ArticlePLOS global public health2024
Iterative evaluation of mobile computer-assisted digital chest x-ray screening for TB improves efficiency, yield, and outcomes in Nigeria.
Article in PLOS global public health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 10 citations in OpenAlex.
- A public-private partnership for facility-based tuberculosis screening using chest radiographs, Viet Nam.Bulletin of the World Health Organization · 2026Article
- Accelerating tuberculosis diagnosis in Mozambican prisons using digital chest X-rays with computer-aided detection: a longitudinal, comprehensive health intervention.BMC global and public health · 2026Article
- Routine active case finding in Nigerian penitentiary institutions: comparing yields from digital X-ray with CAD4TB and WHO 4-symptom screening.BMC infectious diseases · 2026Article
- Global status of policies and practices for systematic TB screening in high-burden countries.IJTLD open · 2025Article
- Health care needs survey to improve preparedness of community outreach clinics after severe flooding in Mulanje district, Malawi.PLOS global public health · 2025Article
- Addressing the challenge of tuberculosis screening in diabetic populations: a narrative review of methods and strategies.Frontiers in public health · 2025Review
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Authors and funding
21 authors at 9 institutions in 5 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Wellness on Wheels (WoW) is a model of mobile systematic tuberculosis (TB) screening of high-risk populations combining digital chest radiography with computer-aided automated detection (CAD) and chronic cough screening to identify presumptive TB clients in communities, health facilities, and prisons in Nigeria. The model evolves to address technical, political, and sustainability challenges. Screening methods were iteratively refined to balance TB yield and feasibility across heterogeneous populations. Performance metrics were compared over time. Screening volumes, risk mix, number needed to screen (NNS), number needed to test (NNT), sample loss, TB treatment initiation and outcomes. Efforts to mitigate losses along the diagnostic cascade were tracked. Persons with high CAD4TB score (≥80), who tested negative on a single spot GeneXpert were followed-up to assess TB status at six months. An experimental calibration method achieved a viable CAD threshold for testing. High risk groups and key stakeholders were engaged. Operations evolved in real time to fix problems. Incremental improvements in mean client volumes (128 to 140/day), target group inclusion (92% to 93%), on-site testing (84% to 86%), TB treatment initiation (87% to 91%), and TB treatment success (71% to 85%) were recorded. Attention to those as highest risk boosted efficiency (the NNT declined from 8.2 ± SD8.2 to 7.6 ± SD7.7). Clinical diagnosis was added after follow-up among those with ≥ 80 CAD scores and initially spot -sputum negative found 11 additional TB cases (6.3%) after 121 person-years of follow-up. Iterative adaptation in response to performance metrics foster feasible, acceptable, and efficient TB case-finding in Nigeria. High CAD scores can identify subclinical TB and those at risk of progression to bacteriologically-confirmed TB disease in the near term.
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Registered trials
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