15 Jul Pakistan: Indus Hospital – a trailblazer for initiating chest X-ray screening at large tertiary public and private hospitals
[vc_row css_animation=”” row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” angled_section=”no” text_align=”left” background_image_as_pattern=”without_pattern”][vc_column][vc_separator type=”normal” thickness=”2″ up=”20″ down=”20″][/vc_column][/vc_row][vc_row css_animation=”” row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” angled_section=”no” text_align=”left” background_image_as_pattern=”without_pattern”][vc_column][vc_gallery type=”nivo” interval=”3″ images=”1441,1443″ img_size=”full”][vc_column_text]The Indus Hospital is implementing chest X-ray based screening at large tertiary hospitals in the public and private sectors, using especially designed mobile X-ray vans equipped with digital X-ray machines and CAD4TB. Targeting people at risk of TB in large public and private tertiary care hospitals and community settings, the intervention is the first of its kind in Pakistan and has been successful in identifying presumptive TB cases and increasing TB case notification.
The intervention was initiated in the city of Karachi – which had seen consistently low TB case notification despite its population of about 20 million – but has recently also been implemented in Peshawar and Quetta. The case finding approach targets adult patients and attendants visiting public and private tertiary care hospitals, densely populated areas and communities identified as high-burden, contacts of registered TB patients, prisoners as well as factory and health care workers.
The approach has been successfully pursuing its objective of finding people with TB who are either missed by the public health system or in the early stages of the disease and hence are not presenting to health facilities. The mobile X-ray vans have provided access to screening and healthcare solutions to large expanses of the population residing in low-income areas. It has also helped mitigate gender-related barriers by actively engaging women and transgender people who are otherwise marginalized in this part of the world.
Previously, the main screening method for TB had been a verbal symptom screen. The introduction of chest X-ray screening in conjunction with CAD4TB has had a significant impact on detection rates of people with TB. This innovative approach has resulted in a marked increase in patient yield, averaging to about 1% (of individuals X-rayed) – almost double that of the previously employed screening method.
Particularly in Karachi, 188,159 people have been screened since early 2017 using chest X-ray, out of which 9,242 were tested on GeneXpert, resulting in the diagnosis of over 1,620 adults with bacteriologically and clinically diagnosed TB. The screening numbers are highly linked with the number of vans available at a point in time.
The design of the intervention has improved the identification of TB in high disease-burden areas and increased access to facilitate detection of missing people with TB. It is expected that through active TB case finding, the incidence of TB will be reduced to a greater extent than through conventional diagnostic approaches.
In the upcoming months, Pakistan will see an increase in the number of mobile chest X-ray vans deployed across different parts of the country, where many people with TB are expected to be found, especially in the rural areas of Sindh and Punjab.
With the use of the data collected via the CAD4TB software and a mobile health application, GIS mapping to assess geographic coverage of the intervention along with patient yields from different areas is now also in progress to help identify TB hot-spots. This will assist in further optimization of results, enhance patient yield, improve efficiency in enabling rapid and early identification of the missing people with TB and hence positively impact on TB case notification.[/vc_column_text][/vc_column][/vc_row]