{"id":"AIBD-0647","title":"Randomized trial in Kilimanjaro and Arusha, Tanzania: SELENA+ results at the point of screening double clinic attendance for referable diabetic retinopathy","summary":"In a Tanzanian trial of 2,378 people with diabetes, SELENA+ results and counselling at screening raised clinic attendance for referable retinopathy from 18.2% to 35.9%.","date_observed":"2024-08-31","date_basis":"event","date_precision":"day","benefit_status":"reported","source_collection":null,"source_entry":null,"account":"Researchers from the London School of Hygiene & Tropical Medicine and Kilimanjaro Christian Medical Centre ran an individually randomized trial at diabetes and noncommunicable disease clinics in 24 hospitals in the Kilimanjaro and Arusha regions of Tanzania. Between 8 March 2023 and 31 August 2024 they enrolled 2,378 adults with diabetes. In the AI group, retinal photographs went to the SELENA+ software from EyRIS, and each person received the result with face-to-face counselling before leaving the photography room. In the standard group, people received a result from human graders by telephone a few weeks later. Among the 904 participants whom masked UK-certified graders judged to have referable diabetic retinopathy, 157 of 437 (35.9%) in the AI group attended the central ophthalmology clinic within eight weeks, against 85 of 467 (18.2%) in the standard group. The trial tests the whole pathway, so the effect combines the instant result with face-to-face counselling. Even in the AI group, nearly two in three people with referable disease did not attend within eight weeks. The British Council for the Prevention of Blindness, the Christian Blind Mission and the Sir Halley Stewart Trust funded the trial.","category":"general benefit","unexpected":false,"purpose":"SELENA+ was built to grade retinal photographs for diabetic retinopathy. In this trial it gave a result at the point of screening so that staff could counsel and refer people at once; the higher attendance was the purpose of that use.","system":"SELENA+","model_version":null,"developer":"EyRIS","deployer":"London School of Hygiene & Tropical Medicine and Kilimanjaro Christian Medical Centre, with diabetes clinics in 24 hospitals","location":"Kilimanjaro and Arusha regions, Tanzania","domain":"Healthcare","segment":null,"benefit_type":"Improved Accessibility","taxonomy_note":null,"registry_ids":{},"ratings":[{"group":"personal","depth":2,"reason":"Among people with referable diabetic retinopathy, 35.9% in the AI group reached the eye clinic within eight weeks against 18.2% in the standard group."},{"group":"organizational","depth":2,"reason":"The screening program doubled the share of referred people who completed the referral."}],"ai_role":{"status":"assessed","statement":"Participants were randomly assigned to AI-supported screening with an immediate result or to standard screening with deferred human grading. The design does not separate the AI result from the face-to-face counselling that it made possible."},"evidence":[{"kind":"peer-reviewed study","citation":"Cleland CR, Bascaran C, Makupa WU, et al. Artificial intelligence-supported diabetic retinopathy screening in Tanzania: a randomised controlled trial. Lancet Glob Health. 2026. doi:10.1016/j.langlo.2026.104062","title":"Artificial intelligence-supported diabetic retinopathy screening in Tanzania: a randomised controlled trial","url":"https://pubmed.ncbi.nlm.nih.gov/42863478/","date":"2026-10-12","written_by":"independent","quote":"Of the participants in the AI-intervention group, 157 (35·9%) of 437 attended the central ophthalmology clinic within 8 weeks, compared with 85 (18·2%) of 467 in the standard-of-care group, an absolute difference of 17·7 percentage points (95% CI 12·0-23·4; odds ratio 2·52 [95% CI 1·86-3·42]"},{"kind":"peer-reviewed study","citation":"Cleland CR, et al. Artificial intelligence-supported diabetic retinopathy screening in Tanzania: rationale and design of a randomised controlled trial. BMJ Open. 2024;14:e075055.","title":"Artificial intelligence-supported diabetic retinopathy screening in Tanzania: rationale and design of a randomised controlled trial","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC10824006/","date":"2024-01-25","written_by":"independent","quote":"The SELENA+AI software (EyRIS) 15 was the only system to meet all these criteria and was therefore selected."}],"replication":{"produced_by":["The AI gave a grade at the clinic before the person left.","Staff counselled people face to face and referred them at once.","The comparison was deferred human grading with telephone counselling weeks later."],"must_hold":["The AI must work offline and with the local cameras, two criteria that the trial team used to choose it.","Staff must be available to counsel people at the point of screening.","People must be able to travel to the central eye clinic."],"echoes":[{"date":"2021-07-01","setting":"RAIDERS trial at four diabetes clinics in Kigali, Rwanda (Cybersight AI)","model_version":null,"outcome":"recurred","source":"https://pmc.ncbi.nlm.nih.gov/articles/PMC9754978/"},{"date":"2022-12-06","setting":"ACCESS trial at Johns Hopkins Pediatric Diabetes Center, Baltimore (autonomous AI eye exam; AIBD-0067)","model_version":null,"outcome":"recurred","source":"https://pmc.ncbi.nlm.nih.gov/articles/PMC10784572/"}]},"paired_incident":null,"headline":"*SELENA+* results on the spot bring more Tanzanians to eye care","metric":"raised clinic attendance for referable retinopathy from 18.2% to 35.9%","comparator":{"against":"Standard screening with deferred human grading and telephone counselling","before":"18.2% of people with referable retinopathy attended the eye clinic within 8 weeks","after":"35.9% attended within 8 weeks","basis":"measured","quote":"157 (35·9%) of 437 attended the central ophthalmology clinic within 8 weeks, compared with 85 (18·2%) of 467 in the standard-of-care group","url":"https://pubmed.ncbi.nlm.nih.gov/42863478/"},"later":null,"value":null,"developer_country":"Singapore","deployer_country":"Tanzania","unrated_because":null,"brief_notes":null,"brief":null,"revisions":[{"date":"2026-10-29","change":"Added the case.","source":"https://pubmed.ncbi.nlm.nih.gov/42863478/","editor":"AIBD"}],"confidence":"studied","shade":"high","claim_status":"Independently studied","claim_basis":"Sources: two independent peer-reviewed studies. 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