Technology Challenges and Opportunities Across the Cascade of TB Care
PHC facilities serve an essential role across the cascade of TB care. They face multiple challenges, however, to fully implement national and WHO TB control guidelines. New technologies and improvements to existing ones are needed to address these challenges and create new opportunities to stop the spread of TB and drug resistance. Missed diagnosis is currently the most critical gap to fill, with tools and equipment needed that can be effectively used for care at the PHC level. Innovations across the cascade of TB care can enhance early detection and ensure timely, effective treatment to stop the spread of TB. A web-based atlas of innovations is in development to showcase new approaches for TB elimination at varying stages from discovery to deployment and for an audience including health officials, policy makers, researchers and funders.
Screening
Screening to identify potential TB cases is crucial for increasing the number of people who are diagnosed and can start treatment. Screening based on blood or skin tests used in high-income settings are less suitable for LMICs for technical and practical reasons. Symptom screening, commonly used in LMICs, is a subjective tool with varying quality and consistency. People with TB also do not always seek health care because of lack of access or because they have subclinical symptoms, and they may not routinely be screened for TB when they do seek care. New TB screening tools are needed that are low-cost, easy to use by care providers, and readily accessible at the PHC level, including being suitable for community-based active case finding programs.
New TB screening tools use non-invasive, rapid technologies like computer-aided detection (CAD) chest x-ray, cough sounds analysis, and ultrasound imaging. CAD chest x-rays enable scalable, automated detection of lung abnormalities; cough analysis via mobile phone offers a low-cost method to identify potential TB cases; point-of-care ultrasounds are being explored for broader indications including TB screening, especially where equipment is already available in PHC settings.
The table provides an overview of the state of innovation, with the listed technologies serving as representative samples of products available in the market or in development.
Name | Innovator | Description | Image | Technology | Development Status + Regulatory Approval | Learn More |
|---|---|---|---|---|---|---|
WHO | World Health Organization (WHO) four-symptom screening (W4S) questionnaire for TB |  | Questionnaire | On MarketWHO Recommended (2011) | ||
Blood test to detect interferon gamma, a protein produced by T cells in response to TB antigens |  | Protein; blood sample | On Market | |||
Skin test to detect response to injection of a processed mix of TB proteins | .png) | Purified protein derivative (PPD) from TB; Skin | On Market | |||
Qure.AI | Rapid identification (40 seconds) of tuberculosis with intergration into many compatible x-ray machines and streamlined workflow |  | CAD Chest X-Ray | On MarketFDA ClearedCE Mark | ||
Delft Imaging | Computer aided detection product with automated and standardized interpretation of digital chest x-rays based on artificial intelligence. |  | CAD Chest X-Ray | On Market (2007)CE Mark | ||
DeepTek AI | Comprehensive lung health solution with probability score for TB in 30 seconds |  | CAD Chest X-Ray | On MarketFDA ClearedCE MarkCDSCO | ||
GH Labs | AI-supported platform for computer-aided analysis of collected cough sounds for TB screening and to support diagnosis on a mobile phone app | Audio Detection | Research | |||
Salcit Technologies | 15 second assessment using AI and ML to analyze cough sounds and assess lung health aiming to substitute spirometry on an “affordable cost” mobile phone app |  | Audio Detection | On MarketCDSCO | ||
RAIsonance | Investigational diagnostic SaMD platform, designed to diagnose COVID-19, TB, and Influenza when user coughs 8-10 times into the app and results in ~2 minutes on a mobile phone app (currently used for clinical research only) |  | Audio Detection | ResearchUnder Review by FDA and Health Canada | ||
Wadwhani | AI-based cough sound analysis technology to help identify at-risk Covid patients before administering lab-based tests, even if they’re asymptomatic on a mobile phone app |  | Audio Detection | Under Development | ||
Delft Imaging | Imaging technology alternative to chest x-ray for TB screening and to support diagnosis presented at TB Union (2024) | Ultrasound | Early-stage Development |
