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

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.

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.

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%).

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