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At A Glance

Location: Punjab, Khyber Pakhtunkhwa, and Sindh provinces

Project timeline: August 2023 - Present

AI: InferRead DR Chest by Infervision

Ultra-portable X-ray System: Sinopharm, Shantou Institute of Ultrasonic Instruments (SIUI)

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Context

With over 600,000 tuberculosis (TB) cases in 2022, Pakistan has the fifth highest TB burden globally. Despite recent improvements in notifications, more than 179,000 people with TB in the country went undiagnosed and unnotified in 2022, and the country faces a growing challenge of multidrug-resistant disease ¹ . Many of these undiagnosed cases are found among key and vulnerable populations who face a higher risk of TB and greater barriers to accessing care.

Dopasi Foundation has been a leader in TB innovation in Pakistan, embracing ultra-portable chest X-ray (UP-XR) systems equipped with AI-powered computer-aided detection (CAD) software. These innovations bring TB screening directly to hard-to-reach, key, and vulnerable populations through community-based screening campaigns and active case finding.

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AI Intervention

In August 2023, with the support of the national and provincial TB control programs, Dopasi expanded the reach of its case finding by implementing new CAD and UP-XR systems, InferRead® DR Chest from InferVision with Sinopharm UP-XR. These were deployed across nine districts in three provinces - Punjab, Khyber Pakhtunkhwa, and Sindh- by two mobile teams to screen vulnerable populations, such as prisoners, transgender people, refugees, and healthcare workers.

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Weighing just 30kg, the fully integrated CAD and UP-XR system provides mobile teams with the portability necessary to deliver decentralized TB screening to hard-to-reach populations, such as those in rural regions beyond the reach of screening vans and within prisons where van-based systems are not permitted.

On average, between 100-150 people are assessed daily during screening campaigns. Each person undergoes a chest X-ray, interpreted by AI, regardless of whether they present TB symptoms. AI analyzes the X-ray in under 30 seconds, flagging TB and over 20 other lung, heart, and musculoskeletal conditions. Those with positive AI results are linked to diagnostic testing using GeneXpert, while an on-site physician interprets findings for non-TB diseases. For high-risk individuals, including TB contacts and key populations such as prisoners, TB preventive treatment is offered to stop disease from later developing.

Looking Ahead

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Following the success of these campaigns, Dopasi is planning to continue to expand its UP-XR and AI/CAD efforts, particularly aiming to leverage InferRead DR Chest’s capability to detect additional lung diseases, such as pneumothorax, to improve overall respiratory health in underserved populations.

The deployment of CAD with UP-XR technology has significantly extended the reach of TB screening in Pakistan’s rural and high-risk communities. The portability of the UP-XR system, combined with the speed and accuracy of AI-powered interpretation, makes it an essential tool in the fight against TB.

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Acknowledgements

We would like to thank Dr. Usman Lodhi (Program Manager, Dopasi), Dr. Mohammed Ali (Monitoring and Evaluation Manager, Dopasi), and Mishaal Javed Sehgal (Communications Manager, Dopasi) for taking the time to share their experiences for the development of this case study. Funding for these activities was provided by the Stop TB Partnership’s TB REACH Initiative Wave X.  

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About This Document

This document is one of a series spotlighting the experiences of implementers using computer-aided detection (CAD) and ultra-portable chest X-ray (UP-XR) for TB screening. We hope it will inspire prospective implementers and enable knowledge exchange between current users of these tools.

The views expressed in this publication are those of the authors and do not necessarily reflect those of the United Nations. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of UNOPS.

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_{1 WHO. Country TB Profile - Pakistan. Available online:https://worldhealthorg.shinyapps.io/tb_profiles/?_inputs_&entity_type=%22country%22&iso2=%22PK%22&lan=%22EN%22}

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