In 2022, Médecins Sans Frontières (MSF) launched a tuberculosis (TB) active case finding (ACF) project in Tondo, Manila. Tondo is one of Asia’s most densely populated and impoverished urban slum areas, where people are most susceptible to TB infection -the number 1 infectious killer disease in the world. The TB case detection rate was low, and the community had limited access to GeneXpert diagnosis. The team uses a mobile X-ray truck aimed at further improving our ability to reach the population for TB screening inside Tondo. In collaboration with the Manila Health Department (MHD), our outreach team conducts health promotion activites and encourages households’ members to undergo digital chest X-ray TB screening in our truck.

Radiographic detection of TB is a challenge for radiologists and even more difficult for clinicians without formal training and experience in X-ray interpretation. To address this, MSF has introduced innovative artificial intelligence (AI)-assisted radiography technology to enhance tuberculosis detection in the community. A computer-aided-diagnosis (CADx) software uses new image interpretation technology checking x-rays for anomalies suggestive of pulmonary TB speeding up the diagnosis process. Following the reading, an anomaly score from 0 to 100 is produced which, when compared to a selected threshold, signals whether a molecular confirmatory GeneXpert test for TB is required. The WHO recently recommended the use of this technology for interpretation of digital chest radiographs for screening adults aged 15 years or older.

GeneXpert testing machines are used in the laboratories of the Department of Health in Manila to confirm the diagnosis. Patients diagnosed with TB are then referred to local health centres for treatment. Our team also conducts home visits immediately after the diagnosis, to screen households’ close contacts, administer TB skin tests and offer preventive TB treatment.

A study conducted by Epicentre assessed the feasibility and acceptability of this approach. The study shows that the use of CADx linked to chest Xray screening is feasible, but also that it is effective in screening for TB in high-risk urban populations such as Tondo. This approach achieved high screening rates, with good community acceptability. The results indicate that this technology could be deployed in similar contexts, but that it is essential to accompany this with efforts to encourage linkage to treatment.