One-Stop TB Service
Complementary TB diagnostics in a 20 foot solar powered container facilitate fast track screening in key populations. A smart integration of a X-ray room, CAD, a mini-lab for Xpert® MTB/RIF and internet connectivity responds to the need for more (cost) effective high throughput screening.
Bringing TB services closer to the people who need them: the “one-Stop TB-service” concept offers an innovative integration of diagnostic technologies into a 20 foot container which brings these diagnostics to where key populations are, such as prisons or mines. The set-up permits a daily throughput of over 300 individuals.
TB diagnostic tools at (primary) health facilities should be:
- Operative with single phase electric power for use on solar energy only
- Easy to operate in view of the shortage of skilled health care workers
- Integrated in DOTS program and linked to TB treatment services with registration and follow-up
- Support diagnosis of multiple diseases and contribute to Health System strengthening
- Economic: low cost per test and affordable for the patient
- Multi-functional: e.g. X-ray for imaging of extra-pulmonary TB, trauma and extremities
The One-Stop-TB service was first introduced to Zambia, where with the support from the National TB program and Zambart a container was designed. The service is provided in a standard size 20 foot container, which can function autonomously at almost any location including district hospitals.
Any local available truck can transport the container. An integrated lifting device can place the unit where its service is required and can become operational in just 1 hour. The unit can be self-supporting in terms of electrical power (solar power with batteries and inverters). In addition water reservoirs can be included for continued operations in outreach settings. Internet connectivity and a database for laboratory results, X-ray DICOM images and other health services are part of the ICT component.
Layout of the "One-Stop TB" Container
The container unit can consist of three workspaces and two folding screens can provide additional external space.
- In the X-ray room the digital X-ray unit is placed and patients are X-rayed in an upright position
- In the X-ray control area, the radiographer enters patient data, makes the Chest image and the CAD system provides an abnormality score for decision on further testing, with e.g. Xpert®. If necessary, the person X-rayed can receive a hardcopy print-out for further reference at a cost of € 0,03 per print (approximately).
- In the well-ventilated laboratory space, a laboratory technician or health care worker can process the sputum samples. The room can contain a LED Fluorescent microscope and/or a molecular test unit (GeneXpert machine); a specially foamed transport case for the GXIV system and a rubber mat ensures safe transportation and use of the equipment in outreach settings.
- Fall-out screens provide shelter and a separate waiting and sputum collection area.
Integration of communication/database system
Communication between the unit and a central database can go through GPRS/EDGE and if available UMTS techniques.
Health System Strengthening
By linking TB control activities to respiratory health, TB programs can improve the overall quality of healthcare. Multifunctional X-ray systems allow for broader medical imaging use including the possibility to generate income from patient fees.
All diagnostic techniques and tests are easy to operate and require basic training.
The one-Stop TB-service when communicated as a more general (Lung) Health screening program and brought close to the community, can reduce barriers to TB care. Most people are willing to get their X-ray taken and are more likely to accept to undergo additional testing if the CXR is considered to be abnormal. Other screening services such as for instance hypertension and diabetes can also be performed in the container to reduce risk of stigma.
- Integration of communication/database system