Introducing New Tech to Defeat TB: Implications for Drug-Resistant TB

Ersin Topcuoglu

Senior Portfolio Director, Asia, Middle East, & Northern Africa Programs

The expanded use of ultraportable AI-assisted X-ray, coupled with molecular diagnostic tools to screen, test, and diagnose TB in community settings, is changing the global TB response and the patient care experience.

Fundamentally, these technologies bring TB screening, testing, and treatment initiation to the patient. 

This has immense implications in the case of drug-resistant (DR) TB. Before ultraportable X-ray and bacteriological testing using Truenat or GeneXpert became available, presumptive DR-TB patients would need to make multiple visits to a diagnostic center for further testing, diagnosis, and treatment initiation.

A Difficult Path to Care

Many patients face significant barriers to seeking care: distance from diagnostic centers, transportation challenges including difficulty accessing and paying for transportation, coupled with their dependency on their daily wages for survival. Their halted access to care, diagnosis, and appropriate treatment has broad implications – a large number of undiagnosed DR-TB cases allows the disease to run rampant in communities. TB mortality rates also increase due to the insufficient diagnosis and inadequate treatment of many DR-TB patients.

Bringing the Point of Care Home

Ultraportable AI-driven X-ray coupled with Truenat or GeneXpert opens opportunities for individuals with DR-TB to receive point-of-care testing, diagnosis, and treatment initiation. The point of care for these patients is no longer confined to health centers; national TB programs can effectively bring services to the people, eliminating many of the barriers and burdens of seeking care.

We can improve the quality of care for DR-TB patients while addressing one of the three pillars of the Global Plan to End TB 2020-2030 – zero catastrophic cost to the patient. Approximately half of the catastrophic costs experienced by patients are incurred before diagnosis. With community-based screening, testing, and diagnosis, these catastrophic costs can be mostly eliminated.

Following initiation on treatment, ongoing treatment can be monitored by family members, trained patient supporters living in the same geographic area, or through distant support mechanisms such as video directly observed therapy (vDOT). All these mechanisms maintain the patients’ treatment at the community level, further eliminating catastrophic costs associated with DR-TB treatment.

Breaking the Transmission Chain

The main goal of TB control is to break the infection transmission chain. Point-of-care screening, testing, and diagnosis of drug-sensitive and DR-TB in high burden settings is an effective intervention for finding and treating all people with TB and preventing them from infecting others. Ultraportable AI-driven X-ray coupled with a molecular diagnostic test makes this goal achievable.