Tuberculosis is rampant and underreported in the Philippines; now early detection by latest portable testing kits is helping its eradication

Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has,” said the famous anthropologist, Margaret Mead. Bearing testimony to this, a small group of people in the Bantayan Municipality of Cebu, Philippines, has changed the lives of many people affected by tuberculosis . TB, despite being curable, continues to be the deadliest diseases in high TB burden countries.

Carrying innovative new diagnostic tools for TB in plastic tubs, they went from islet to islet on pump boats, braving inclement weather, to screen and diagnose people with TB. This resulted in a tremendous increase in TB case finding upfront: a 316% rise in new TB case detection, and a 1292% rise in screening of those with presumptive TB. Imagine the difference it can make in the Philippines' fight to end TB if such interventions can be scaled up and become a norm. As per the latest Global TB Report 2022 of the World Health Organization (WHO), out of the estimated 741,000 people with TB in the Philippines, only 321,600 were notified to the national programme, and over 60,000 lives were lost due to TB.

 As of now, only 43 out of every 100 people with TB are reached by the TB services in the Philippines, and only 65% of those reached, get a WHO-recommended molecular test diagnosis, while the rest get a smear microscopy (which underperforms in TB diagnosis), or get treated without any bacteriological confirmation. As early and accurate TB diagnosis is the gateway to the TB care pathway (and breaking the chain of infection transmission), the Philippines has a two-fold task:- firstly, it must ensure that it is reaching out to all those with TB (and not just 43/100), and- secondly, it must use WHO recommended molecular tests to diagnose TB timely and correctly. This paradigm shift in TB diagnostics is a critical entry point, not only to the full spectrum of TB care cascade but also towards ending TB in the country.

 When the WHO recommended point-of-care, decentralised, laboratory and battery-operated molecular test Truenat (made by Molbio Diagnostics), along with the ultra-portable and battery-operated x-ray made by Fujifilm, was deployed in Bantayan islets, new TB case notifications, as well as treatment success rate, increased manifold. Using the latest and state-of-the-art diagnostic tools in the Philippines was made possible in 2022 by introducing the New Tools Project (iNTP) of the Stop TB Partnership and the United States Agency for International Development (USAID), which has helped in the rollout of a package of latest innovations in diagnostics, treatments, and digital health technologies to strengthen TB care in high burden countries. Bantayan is the largest municipality of Bantayan Island and it 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). Most of the people here are fisherfolk or farmers and their income is Pesos 300-350 (USD 6-7) a day.

 “During September to October 2022, we were able to screen 1774 people with presumptive TB by bringing these tools right to their doorstep. Most of them cannot afford to travel to the mainland for diagnosis or treatment. So we brought TB point-of-care testing to their doorsteps and saw a very high increase in case detection as well as in treatment success rate,” said Dr. Tinsay. "As TB diagnostic technology was brought to the people (and not the other way round), people were more open to getting tested for TB." When Dr Samantha Tinsay began the introduction of these new innovative diagnostic tools in September 2022, extreme climate events- such as typhoons and storms- compounded the challenge. But it was sheer determination on her and her team’s part to hop on a pump boat and brave the storms and typhoons to go from islet to islet find and treat TB. On 29 October 2022, Tropical Storm Nalgae, locally known as Paeng, hit the Philippines. On that fateful day, Dr Samantha Tinsay and her team were en route to one of the islets with the diagnostics tools in tow. “We did not know that a storm signal had been raised, and that nobody should be travelling. We were working and could not have stopped as patients were already waiting at the clinic,” said the spirited Dr Tinsay.

Because of the introduction of new tools, TB case detection went up from 110 in 2021 to 458 in 2022. The number of people who got tested for TB also went up from 180 people in 2021, to 2506 people in 2022, an astronomical increase of 1292%. “These new innovative TB diagnostic tools are very crucial in the fight against TB, especially for people living in geographically isolated and disadvantaged areas (GIDA). These tools can really help eradicate TB. Bringing these tools to the people in a country like the Philippines where TB is very rampant, will help end TB, one Barangay at a time,” rightly said Dr Tinsay.

The writers are part of the editorial team of CNS (Citizen News Service). Both are on the governing board of Asia Pacific Media Alliance for Health and Development (APCAT Media) and PRB Public Health Reporting Corps; views are personal