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Automated chest radiography and mass systematic screening for tuberculosis

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BACKGROUND: Systematic screening for TB using automated chest radiography (ACR) with computer-aided detection software (CAD4TB) has been implemented at scale in Karachi, Pakistan. Despite evidence supporting the use of ACR as a pre-screen prior to Xpert® MTB/RIF diagnostic testing in presumptive TB patients, there has been no data published on its use in mass screening in real-world settings.

METHOD: Screening was undertaken using mobile digital X-ray vehicles at hospital facilities and community camps. Chest X-rays were offered to individuals aged ≥15 years, regardless of symptoms. Those with a CAD4TB score of ≥70 were offered Xpert testing. The association between Xpert positivity and CAD4TB scores was examined using data collected between 1 January and 30 June 2018 using a custom-built data collection tool.

RESULTS: Of the 127 062 individuals screened, 97.2% had a valid CAD4TB score; 11 184 (9.1%) individuals had a CAD4TB score ≥70. Prevalence of Xpert positivity rose from 0.7% in the <50 category to 23.5% in the >90 category. The strong linear association between CAD4TB score and Xpert positivity was found in both community and hospital settings.

CONCLUSION: The strong association between CAD4TB scores and Xpert positivity provide evidence that an ACR-based pre-screening performs well when implemented at scale in a high-burden setting.
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Keywords: CAD4TB; TB, active case finding; Xpert® MTB/RIF; automated chest radiography; chest X-ray screening; mass screening; systematic screening

Document Type: Research Article

Affiliations: 1: Global Health Directorate, Indus Health Network, Karachi, Pakistan 2: Provincial TB Control Program, Department of Health, Government of Sindh, Hyderabad, Pakistan 3: Interactive Research and Development, Singapore 4: Global Health Directorate, Indus Health Network, Karachi, Pakistan, Interactive Research and Development, Singapore 5: Interactive Research and Development, Singapore, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom

Publication date: July 1, 2020

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on lung health world-wide.

    To share scientific research of immediate concern as rapidly as possible, The Union is fast-tracking the publication of certain articles from the IJTLD and publishing them on The Union website, prior to their publication in the Journal. Read fast-track articles.

    Certain IJTLD articles are also selected for translation into French, Spanish, Chinese or Russian. These are available on the Union website.

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