“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has,” had said the famous anthropologist, Margaret Mead. Imbibing these values, a small group of people in India and Philippines have changed the lives of many people affected by tuberculosis (TB) – especially those who were being missed or left behind by public services. TB, despite being preventable and curable, continues to be the deadliest of infectious diseases in high TB burden countries. In 2023 TB infected 10.8 million people and killed 1.25 million people worldwide.
Globally almost a third of people who get active TB disease every year are missed. The number of people with TB who are missed in high burden settings (almost all in the Global South) is alarmingly higher than the global average.
More worryingly, we also miss TB among those who take a TB test. Almost half of those who get a TB test worldwide, are tested through sputum microscopy – an outdated test that underperforms and is likely to miss finding TB in around half of those who take this test. But when we see the numbers in high burden settings, use of underperforming microscopy is higher. For example, in India – a country with highest TB burden worldwide – as per India TB Report 2024, 79% of TB tests in 2023 were done using the underperforming microscopy (which misses around half of them). That is why the World Health Organization (WHO) had called upon in 2018 to replace all microscopy with upfront molecular testing by 2027.
In multiple islets of Bantayan in the northernmost part of Cebu, Philippines, only around one-third of the estimated TB cases could be notified before the pandemic. But after the introduction of new TB screening and diagnostic tools, now almost all the TB (99%) is found in 2024.
Bantayan has 25 barangays (small townships) and one district hospital which is understaffed and undersupplied. These areas are also marked as geographically isolated and disadvantaged areas (GIDA). Pump boats are the main form of transportation here. Most of the residents there are fisherfolk or farmers and their income is a humble 300-350 Pesos (USD 6-7) a day.
Using latest and state-of-the-art TB screening and diagnostic tools in the Philippines was made possible in 2022 through the Introducing New Tools Project (iNTP) of the Stop TB Partnership, United States Agency for International Development (USAID) and FHI360. These new diagnostic tools included computer and artificial intelligence aided ultraportable handheld X-ray machines of Fujifilm (to screen for TB) and point-of-care, laboratory independent and decentralised WHO-recommended molecular test Truenat of Molbio Diagnostics (to diagnose TB). Both, Truenat and ultraportable X-ray machines, are battery operated, and can be deployed at point of need, even in remote and hard to reach areas like the Bantayan islets.
When these new tools were deployed in Bantayan islets, new TB case........