One of the key recommendations from the National TB Prevalence Survey is to increase “access to TB screening and testing services through outreach programmes using mobile testing and X-ray facilities”. Spotlight reports that in line with this, a pilot study was launched in six districts looking at the feasibility of using mobile and portable X-ray technologies. The project is implemented by Isibani Development Partners (an NGO) and funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Implementation started in November 2020 (at which time the Health Department already had access to the prevalence survey findings for around a year). In short, the national mobile X-ray project aims to find those people who do not present at health facilities and who may have TB but are asymptomatic.
Professor Martie van der Walt, director of the Tuberculosis Platform at the South African Medical Research Council, says the mobile X-ray equipment can be fitted in mobile vans or trucks and have the same performance as floor-mounted models. She says the X-ray needs to be read by a trained medical officer, and a mobile unit requires a mobile truck, a driver, and a radiographer, so certain levels of resources are required.
“But it is not more expensive than a floor-fixed model. For the latter, a radiographer and a trained medical officer are also needed,” she says.
Spotlight reports that among the biggest advantages of the mobile X-ray units, is that more people can be screened and diagnosed because they can be moved to where the services are most needed, such as workplaces or for community outreach activities or campaigns.
Gauteng Health Department spokesperson Kwara Kekana says Gauteng is part of the National Mobile X-ray project. The province’s pilot sites are Ekurhuleni and Johannesburg.
In the Western Cape, TB HIV Care (an NGO) is implementing the National Mobile X-ray project. Alison Best, TB HIV Care communications manager says “we need to be using mobile X-rays in a very strategic and data-driven way – looking for areas where TB prevalence is high and targeting those areas with screening efforts.
KwaZulu-Natal Health MEC Nomagugu Simelane-Zulu during a recent World TB Day commemoration event in KwaDukuza unveiled a new mobile X-ray clinic and said that it will “produce TB results in a record time of 15 minutes”. At present, the mobile X-ray service is only available in areas such as eThekwini and Ilembe.
Spotlight quotes van der Walt as saying that while the image of TB on a chest X-ray is very typical of TB, the disadvantage is that the image does not show if it is a current/active disease or scars from an old/already cured disease.
“Therefore, a diagnosis by chest X-ray does not mean a person should be treated and seen as infectious. When a diagnosis by chest X-ray is made, the person will still have to undergo other investigations (typically Gene Xpert or culture testing) to determine if it is active disease. The investigations are to look for TB organisms in sputum. If found in sputum it is an indication of current disease,” she says. “In a high prevalence country, there are many people who had TB long ago and therefore when screening a population at community level a lot of old or healed TB is seen on chest X-rays.”
But, Spotlight reports, there are other concerns. Best says X-ray technology is difficult to transport and relatively expensive. “These can be limiting factors in terms of the large-scale roll-out of the technology. In addition, if stigma around TB is rife, people are unwilling to screen and this can result in a limited uptake of the service,” she says.
“The cost of the chest X-rays is almost negligible as they take digital images, however, funding is needed for more trucks and radiographers,” says van der Walt. “The medical doctors do not have to be on-site as the digital chest X-ray image can be uploaded to where the reader is, as long as there is an internet connection. Reading of a chest X-ray takes only a couple of minutes and the result can almost immediately be sent back to the truck,” she says.
Meanwhile, Spotlight reports, Kekana points out that the mobile X-ray units will help in rural communities where access to healthcare facilities is a challenge. “In most cases, clients only consider attending health services when they feel that they are sick. Now, the mobile X-ray will detect the abnormality and clients will be referred to the nearest health facility for further investigation, early TB case detection, and linkage to TB treatment,” Kekana says.
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