Operational feasibility of the ultra-portable digital X-rays with Computer-Aided Detection (CAD) for community active case finding for TB in Nigeria: Health care workers and client’s perspectives

Nigeria received 10 Ultra-Portable digital X-rays (UPDX) with Computer-Aided Detection (CAD) from the Stop TB Partnership, as part of the USAID-funded introducing New Tools Project (iNTP). The UPDX machines (Delft Light systems) were deployed to 8 states for TB screening and triaging algorithms for early TB detection. This study sought to explore the perspectives of health workers and clients on the operational feasibility and ease-of-use of the UPDX with CAD, with a view to determining the acceptability, enablers and barriers to effective use and exploring the perceived ease-of-use by the end-users. This is a cross-sectional descriptive study, conducted between April and June 2023, using mixed quantitative and qualitative methods to determine the feasibility, acceptability, and ease-of-use of the UPDX with CAD in Nigeria. Purposive sampling was done for 57 respondents made up of radiographers, radiologists, key informants, TBLS/DOT nurses and clients. All aged from 20-60 years. They reported ease-of-use and access to screening, portability, availability in hard-to-reach areas, usefulness for mass screening in communities, comparable quality of x-ray with fixed x-ray, rapid results and had challenges with equipment/implementation costs, fears of irradiation, lack of collaboration with other programs and inability to use UPDX-with-CAD on children < 4 years. All (100%) strongly agreed that the UPDX/accessories were easy to set up, considered themselves proficient with operating the UPDX and to a lesser extent agreed that the programs and software are user-friendly and easy to set up. They however disagreed that the device is portable enough for one person to carry. Our study gave insight into the barriers and facilitators of acceptance and use of integrating new health technology into existing health systems and findings suggest that the implementation of the UPDX with CAD is feasible in Nigeria with very good perception on acceptability and ease-of-use for community TB screening activities.