Published
Union Conference on Lung Health (2024)
Authors
J Lecciones1, JP Ubalde1, MR Santiago2, S Guirgis2, L Stevens3
Affiliations
1Tropical Disease Foundation, Philippines,
2Family Health International (FHI) 360, Philippines,
3FHI 360, Asia Pacific Regional Office, Thailand
*to be published soon.
Summary
Amid the increase in the Philippines’ TB burden, active case finding targeting at- risk populations remains a key strategy in finding people with active TB disease. To sustain campaigns against TB vis-à-vis universal health care implementation, integrating TB screening within the provision of other essential primary healthcare services is necessary.
Background
Despite efforts to address the high burden of tuberculosis (TB), a large proportion remains undiagnosed due to poor health seeking behavior and limited access to healthcare, especially in urban poor communities. Fragmented service delivery further complicates access to healthcare.
Intervention
Active TB case finding (ACF) through symptomatic screening and chest X-rays (CXR) equipped with computer-aided detection powered by artificial intelligence (CAD-AI) was implemented alongside other primary healthcare (PHC) services in urban poor communities in two highly urbanized cities in Metro Manila. The CXR CAD-AI was brought to the targeted communities through mobile vans while other PHC services were either organized in ACF activity areas or were provided by the nearby health facilities. Spot sputum specimens for molecular World Health Organization-recommended rapid diagnostic test (mWRD) were collected from those with presumptive TB.
Results
Between August-October 2023, approximately 25,000 individuals received primary healthcare services and 20,042 individuals underwent TB screening (67% females, 33% males). Of those screened for TB, 27% had presumptive TB either through symptoms, CAD-AI or human CXR reading, and 41% of presumptives were tested with mWRD. A total of 380 individuals with presumptive TB (7% of those screened) were diagnosed with TB (315 bacteriologically confirmed and 65 clinically diagnosed) and were referred for treatment initiation at local health centers. Advocacy to primary care providers for household contact investigation for bacteriologically confirmed TB resulted in 145 household contacts assessed for eligibility for TB preventive treatment. Despite several operational challenges including unfavorable weather conditions, logistical constraints and the short implementation period, 67% of the screening target was achieved with a 1.9% yield rate.
Conclusion
Integrating TB screening into other PHC services in urban poor communities is a realistic approach combining community mobilization with collaborative strategic design, problem-solving and decision-making. The approach expands sustained provision of targeted TB screening and contributes to TB case finding.