A New Front Line: How AI and Other Innovations are Transforming the Fight Against TB
There’s no shortage of hype about AI in health care, but in the fight against tuberculosis (TB), AI is already powering a revolution. Handheld digital X-ray devices use AI to stabilize the image. AI analysis of X-ray results enable high volume, high-quality screening for TB cases in even the poorest, most difficult contexts where doctors are in short supply and radiologists nonexistent. This isn’t some vision of the future, but already reality in over 22 countries where the Global Fund invests in TB programs. Coupled with advances in molecular diagnostics and new battery-powered devices that will dramatically improve the speed and accuracy of TB diagnosis, we are seeing a transformation in how we identify those suffering from this terrible disease, which still kills more than any other infectious pathogen.
At the moment, almost 2.5 million people develop active TB but are never diagnosed, let alone treated. With AI-powered screening plus much cheaper, more accurate and swifter diagnosis we can radically reduce this number, putting people on treatment, saving hundreds of thousands of lives and avoiding millions of onward infections.
Of course, cool technologies are not enough on their own. They have to be delivered, at scale, to the people who can benefit the most. For TB, those most at risk are typically the poorest and most marginalized communities and they are the ones who must be reached. That’s why a country like Indonesia, which has one of the world’s largest TB burdens, has totally redesigned its approach to the diseases. Indonesia is at the forefront of rolling out innovative screening and diagnosis at a community level. Treatment initiation has been shifted from distant hospitals to more than 460 local “puskesmas,” or primary health centers. In many of the countries most affected by TB, enlisting private sector clinics and pharmacies is crucial to expanding reach, since these are often the first point of contact for the most vulnerable communities. Devising workable public-private partnerships against TB is perhaps just as important an innovation as the drugs and devices themselves.
In fact, advances in screening and diagnosis are just one element of a wave of innovation in tackling TB. To understand the potential impact of these innovations, it is necessary to provide a brief explanation of the basic epidemiology of TB, since even when simplified it appears more complex than many other diseases. Some 20% of the world’s population have latent TB, which means they carry the bacterium but have no symptoms. While many people with latent TB will never develop active TB, those whose immune systems are compromised, whether through malnutrition, smoking, another infectious disease like HIV, or a noncommunicable condition like type 2 diabetes, may see their latent TB turn into the active disease. Meanwhile, others without latent TB may simply be infected by close proximity by those with active TB. Further complicating the fight against TB is the distinction between drug-sensitive TB, which responds to treatment with relatively inexpensive antibiotics, and drug-resistant TB, which requires much lengthier and more expensive treatment.
Alongside the innovations in screening and diagnostics we are seeing a wave of innovations offering new ways to tackle every stage of this disease. Better treatments for latent TB. An array of prevention tools that reduce the risk of latent TB being activated, including a likely TB vaccine that should be available around 2029. More effective treatments for both drug-sensitive and drug-resistant TB. In fact, one of the biggest challenges for national TB programs will be devising the optimal mix of interventions. Since there will never be enough money to do everything, ministers of health will have to determine what combination of tools will have most impact given the specific TB epidemiology confronting each community. Where most of the TB cases arise from HIV infection, as is the case in much of Southern and Eastern Africa, the answer may be primarily around investment in HIV prevention and in prophylaxis for those who are HIV positive. Where extreme poverty and malnutrition drives active cases, the answer will put greater emphasis on these socio-economic determinants.
This is not a case of “one size fits all,” nor of putting all bets on a “silver bullet,” but of crafting the combination strategies that fit each context. The good thing is that we will have an increasingly powerful set of tools to work with. The challenge will be making sure we make best use of them. Countries themselves – ministries of health, national TB programs, those in the most affected communities – are best placed to make these decisions. That’s why the Global Fund model gives countries the power to determine how the money we provide should be prioritized and spent. Yet together with partners, we also need to provide countries with evidence and technical insights to inform their decision-making. Here again, AI may have a role.
Global efforts to fight TB have always been under-resourced. With the cuts to global health funding that is now even more true. Displaced people and refugees have always been particularly vulnerable to TB and the current wave of conflicts will only increase the numbers. So on this World TB Day it would be all too easy to paint a dismal future for our fight against the disease. But that’s a choice, not an inevitability. With determined leadership – such as has been demonstrated in Indonesia – and by making smart use of current and future innovations we can surmount the challenges and not just sustain our momentum, but accelerate the pace of progress in defeating TB.
This op-ed first appeared on Forbes.