{"id":"AIBD-0634","title":"PROSPECT randomized trial in Blantyre, Malawi: HIV testing plus CAD4TB-read chest X-rays speeds TB treatment for adults with cough","summary":"In the PROSPECT trial at a Blantyre clinic, TB patients offered HIV testing plus chest X-rays read by CAD4TB started treatment a median of 1 day after the visit, against 11 days under standard care.","date_observed":"2019-11-27","date_basis":"event","date_precision":"day","benefit_status":"reported","source_collection":null,"source_entry":null,"account":"Researchers from the Malawi-Liverpool-Wellcome Trust Clinical Research Programme, the Liverpool School of Tropical Medicine and the London School of Hygiene and Tropical Medicine ran the PROSPECT trial at Bangwe Health Centre in Blantyre, Malawi. Between 15 November 2018 and 27 November 2019 they randomly assigned 1,462 adults with cough to standard care, to oral HIV testing with linkage to care, or to HIV testing plus a digital chest X-ray read by CAD4TB version 5 software. People in the X-ray arm whose score was 45 or higher gave sputum for an on-site Xpert test, and a radiologist also read the X-rays remotely. Within 56 days, 15 people in the X-ray arm had started TB treatment, against 5 in the standard-care arm; the authors report that this difference was not statistically significant. Median time to treatment was 1 day in the X-ray arm and 11 days under standard care (hazard ratio 2.86, 95% confidence interval 1.04 to 7.87), and 6 of the 15 patients in the X-ray arm started treatment on the day of the visit, against none of the 5 under standard care. TB was less common among participants than the investigators expected, and follow-up lasted 56 days. The authors estimate that the probability that the X-ray package was cost-effective at US$1,200 per quality-adjusted life year was 0%. The trial tests the X-ray and the software as one package. It does not compare the software with a human reader. Wellcome funded the study, and no author reports a tie to Delft Imaging.","category":"general benefit","unexpected":false,"purpose":"CAD4TB was built to score chest X-rays for signs of pulmonary TB so that staff can decide who needs a confirmatory test. Faster diagnosis and treatment of TB was the purpose of its use in this trial.","system":"CAD4TB computer-aided detection software reading digital chest X-rays","model_version":"CAD4TB v5","developer":"Delft Imaging","deployer":"PROSPECT trial team of the Malawi-Liverpool-Wellcome Trust Clinical Research Programme at Bangwe Health Centre","location":"Bangwe Health Centre, Blantyre, Malawi","domain":"Healthcare","segment":null,"benefit_type":"Improved Physical Health","taxonomy_note":null,"registry_ids":{},"ratings":[{"group":"personal","depth":2,"reason":"Median time to TB treatment fell from 11 days under standard care to 1 day in the X-ray arm, and 6 of 15 TB patients in that arm started treatment on the day of the visit."}],"ai_role":{"status":"unassessed","statement":"The trial compares HIV testing with and without the combined X-ray and CAD4TB package. It does not separate the software from the X-ray or compare it with a human reader."},"evidence":[{"kind":"peer-reviewed study","citation":"MacPherson P, Webb EL, Kamchedzera W, et al. Computer-aided X-ray screening for tuberculosis and HIV testing among adults with cough in Malawi (the PROSPECT study): a randomised trial and cost-effectiveness analysis. PLoS Med. 2021;18(9):e1003752. doi:10.1371/journal.pmed.1003752","title":"Computer-aided X-ray screening for tuberculosis and HIV testing among adults with cough in Malawi (the PROSPECT study): A randomised trial and cost-effectiveness analysis","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC8459969/","date":"2021-09-09","written_by":"independent","quote":"Median (IQR) time to TB treatment was 11 (6.5 to 38), 6 (1 to 22), and 1 (0 to 3) days (hazard ratio for HIV-TB versus SOC: 2.86, 1.04 to 7.87)"}],"replication":{"produced_by":["Adults with cough at an urban primary clinic were offered a digital chest X-ray during the same visit.","A CAD4TB score of 45 or higher led to an on-site Xpert sputum test.","The clinic TB officer started treatment when the Xpert test was positive."],"must_hold":["X-ray equipment, Xpert testing and trained staff must be available during the visit.","The score threshold must suit the local population."],"echoes":[{"date":"2022-08-01","setting":"17 adult correctional centers in 11 Nigerian states, where KNCV Nigeria compared digital X-ray with CAD4TB against symptom screening for TB yield; time to treatment was not compared","model_version":null,"outcome":"unknown","source":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12918570/"}]},"paired_incident":{"database":"AI Incident Database","identifier":"81","title":"Researchers find evidence of racial, gender, and socioeconomic bias in chest X-ray classifiers","url":"https://incidentdatabase.ai/cite/81","severity":null,"group":"personal","basis":"Both involve AI software that reads chest X-rays to flag disease, and in the incident researchers found that such classifiers were biased against patients by gender, race and income."},"headline":"Computer-read chest X-rays speed TB treatment at a Malawi clinic","metric":"Median time to treatment was 1 day in the X-ray arm and 11 days under standard care","comparator":{"against":"Standard care for adults with cough at the same clinic","before":"0 of 5 TB patients treated on the day of the visit; median 11 days to treatment","after":"6 of 15 TB patients treated on the day of the visit; median 1 day to treatment","basis":"measured","quote":"with same-day treatment of 0/5 (0%) SOC, 1/8 (12.5%) HIV, and 6/15 (40.0%) HIV-TB screening arm TB patients ( p = 0.03)","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC8459969/"},"later":null,"value":null,"developer_country":"Netherlands","deployer_country":"Malawi","unrated_because":null,"brief_notes":null,"brief":null,"revisions":[{"date":"2026-10-29","change":"Added the case.","source":"https://pmc.ncbi.nlm.nih.gov/articles/PMC8459969/","editor":"AIBD"},{"date":"2026-10-29","change":"Linked a comparable incident in the AI Incident Database (incident 81).","source":"https://incidentdatabase.ai/cite/81","editor":"AIBD"}],"confidence":"studied","shade":"high","claim_status":"Independently studied","claim_basis":"Sources: one independent peer-reviewed study. 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