Introducing Start4All: An exciting research project aiming to improve TB diagnosis worldwide
Start4All
Start4All, formally known as Start Taking Action for TB Diagnosis, is a groundbreaking 4-year research project generously funded by UNITAID with a commitment of $15 million.
The initiative is co-led by the prestigious Liverpool School of Tropical Medicine (LSTM) and Stop TB Partnership, engaging collaboratively with local partners in Bangladesh, Brazil, Cameroon, Kenya, Malawi, Nigeria, and Viet Nam.
Our involvement in the Start4All project began in early 2024, although the project itself was launched earlier in 2022. While our current participation is scheduled to conclude in June 2025, the Start4All project is expected to continue beyond this date.
This ambitious initiative is dedicated to transforming the global landscape of tuberculosis (TB) diagnosis and treatment by addressing existing gaps, enhancing scalability, and building strong partnerships at both local and global levels.
By focusing on these areas, Start4All aspires to make TB care more accessible, affordable, and equitable worldwide.
Radiographer John Jabu using the portable X-ray equipment for a TB Chest X-ray with CAD study in a community clinic in Blantyre, Malawi.
Project Goals and Objectives
The Start4All initiative is strategically positioned to address the pressing global health challenge posed by TB. The primary goals of the project are multifaceted, targeting key areas that have historically hindered effective TB management.
Evaluating Diagnostic Tests
A critical first phase of the project involves evaluating various combinations of TB diagnostic tests across different demographics to determine the most effective approaches, particularly for high-risk groups such as children in Cameroon and Viet Nam.
Creating Diagnostic Resources
A major objective is to develop a comprehensive library of 1,000 paediatric chest x-rays. This resource will support the training and validation of CAD software tailored for TB diagnosis in children, addressing a significant shortfall in current diagnostic practices.
Strengthening Global and Local Partnerships
By working closely with health authorities and organisations at the national and international levels, the project aims to influence policy and practice in TB care, ensuring that advancements in diagnosis and treatment are widely adopted and implemented.
The Challenge of TB Diagnosis
Tuberculosis remains a complex challenge in global health, responsible for over 1.3 million deaths annually, including a disproportionately high number of children. The challenge is exacerbated in low-resource settings where diagnostic tools are either unavailable or prohibitively expensive.
Furthermore, diagnosing TB in children is complex, often requiring specialised knowledge and equipment, scarce in many regions. These challenges underscore the critical need for innovative solutions to improve diagnostic accuracy and accessibility, which are at the heart of the Start4All project.
The Role of Chest X-Rays and CAD
Chest X-rays serve as a cornerstone in the diagnosis of TB, being one of the most accessible forms of imaging worldwide.
However, the interpretation of these X-rays, especially in children, requires specialised skills that are not widely available in resource-limited settings.
This is where computer-aided detection (CAD) comes in. CAD systems use advanced algorithms to analyse chest X-ray images and assist in diagnosing TB by highlighting potential areas of concern.
This technology promises to standardise and improve the accuracy of TB diagnosis across diverse healthcare settings, particularly where expert radiological input is limited.
While CAD is now recommended by WHO for adults, more robust evidence for safe application in children is urgently needed. Our library of cases will contribute to this evidence.
Leveraging our Expertise for Start4All Impact
With our expanding radiology community network in countries with a high burden of TB and our extensive previous experience in contributing to CAD for TB evaluation studies, we are uniquely positioned to lead on the development of this new pediatric Chest X-ray library.
Our commitment to advancing global health and to fair, ethical development of AI driven imaging solutions, aligns perfectly with the project’s objectives.
As we contribute to the evaluation, development and dissemination of new technologies like CAD, we are also helping to reshape diagnostic services in under-resourced areas, promoting equity and effectiveness.
This initiative not only highlights the critical role of advanced diagnostics in managing global health challenges but also reinforces our commitment to achieving a TB-free world.
Our Contribution
As a key partner in the Start4All project, Worldwide Radiology brings all the relevant expertise in medical imaging in low resource settings to the forefront of the fight against TB.
The successful execution of the Start4All project is expected to set new benchmarks in the diagnosis of paediatric TB, leading to earlier and more accurate detection and treatment.
This initiative has the potential to influence global health policies and contribute to the reduction of TB mortality rates, especially among children.
Technical Consultation
We support the collection and processing of high-quality paediatric chest x-rays.
Quality Assurance
We work in collaboration with AI experts to ensure that the X-ray data sets meet the highest standards of accuracy and efficacy
Capacity Building
We bring comprehensive medical imaging expertise on the application of Chest X-rays to the TB community, informing research, care and policy.
Meet the Team
Laura Chillag
Project Lead
Laura is a UK based diagnostic radiographer with over ten years experience across a range of imaging modalities. She has been a volunteer with Worldwide Radiology since 2021, providing clinical and administrative support to various projects and helping to set-up and run teleradiology services in Malawi and the Gambia. Last year, Laura completed an MSc in Global Health at the University of Manchester. She currently divides her time between her clinical role in the NHS and her work with Worldwide Radiology.
Dr Karen Chetcuti
Radiologist, Malawi
Dr Chetcuti completed her medical training in Malta before qualifying as a consultant paediatric radiologist in the UK. Dr Chetcuti has worked in the realm of global radiology for the past 12 years. Since 2020, Dr Chetcuti has been the consultant radiologist at the Queen Elizabeth Central Hospital in Blantyre, Malawi, as well as being a radiology lecturer and postgraduate lead for the newly created radiology residency programme at the Kamuzu University of Health Sciences in Malawi. Dr Chetcuti is a former Chair of the British Society of Paediatric Radiologists Outreach Group, has held the role of senior specialist consultant radiologist for Médecins Sans Frontières and has worked extensively with Worldwide Radiology and the Malawi-Liverpool Wellcome Trust to develop radiology services in Malawi.
Dr Ijeoma Anyitey-Kokor
Radiologist, Ghana
Dr Anyitey-Kokor currently works as a senior specialist radiologist at the Komfo Anokye Teaching Hospital, as well as lecturing at the Kwame Nkrumah University of Science and Technology in Kumasi, Ghana. She has over 15 years of experience as a radiologist in TB and HIV clinics, where she has reviewed thousands of adult and paediatric chest x-rays. Dr Anyitey-Kokor has received specialist training in TB chest x-ray interpretation as part of the ORIO-Project "Accelerating Case Detection of Tuberculosis in Ghana".
Dr Abimbola Sojimi
Radiologist
Dr Sojimi is a radiologist with over three years experience in the field as a specialist. He currently serves as a consultant radiologist at Reddington Hospital in Lagos, Nigeria where he performs and interpretes a diverse range of radiological studies. Beyond his clinical skills, Dr. Sojimi is keenly interested in teleradiology and radiology informatics. For the past two-and-half years, Dr. Sojimi has contributed his expertise as a remote radiologist for the Dutch NGO ‘KNCV Nigeria’. In this role, he has reported thousands of chest x-rays, playing a crucial part in the organisation's mission to enhance TB prevention and care.
Dr Amber Goraya
Radiologist, Pakistan
Dr Goraya has over 20 years of experience in her field and is currently associate professor of paediatric radiology at the University of Child Health Sciences and The Children’s Hospital in Lahore. She has a vast amount of experience in diagnosing paediatric TB on chest x-rays, both through her work at The Children’s Hospital and through her role as a consultant radiologist at a Gulf Council centre for travel and medical fitness. During her career, Dr Goraya has also authored numerous papers and publications on paediatric imaging.
Dr Joyce Nayiga
Radiologist
Dr Nayiga worked as a radiographer before transitioning to medicine and qualifying as a radiologist in 2020. She is currently a specialist radiologist and faculty lecturer at Makerere University College of Health Science in Kampala, as well as acting as a Adjunct Assistant Professor in radiology as part of a collaboration with the University of Vermont, USA. Dr Nayiga has extensive experience in TB diagnosis and recently offered her expertise as a consultant on the TB SPEED (Strengthening Pediatric Tuberculosis Services for Enhanced Early Detection) study.