Screening for Tuberculosis with Computer-Aided Detection in Diabetic Patients in Armenia

Background: Computer-aided detection (CAD) software products are increasingly used as a tool to enhance the feasibility and accuracy of chest radiography interpretation. The research objectives of this study include: evaluation of the diagnostic accuracy of CAD strategy for screening and detection of TB in diabetic patients and assessment of the feasibility of using CAD within TB screening programs among patients with diabetes mellitus (DM). Methods: This study has a cross-sectional design considering the individuals with DM to be screened for TB by CAD. As a qualitative component of the study, we carried out in-depth interviews with key informants to understand acceptability of using CAD for TB screening activities. Results: Of 380 study participants screened and analyzed, only one case was confirmed bacteriologically (0.3%, 95% CI: 0 - 0.8) and two participants were confirmed for TB in total (0.5%, 95% CI: 0 - 1.3). One pulmonary tuberculosis case was missed by CAD and confirmed by sputum Gene-Xpert test. The feasibility and acceptability of using CAD within TB screening programs among patients with DM is obvious, given not only the yield of results and interpretations but also the outcome and expectations of in-depth interviews. All interviewees accepted CAD as a screening tool for TB detection, not only among DM patients but also in the other risk groups. Conclusion: Utilization of CAD is feasible to perform in PHC setting for any population, including key populations such as people living with DM. Further studies devoted to CAD screening in DM patients are reasonable to conduct with application of CAD at a threshold lower than 70, as at least one PTB case was missed by CAD and confirmed by sputum GeneXpert test.