App aiming to identify TB cough receives R48 million boost

A grant of R48 million is currently facilitating the development of a smartphone app that will be able to distinguish the sound of a Tuberculosis (TB) cough from other types of coughs. 

This app is currently being developed by Stellenbosch University’s (SU) faculty of medicine and health sciences (FMHS). The development of the app, called the Cough Audio Triage for TB (CAGE-TB) project, is being led by the Clinical Mycobacteriology and Epidemiology (CLIME) Group in the FMHS’s Division of Molecular Biology and Human Genetics. This was according to Dr Byron Reeve, CLIME project manager of CAGE-TB.

The development of the Cough Audio Triage for Tuberculosis (CAGE-TB) app is a collaboration between Stellenbosch University’s (SU) faculty of medicine and health sciences (FMHS), SU’s department of electrical and electronic engineering, the University of Makerere in Uganda, collaborators in the Amsterdam Institute for Global Health and Development (AIGHD) and the University of Gottingen, according to the AIGHD’s website. PHOTO: Marianne Francis Stewart

The European and Developing Countries Clinical Trials Partnership (EDCTP) awarded the grant to the CLIME Group on 1 July, according to Prof Grant Theron, head of the CLIME group.

“EDCTP is a response-mode funder, awarding grants on the basis of open competition (which includes: calls for proposals, submission of proposals and evaluation by independent experts),” said Illona van den Brink, communications officer at EDCTP, in email correspondence with MatieMedia.

The grant “was awarded from a call for proposals that was published in 2020”, according to Van den Brink.

The European and Developing Clinical Trials Partnership (EDCTP) awarded the grant for the development of the Cough Audio Triage for Tuberculosis (CAGE-TB) app to Stellenbosch University (SU), because Stellenbosch is one of the top research institutions in South Africa and is very active in Tuberculosis research, according to Illona van den Brink, communications officer at EDCTP. PHOTO: Supplied/European and Developing Clinical Trials Partnership.

The CAGE-TB project

The CAGE-TB app is set to be launched in 2024, and will address previous problematic testing methods, according to Reeve. 

“Part of the problem with the world’s current TB health system is that we still miss so much TB that goes undiagnosed. This awkward, outdated, subjective and poor TB symptoms screening model is part of the problem,” said Reeve.

The current screening models are either Tuberculin Skin Tests (TST),  TB blood tests, chest x-rays or sputum testing, according to the Centers for Disease Control and Prevention’s website.

The CAGE-TB smartphone app will record a person’s natural or deliberately forced cough for a duration of up to 30 seconds through the phone’s built-in microphone, according to Reeve. The app will then use the recording to identify whether the cough is a TB or a non-TB cough. If the app identifies the cough as being a TB cough, it will refer the patient for specialised care, said Reeve.

The Cough Audio Triage for Tuberculosis (CAGE-TB) app, which will be able to distinguish the sound of a TB cough from other coughs, is currently being developed by Stellenbosch University’s faculty of medicine and health sciences. The app will consist of a three-step process. In order to use the app, a person will need to cough into their smartphone’s speaker. They will then receive their diagnosis, whereafter they will receive specialised care. This was according to Dr Byron Reeve, project manager of the CAGE-TB app. INFOGRAPHIC: Marianne Francis Stewart

The department of electrical and electronic engineering at SU is also involved in the development of the app, according to Prof Thomas Niesler, a postgraduate coordinator in the department of electrical and electronic engineering, and leader of the engineering component of the app.

“The role of the [department] is to design and train the machine learning algorithms [so] that [they are] then able to distinguish between TB and non-TB coughs,” said Niesler.

An African focus

The app is being developed with a specific focus on making TB testing on the African continent easier, according to Reeve.

“It will be an app designed in Africa, for Africa, with the cooperation of bodies like the World Health Organization (WHO),” said Reeve.

The CLIME Group envisions free TB screening for everyone through the app, according to Reeve. The app will motivate a rethinking of how TB is diagnosed, as well as the treatment and managing of TB at “individual, community, country health system and global health system levels”, said Reeve. 

Geographically, most people who developed TB in 2019 were in the WHO’s regions of South-East Asia (44%), Africa (25%) and the Western Pacific (18%), according to the WHO Global Tuberculosis Report of 2020.