IMCI-PLUS

The challenge

Respiratory tract infections are the leading cause of morbidity and mortality in sub-Saharan Africa. 

A major challenge in patient care is that many different infections can cause the same symptoms. With few diagnostics available in most sub-Saharan African settings, treatment is rarely targeted at a specific pathogen. Moreover, as viral chest infections are more common than once thought, this is leading to significant overuse of antibiotics: in sub-Saharan African hospitals, most children with respiratory tract infections receive antibiotics, but it is likely that only one in ten actually need them. This overuse is a poor use of scarce resources and a major driver of antimicrobial resistance.

It is not feasible to use a raft of pathogen-specific diagnostic tests on patients with respiratory symptoms, but a tool that could distinguish between viral and bacterial infections could help to target antibiotic use. There is accumulating evidence that point-of-care ultrasound (POCUS) can reliably distinguish the two, and may also be able to pick up tuberculosis infections, which are commonly missed.

The project

The IMCI-PLUS project has been designed to provide evidence on the clinical impact of POCUS in sub-Saharan African hospitals and the feasibility of its routine use in managing respiratory tract infections. Previous work has shown that POCUS equipment is relatively easy to use, but health workers are not always confident in their interpretation of the images generated. The project is therefore also developing an AI tool to support automated image analysis and provide decision-making guidance to clinicians.

The project is carrying out a randomised controlled trial in three African countries – Senegal, South Africa and Tanzania – comparing clinical outcomes when POCUS or standard management of patients with respiratory symptoms is used. It will also focus on other key metrics, such as levels of antibiotic use. 

A TB-focused sub-study will similarly compare WHO-recommended diagnostic algorithms (one based on chest X-ray results and one on POCUS) to determine whether POCUS could replace chest X-rays, which are not available at most primary healthcare facilities. 

The project will also conduct consultations with a wide range of stakeholders, including health workers, patients and policymakers, to explore the acceptability of POCUS and factors likely to affect its adoption in routine practice. 

Impact

The IMCI-PLUS project will generate evidence from real-world African settings on a promising technology with wide potential applicability. It will:

• Demonstrate whether using point-of-care ultrasound (POCUS) to investigate respiratory tract infections leads to better clinical outcomes.
• Reveal whether POCUS drives more targeted use of antibiotics.
• Identify key factors associated with the successful implementation of POCUS in routine clinical care.

As well as demonstrating whether POCUS saves lives and reduces antibiotic use, the project will also build confidence in POCUS use, potentially leading to its wider deployment in African health systems.