A portable ultrasound device: a game changer for TB screening?

TB remains one of the leading causes of illness and death worldwide. Early diagnosis of TB is a high priority for TB programmes, however there is not consensus on the best way to implement effective screening for early TB.

Africa Health Research Institute (AHRI) scientists are exploring whether ultrasound can assist in diagnosis of pulmonary tuberculosis (TB). Portable ultrasound devices which could be used in rural clinics (Point of Care Ultrasound [POCUS]) are becoming available at lower cost. If ultrasound can identify TB in the lungs it may have potential to be useful in decentralized TB screening initiatives, especially in low and middle-income settings.

“Our ‘Evaluation of ultrasound for first-line adult tuberculosis screening’ POCUS-TB study, funded by the Bill and Melinda Gates Foundation, is a small-scale proof-of-concept evaluation to explore how ultrasound performs in identifying signs of TB disease. We are comparing the performance of ultrasound to multiple gold standards including microbiological evaluation of sputum, chest x-ray and chest CT scan,” said study co-Principal Investigator, Dr Emily Wong.

This is a particularly exciting study for AHRI as it is the first to truly unite the research infrastructures of AHRI’s Somkhele (northern KwaZulu-Natal) and Durban campuses in a single study. The team is recruiting participants into the POCUS-TB study using the framework of Vukuzazi, a population-based survey screening for multimorbidity – including TB – in Somkhele, and the clinical infrastructure of Durban clinic-based TB cohorts. This design allows the study to enroll participants with different results on microbiological and radiological TB tests. Participants from Somkhele and the outskirts of Durban are being transported to a radiology facility in central Durban where radiologists and collaborators from the University of KwaZulu-Natal (UKZN) Department of Pulmonology perform the required radiological tests.

“POCUS-TB is a milestone for AHRI. For the first time we are inviting members of the demographic surveillance population to Durban to participate in procedures only available here. It will be really exciting if we can use ultrasound to identify findings of TB in the lungs. If it turns out that we can eventually use ultrasound as a safe portable device to screen for TB in the community that could be a game changer!” added Dr Wong.

“We are excited to be part of this project exploring the use of ultrasound in the diagnosis of TB. There is potential to harness artificial intelligence to improve this process, which could help make this technology more accessible in the settings where it is most needed,” said Professor Alison Grant, who is Principal Investigator of the study.

The study started enrollment in October and is expected to complete enrollment by May 2020. Its results will guide further evaluation of ultrasound for TB, and inform how this new technology can be positioned in the health systems of low- and middle-income countries like South Africa.