Digital X-ray and AI Transform TB Case Finding Among Key Populations in Malawi
While significant progress has been made in closing the gap between estimated cases and those diagnosed with TB on an annual basis, TB case notification remains a significant challenge in Malawi, particularly among key populations such as urban dwellers, migrants, refugees, miners, healthcare workers, and prisoners. Despite recent progress, the country struggles to identify an estimated 25% of TB cases in the community, leaving many undiagnosed and untreated cases of TB (Global TB Report, 2024). Historically, Malawi relied on WHO’s four-symptom screening tool across healthcare facilities. While this is effective in some contexts, the approach yielded a low detection rate, especially in remote or high-burden areas where access to TB diagnosis is limited. Addressing these gaps required quick adoption of the WHO’s recommendation to use digital X-rays for TB screening as an innovative and scalable solution.
To tackle these challenges, the GF and TB Leap Advisor supported the NTLEP in integrating digital X-ray technology and AI into TB screening protocols. This intervention focused on underserved and high-risk populations, enabling more effective identification and diagnosis of TB cases.
Results
With the continued day-to-day technical support of the GF and TB advisor, Malawi has successfully scaled up active TB case-finding intervention that significantly reduced the gaps in TB case notification and improved access to X-ray-based TB screening both in community and health facility settings. The intervention yielded positive outcomes in case notification and linkage to treatment.
Since the inception of the intervention:
- A total of 798,141 people were screened (47% Females) and 7,426 TB cases were diagnosed representing 930 cases per 100,000 people screened.
- Between July and October 2024 alone, 65,557 individuals were screened with X-rays, 54% of whom were female.
- 5,368 presumptive TB cases (8%) were identified, with 4,526 individuals (84%) undergoing confirmatory testing using GeneXpert. About 16% of presumptive TB were not able to produce sputum for Xpert testing and evaluated clinically.
619 TB cases were diagnosed, translating to a case notification rate of 994 cases per 100,000 people screened, and 99% of diagnosed patients were successfully linked to treatment centers.
Of these cases:
- 55% were bacteriologically confirmed.
- 43.9% were clinically diagnosed.
- 1.1% were identified as rifampicin-resistant TB (RR-TB).
The initiative also garnered international recognition, with three oral abstracts presented at the 2024 Union Lung Health Conference, highlighting the program’s innovative approach to TB detection.
