployment of AI-enabled portable X-ray units such as Delft Light with CAD4TB has expanded from 10 units in 2020 to 73 units nationwide. Community outreach through Wellness on Wheels Clinics and Wellness on Keke platforms has significantly improved access to TB screening in hard-to-reach areas. Dr. Ubochioma emphasized, “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.”

Case studies

2021

  • Bi-directional screening with OneStopTB Mobile Clinic & CAD4TB: Nigeria’s OneStopTB Mobile Clinic, also known as the “WoW” truck, implemented an integrated testing model combining EasyDR digital X-ray, CAD4TB, and GeneXpert for TB, alongside COVID-19 and HIV screening. Between June and July 2020, the initiative enrolled 1,931 individuals, with 1,928 (99.8%) screened via CAD4TB X-rays. This effort identified 83 presumptive TB cases, confirming 11 (13%) through GeneXpert. Simultaneously, 1,252 nasopharyngeal swabs were tested for SARS-CoV-2, resulting in 183 COVID-19 cases, while all participants were screened for HIV, diagnosing 12 cases. Co-infection rates were low, with 0.5% for COVID-19/HIV and none for COVID-19/TB. This integrated approach ensured early diagnosis and facilitated prompt linkage to treatment, highlighting its value in addressing multiple health challenges in resource-limited settings (2020, WHO case study; source: Gidado et al., 2020; Delft Imaging Webinar, 2021).
  • CAD4TB to Reduce False Negatives from GeneXpert test: Nigeria’s OneStopTB Mobile Clinic used CAD4TB to identify TB cases that GeneXpert missed, focusing on patients with high CAD4TB scores (≥80). Among 485 symptomatic but Xpert-negative cases, 307 (63%) were clinically diagnosed with TB, accounting for 60% of all WoW truck diagnoses from August 2020 to March 2021. All treated patients showed symptom improvement within weeks, demonstrating CAD4TB’s critical role in reducing false negatives and improving TB outcomes (2020–2021; source: Tukur et al., KNCV Nigeria, UNION Conference).
  • Community-Based TB Active Case-finding with Delft Light & CAD4TB: A four-month TB active case-finding initiative in Nigeria’s Delta Region screened 6,218 people using Delft Light and CAD4TB, identifying 778 presumptive cases and confirming 70 TB diagnoses through Xpert testing. This approach achieved a favorable Number Needed to Screen compared to WoW mobile clinics, proving highly effective for detecting TB in hard-to-reach rural communities (2021; source: Odume et al., KNCV Nigeria, UNION Conference).
  • Prison Screening with OneStopTB Mobile: At Kano Central Correctional Center, the OneStopTB Mobile Clinic screened 1,967 inmates using CAD4TB, identifying 92 presumptive cases and diagnosing 21 TB cases in just two weeks – a 23% case yield compared to only seven cases detected in the previous year. This targeted approach demonstrates the effectiveness of mobile AI-enabled screening in high-risk environments (2021; source: Tukur et al., KNCV Nigeria, UNION Conference).

2022

  • Active Case-finding targeting most-at-risk and hard-to-reach populations: Between December 2021 and March 2022, a parallel screening approach combining WHO’s four-symptom screening and CAD4TB chest X-rays screened 17,261 people in Nigeria, identifying 2,764 presumptive cases and diagnosing 437 TB cases, all linked to treatment. This method improved access for hard-to-reach and high-risk populations, proving efficient and scalable (2021–2022; source: Odume et al., Union Conference).
  • Community Active Case finding with Delft Light & CAD4TB: In Kano State, AI-powered chest X-ray screening with CAD4TB outperformed the WHO four-symptom screen, identifying 116 TB cases from 943 presumptive cases (12%) versus 115 cases from 4,272 symptom-based presumptives (3%). With a Number Needed to Test of 5 compared to 39, CAD4TB screening proved more efficient and cost-effective for early TB detection (2022; source: Bajehson et al., Union Conference).
  • Finding missing TB cases with Delft Light and CAD4TB: From December 2021 to June 2022, Delft Light and CAD4TB were deployed in eight high TB burden states in Nigeria, screening 57,732 people and diagnosing 1,472 TB cases, with 59% clinically confirmed. The approach proved highly efficient, with a Number Needed to Screen of 39 and Number Needed to Test of 5, significantly improving TB detection in hard-to-reach communities (2021–2022; source: Ihesie et al., Union Conference).
  • High-yielding TB case-finding with Delft Solutions: Between January and March 2022, active TB case finding in Northern Cross River State screened 10,488 people, identifying 915 presumptive cases and diagnosing 158 TB cases. The WoW truck accounted for 75% of screenings and 73% of diagnoses, outperforming the Delft Light Backpack in uptake and case yield, demonstrating the strong impact of mobile TB interventions in hard-to-reach communities (2022; source: Chukwu et al., Union Conference).
  • TB Case-finding among school children: In Lagos, a six-month study screened 13,384 schoolchildren and found that mobile X-ray with CAD outperformed the WHO four-symptom screen, detecting 15 TB cases with a lower Number Needed to Test (9 vs. 16) despite screening fewer children. These results underscore the value of mobile CXR for active case finding among school populations (2022; source: Alege et al., Union Conference).
  • TB Screening among Inmates with Delft Light & CAD4TB: From December 2021 to February 2022, Delft Light and CAD4TB were deployed across 16 Nigerian prisons, screening 4,920 inmates and diagnosing 72 TB cases, most from overcrowded medium-security centers. This intervention highlights the urgent need for prison decongestion to curb TB spread (2021–2022; source: Tukur et al., Union Conference).

2023

  • Community Active Case-finding with Delft Light & CAD4TB: In 2022, KNCV Nigeria screened 14,280 people in Delta State using portable digital X-rays with CAD, identifying 1,426 presumptive cases and confirming 270 TB cases – a 19% yield. This approach achieved a 100% evaluation rate, demonstrating the strong potential of PDX-CAD for early TB detection in hard-to-reach communities (2023; source: Wali, Union Conference).
  • Integrated Service for TB, Vaccinations, & Multiple Health Conditions with Wellness-on-Keke: Between October 2022 and January 2023, the Wellness on Keke (WoK) mobile clinic brought integrated services to remote Nigerian communities, delivering 7,199 COVID-19 vaccinations and screening 1,270 people for TB with a 25% yield and 100% linkage to evaluation. This cost-efficient model highlights the potential of WoK for TB detection and broader health interventions in hard-to-reach areas (2022–2023; source: Babayi, Union Conference).
  • Active TB Case-finding in Prisons Delft Light & CAD4TB, OneStopTB Clinic: From January to August 2022, TB screening in 17 Nigerian prisons using digital X-rays with CAD4TB identified 468 TB cases from 26,615 inmates screened, achieving a 17% yield compared to 5% with symptom screening alone. This approach proved three times more effective, underscoring the need for routine AI-powered X-ray screening in prisons (2022; source: Chukwuogo, Union Conference).

2024

  • Detecting asymptomatic TB with Delft Light & CAD4TB: Between January 2022 and January 2024, Nigeria screened 25,993 people using CAD4TB, identifying 39 presumptive TB cases among 659 asymptomatic individuals and diagnosing 11 TB cases (10 clinically, 1 bacteriologically). With an NNS of 60 and NNT of 4, AI-powered X-ray screening proved highly effective in detecting TB in non-symptomatic populations (2022–2024; source: Oyawale et al., Union Conference).
  • Finding TB cases at private health facilities using CAD4TB: Between January 2022 and December 2023, 18 facilities in Lagos screened 95,770 people using CAD4TB, identifying 16,572 presumptive cases and diagnosing 4,969 TB cases (5% yield). With an NNS of 19 and NNT of 3, this facility-based AI-powered approach significantly boosted TB detection and is recommended for scale-up (2022–2023; source: Sokoya et al., Union Conference).
  • High TB yield using parallel screening with W4SS and Delft Light & CAD4TB: KNCV Nigeria deployed seven Delft Light units with CAD4TB across six states, using a parallel screening approach that combined WHO’s four-symptom screen and AI-powered chest X-rays. This strategy optimized TB detection and closed gaps in case finding, offering a scalable model for high-burden settings (2024; source: Chukwu et al., Union Conference).
  • TB Detection in correctional centers with Delft Light & CAD4TB: From January 2022 to December 2023, active TB screening in two Oyo State correctional centers using W4SS and Delft Light with CAD4TB detected 239 TB cases from 3,200 inmates – 237% more than during the previous 36 months of passive screening. This demonstrates the impact of AI-powered X-ray in high-risk prison settings (2022–2023; source: Ajayi et al., Union Conference).
  • Child TB detection: a five-day screening initiative using Delft Light & CAD4TB: In a five-day nationwide initiative, Nigeria screened 331,595 children using Delft Light and CAD4TB, identifying 91,406 presumptive cases and diagnosing 4,054 TB cases (4.9% yield). This targeted approach demonstrates the effectiveness of AI-powered X-ray in closing child TB detection gaps (2024; source: Urhioke et al., Union Conference).
  • TB detection among children with Delft Light & CAD4TB: From January 2022 to December 2023, Nigeria screened 35,636 children using Delft Light and CAD4TB, identifying 2,970 presumptive cases and diagnosing 202 TB cases, with 60% bacteriologically confirmed and 98% starting treatment. This highlights the value of AI-powered X-ray in pediatric TB detection (2022–2023; source: Eneogu et al., Union Conference).

Press coverage

In 2024, NewChampion reported that Ebonyi State received four Delft Light portable digital X-ray machines equipped with CAD4TB for community TB services. The devices, provided by the Global Fund through KNCV Nigeria, will be deployed across hard-to-reach areas to enhance early TB detection and support the state’s efforts to eradicate tuberculosis.

In 2025, Daily Trust reported that Nigeria is leveraging portable digital X-ray systems with CAD4TB to strengthen TB detection in hard-to-reach communities. According to Dr. Olayemi Olupitan of the Institute of Human Virology Nigeria (IHVN), these ultra-portable X-ray units are deployed alongside Wellness on Wheels trucks and community outreach teams, enabling early diagnosis and closing the TB case-finding gap as part of the Global Fund-supported TB/HIV project.

In 2025, NewsNGR reported that Nigeria is scaling up the use of mobile digital X-ray units equipped with AI to improve TB screening among key and vulnerable populations. Coordinating Minister of Health Prof. Muhammad Pate noted, “We are prioritizing the use of mobile digital X-ray units equipped with artificial intelligence, operated by trained radiographers, to enhance TB screening among key and vulnerable populations. Currently, around 400 mobile digital X-ray platforms are deployed across all 36 states and the Federal Capital Territory.”