Personnel time requirements for mobile chest X-ray screening for TB.

Abstract

Background: Community-based active case finding (ACF) using chest X-ray (CXR) is effective for early TB detection, but implementation is limited by high resource demands.

Methods: We assessed human resource needs for two ACF strategies - community-based and facility-adjacent - using mobile CXR with computer-aided detection during a cluster randomised crossover trial in peri-urban Uganda. Tuberculin skin testing (TST) was offered, with referral to preventive therapy for those with positive TST but negative TB evaluation. We conducted time-and-motion observations of three- and four-member screening teams over 90 days (July 2023-April 2024). We estimated staff time per key screening outcome, including time per positive Xpert result and per positive TST reading.

Results: Given an average yield of 6.9 cases per 1,000 individuals screened, three-member (four-member) screening teams collectively spent 65.0 (80.2) person-hours per positive Xpert result, or 26.7 (32.9) person-hours per positive TST read. Staff performed a diverse range of activities, of which the most time-consuming were initial intake (community-based: 2.0 h/day, 23% of time; facility-adjacent: 2.7 h/day, 31% of time) and participant counselling (1.6 h/day, 18%; 2.0 h/day, 22%).

Conclusion: TB ACF requires substantial human resources for implementation. National TB Programs should carefully consider personnel requirements when planning and scaling these programmes.