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Tuberculosis in Tondo, Manila

In 2022, we started using 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, our outreach teams provide health promotion, and encourage households’ members to undergo digital chest X-ray TB screening in our truck. We also recently started using a computer-aided-diagnosis (CADx) software using artificial intelligence to accelerate the process of reading the chest X-rays. GeneXpert testing machines are used to confirm the diagnosis. Patients diagnosed with TB are then referred to local health centres for treatment. Our teams also conduct home visits immediately after the diagnosis, to screen households’ close contacts, administer TB skin tests and offer preventive TB treatment. The high rate of confirmed TB-positive cases (5% on average) in the population we have screened so far tends to confirm our initial hypothesis of a likely increase of TB cases in the aftermath of the COVID-19 pandemic.

According to the Philippines TB Program Review, about 1 million Filipinos had active TB, and nearly 70 Filipinos died every day from this preventable and curable infectious disease3 in 2019. With nearly 10 million people residing in urban slums, social factors are major drivers of tuberculosis endemicity in the country. Since TB bacteria becomes airborne when an infected person sneezes, coughs or speaks, it can be easily transmitted in crowded settings. Vulnerable populations –such as the urban poor living in slums –face greater risk of TB infection and hindered treatment outcomes, and all the more so in the context of the COVID-19 pandemic.

The WHO also reported in 2022 that during the COVID-19 pandemic, the number of people falling ill to TB and drug-resistant TB (DR-TB) had increased for the first time in years worldwide2. While the pandemic disrupted many health services since 2020, it put a particularly severe strain on access to essential TB services —from testing and consultation to treatment and case reporting. Restrictions on movements, concerns over the risks of going to healthcare facilities, staff shortages, closures of facilities, and stigma linked to similarities in COVID-19 and TB symptoms resulted in a drastic drop in the number of notified TB cases, as well as disruptions in diagnosis and treatment.

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