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Case Study

Nepal – Active TB case-finding in prison settings using AI-enhanced chest X-ray

A radiographer taking a chest X-ray with the Delft Light system at a makeshift screening station in Nepal.

A substantial proportion of TB cases in Nepal remain undiagnosed, particularly in high-risk settings such uas prisons. Overcrowding, limited access to healthcare, and high rates of asymptomatic disease increase transmission risk and challenge symptom-based screening approaches.

*This study was conducted using CAD4TB, now part of CAD4TB+.

Intervention

TB screening camps were conducted in large prisons using digital chest X-ray with CAD4TB and symptom screening. Individuals meeting presumptive criteria underwent molecular testing, and all diagnosed cases were promptly linked to treatment.

Result
  • Among more than 1,500 individuals screened, TB prevalence in prisons was approximately three times higher than national estimates.
  • Both bacteriologically confirmed and clinically diagnosed cases were identified, including individuals without symptoms.
A radiographer taking a chest X-ray with the Delft Light system at a makeshift screening station in Nepal.
Conclusion
  • Routine chest X-ray screening with CAD4TB in prisons enables early TB detection in a high-risk population.
  • Scaling this approach could substantially reduce undiagnosed TB and transmission in custodial settings.

REFERENCE: Sharma B. et al. (2024). Active TB case finding using digital chest X-ray and AI in prisons in Nepal.