Comparative analysis of the impact of portable digital X-ray on TB screening in hard-to-reach areas in Nigeria

<sec><title>SETTING</title>TB screening cascade and performance of active case-finding strategies across six states of Nigeria.</sec><sec><title>OBJECTIVE</title>To analyse the impact of portable digital X-ray (PDX) on TB screening in hard-to-reach areas in Nigeria.</sec><sec><title>DESIGN</title>A cross-sectional study involving enrollees with a CAD4TB score of ≥50 had Xpert (sputum) and/or radiographic assessment for TB diagnosis. A TB screening algorithm guided the step-by-step process of identifying a presumptive TB client up to diagnosis and linkage for appropriate treatment. Data were collected, collated, and reported using the national TB tools.</sec><sec><title>RESULTS</title>Seven PDX with CAD4TB used as TB screening and diagnostic tools across six states screened 85,910 persons and identified 8,416 presumptive TB cases. From this study, PDX had the lowest number needed to screen (NNS) of 45 and the number needed to test (NNT) of 4. Similarly, PDX, with a presumptive TB yield of 10%, had the highest TB yield of 23%.</sec><sec><title>CONCLUSION</title>Using PDX with CAD contributed to the highest TB yield during Active TB case finding in hard-to-communities of Nigeria. With a very low NNS and NNT, its national scale-up and use across remote locations will significantly improve TB case-finding.</sec>