Design Health Services Around People, Not The Disease

Scoop

5 days ago

"We need to design services around people, not the disease," rightly said Dr Nittaya Phanuphak. Unless point-of-care health technologies are deployed for those who are most-in-need in a person-centred and rights-based manner, we would fail to deliver on the promises enshrined in #HealthForAll and SDGs goals and targets.
"Point-of-care health technologies sitting in centralised laboratories are as good as centralised, lab-dependent ones - both remain inaccessible to those in acute need," said Shobha Shukla. "But when point-of-care tools are taken and deployed as close as possible to the communities to serve them with equity and human dignity, real change happens."
Shobha and Dr Nittaya were speaking at the 2nd Asia Pacific Conference on Point-of-Care Diagnostics for Infectious Diseases (POC 2025) and in lead up to the 13th International AIDS Society Conference on HIV Science (IAS 2025). Dr Nittaya Phanuphak is the Convener of POC 2025; Executive Director of Institute of HIV Research and Innovation (IHRI) and Governing Council member of International AIDS Society (IAS). Shobha leads CNS (Citizen News Service) and Chairs Global Antimicrobial Resistance Media Alliance (GAMA).
Community-led models proved same day "test and treat" for HCV is feasible and effective
In India's Manipur, Community Network for Empowerment (CoNE) and partners did a path-breaking study to prove that same day "test and treat" is possible, feasible and effective for hepatitis C virus (HCV). They could do so because for the confirmatory test, the sample did not have to go for centralised laboratories but could be tested on WHO recommended point-of-care, decentralised, battery-operated (with solar power recharging capabilities) and laboratory independent multi-disease molecular testing platform, Truenat.
So, when confirmatory test Truenat could be deployed closer to the communities, it became possible to screen people, and offer molecular test on Truenat to those who needed a confirmatory test on-spot. Result came back within an hour after which treatment initiation could be followed upon.
Giten Khwairakpam, one of the study co-authors who works with amfAR's TREATAsia programme, was speaking at POC 2025. Truenat is made in India by Molbio Diagnostics, is the largest used molecular test for TB in India (and also deployed in over 85 countries globally), and over 9000 machines are deployed by the government (for TB) across India.
This study enrolled 643 people (during November 2021 to August 2022) out of which 503 were screened - all were males and had a history of injection drug use. Community people who formerly had a history of injection drug use conducted the screening.
155 people were found to have viraemia, out of which 98% (153) were initiated on treatment on the same day (remaining 2 people also were initiated on treatment soon after). All (100%) completed the treatment. All (100%) those who tested negative were offered vaccination for hepatitis B virus.
It is a powerful example from the communities which should inform national and global policies for improving hepatitis responses on the ground - in person-centred manner.
Philippines' Bantayan offers another strong example when point-of-care tools are deployed at point-of-need
In multiple islets of Bantayan in the northernmost part of Cebu, Philippines, only around one-third of the estimated TB cases could be notified before the pandemic. But after the introduction of new TB screening and diagnostic tools, now almost all the TB (99%) is found in 2024.
Dr Samantha Tinsay, government Municipal Health Officer, Bantayan, Cebu, Philippines and her team made a major difference in bridging the gap between TB services and people who were left behind on islets of Bantayan. She took point-of-care and battery operated AI-CAD enabled X-Rays and Truenat (point-of-care, battery-operated, laboratory independent and de-centralised molecular test) - both kept safely in a moulded plastic box - loaded on a pump boat - and went from islet to islet - screening people for TB and offering confirmatory Truenat molecular test on the spot. Within an hour or so, those found with active TB disease were linked to TB treatment care pathway.
New TB case notifications, as well as treatment success rate, increased manifold. But the journey was not easy - also due to inclement weather and stormy seas.
Dr Samantha's untiring efforts have resulted in a tremendous increase in TB case finding: the number of persons screened for presumptive TB went up from 187 (in 2019) to 2506 (in 2022), 2027 (in 2023), and 5679 people in 2024.
'TB treatment success rate has also increased to 97% in 2023,' she confirmed. Average TB treatment success rate in the Philippines was 78% in 2023 as per the WHO Global TB Report 2024.
Imagine the difference it can make in the Philippines' response to end TB if such interventions can be scaled up and become a norm.
Dr Darivianca Elliotte Laloo, who has earlier served at the Stop TB Partnership and International Union Against Tuberculosis and Lung Disease (The Union) and currently leads Molbio Diagnostics as General Manager, chaired this session at POC 2025. She said that Truenat, which was validated independently by the Indian Council of Medical Research of the Government of India in 2017, offers PCR molecular testing for over 40 diseases (including current strains of COVID-19).
Being WHO recommended battery-operated, laboratory independent, decentralised and point-of-care molecular test for TB with solar power charging capacities, it is increasingly getting deployed in peripheral areas of several high-burden countries now. Largest rollout of Truenat in Africa took place in Nigeria last December. Nigeria is home to largest number of people with TB in Africa.
We need to close the gap between people-in-need and point-of-care standard diagnostics by taking services closer to them or at their doorstep, said Dr Laloo.
Colossal cost of misdiagnosis on communities
Noted #endTB activist Blessina Kumar who leads Global Coalition of TB Advocates (GCTA) shared a powerful real-life testimony of Meera, who survived one of the most serious forms of drug-resistant TB (Extensively Drug-Resistant TB or XDR-TB).
If someone had XDR-TB in 2012, there were tools back then too, to test for TB and drug-resistant TB within 100 minutes. And after drug-susceptibility testing (to ensure that TB bacteria is sensitive to medicines used in the therapy), an effective treatment could have helped Meera towards cure.
But misdiagnosis caused havoc: She had to endure the rigours of going through TB treatment for six years (2012-2018). She also had to spend around INR 300,000 (~USD 4000) as well which is a grim reminder that delayed or wrong diagnosis often results for catastrophic costs for people in need. She also had to be stay away from her 4 months old son because of TB. TB stigma and discrimination also did not spare her: she was not allowed in the kitchen or living room, and had to use separate utensils and clothes. She not only battled depression but also attempted suicide twice.
Experts say that soon after initiation of an effective TB treatment, a person becomes non-infectious. But TB stigma and discrimination still lurks.
After 6 years, Meera finally got the right diagnosis and treatment, and could get cured. She advocates for person-centred TB care since then.
In 2025, if anyone has XDR-TB or any other form of drug-resistant TB, it should take an hour or two for confirmatory TB test (upfront molecular test) and treatment hopefully will be over in next six-months using the latest WHO recommended regimen - and with full health and social care and support. Imagine the difference it can make if we deploy science-based standard healthcare tools to serve the people where they are in person-centred manner.
Inequities and injustices firewall most-in-need people from accessing standard care
"It is not lack of TB diagnostic, treatment and prevention tools that are causing human suffering and killing people but inequity and injustices that plague our world. For example, rich nations like Australia could bring down TB rates to elimination level 50 years ago with whatever tools they had. In USA, lab on wheels with X-Rays were going to remote areas to find more TB in 1950s," said Shobha Shukla. "I have myself seen TB pins of 1940s and 1950s that were worn by people in USA to declare that they had taken an X-Ray to screen for TB."
But, in the Global South, even after 50-70 years - it is not so common as it should be - to see lab on wheels taking an (AI-CAD enabled) X-Ray and molecular test closer to the unreached people with standard TB services.
WHO called upon all governments in 2018 to replace microscopy with 100% upfront molecular testing for TB by 2027. All world leaders agreed to do so too in their Political Declaration of United Nations General Assembly High-Level Meeting on TB 2023.
Despite this, out of those who got diagnosed, more than half (52%) did not get upfront molecular test in 2023 – rather they got microscopy or were not bacteriologically confirmed at all. Most of them would be in the Global South, wonders Shobha.
"Early and accurate diagnostics is the ONLY entry-gate towards TB treatment care pathway. It reduces catastrophic costs faced by the most vulnerable, reduces avoidable human suffering and risk of TB death and helps stop the spread of TB infection," she said.
100 days campaign in India heralds a foundational shift on how we find TB based on science and evidence
India's TB Prevalence Survey 2019-2021 showed that almost half of TB patients were asymptomatic. The Indian govt-led 100 days campaign from 7 December 2024 to 24 March 2025 was launched in 347 most affected districts to screen everyone regardless of symptoms among high-risk populations, including homeless and migrants. After 24 March 2025, given the impact, it was expanded to all 806 districts nationwide.
As per government's concept note of 100 days campaign, vans were to go closer to high-risk groups with Artificial Intelligence Computer-Aided Detection (AI-CAD) enabled portable X-rays, Truenat molecular test machines for sputum testing, and other tests as required.
129.7 million people were screened and over 285,000 asymptomatic people with active TB disease were found – all of whom would have been missed if AI-CAD enabled X-ray was not done.
"Imagine the public health impact of stopping TB spread, reducing human suffering and putting an additional nearly 300,000 to path of healing perhaps," said Shobha.
Walk-the-talk on multi-disease elimination approach
"As WHO multi-disease elimination approach is being finalised, we need to recognise that we have a lot of under-utilised multi-disease tools which we use for TB only. Truenat offers molecular testing for over 40 diseases. Likewise, artificial intelligence we use for TB detection, such as DeepTek's Genki and QureAI, both screen people within seconds for a number of diseases (DeepTek's Genki screens for more: 26 pathologies)," said Shobha.
"Let us be responsible and fully optimally utilise diagnostic infra we have at point-of-need and scale them up too. It helps with pandemic prevention, preparedness and response too."
And with regards to TB, follow the science – screen everyone in high-risk settings in people-centred manner.
Bobby Ramakant – CNS (Citizen News Service)
(Bobby Ramakant is part of CNS (Citizen News Service) and a World Health Organization (WHO) Director General's WNTD Award 2008. He is also on the Board of Global AMR Media Alliance (GAMA) and Asia Pacific Media Alliance for Health and Development (APCAT Media). Follow him on X: @bobbyramakant)