Implementing AI-enabled chest X-ray for community-based integrated screening for tuberculosis, chronic respiratory diseases, and cardiovascular diseases in Nigeria

Background Low- and middle-income countries face a growing dual burden of communicable and non-communicable diseases, while health services remain largely organised around vertical programmes. In Nigeria, tuberculosis (TB) services are relatively established at the primary healthcare level, whereas access to cardiovascular disease (CVD) and chronic respiratory disease (CRD) care remains limited in rural settings. Artificial intelligence (AI)–enabled chest X-ray offers an opportunity to integrate TB screening with the identification of other cardiopulmonary abnormalities at the community level. This study describes the implementation and outcomes of a community-based, AI-enabled integrated screening intervention in rural Nigeria. Methods We conducted a non-randomised implementation study across five Local Government Areas in Ebonyi and Nasarawa States between January 2023 and December 2024. Community outreach activities used portable digital chest X-ray integrated with AI software to screen individuals aged six years and above. Presumptive TB cases underwent GeneXpert testing, while non-TB radiographic abnormalities were referred for further evaluation. Descriptive analyses summarised screening yield, diagnostic outcomes, and linkage to care. Results A total of 9,585 individuals were screened through 93 community-based outreach activities. Overall, 3,166 (33%) chest radiographs were flagged as abnormal by AI. In total, 1,336 individuals were classified as presumptive TB cases, of whom 1,123 (84%) produced sputum samples for GeneXpert testing. 204 individuals were bacteriologically confirmed with TB, and 194 (95%) were initiated on treatment. An additional 199 individuals were clinically diagnosed with TB following radiologist review. Among abnormal radiographs, 2,367 (75%) showed features suggestive of CVDs or CRDs. All clients with such conditions were referred to tertiary facilities; however, only 12% completed the referral. Implementation adaptations, including improved imaging protocols and community-based follow-up strategies, supported TB linkage but had a limited impact on non-TB referral completion. Conclusions AI-enabled community chest X-ray screening is feasible for TB case finding in rural Nigeria and achieves high linkage to TB treatment. However, limited decentralisation of non-communicable disease services constrains care continuity for CVDs and CRDs. Integrated screening programmes should be paired with strengthened primary healthcare capacity, complementary tools such as blood pressure measurement, and context-specific community engagement strategies.