Breaking barriers by deploying AI-enabled health tech

Artificial intelligence is not only for the rich and famous but is also deployed in health technologies to serve the poor and the marginalised communities with equity and human dignity.

With remarkable ingenuity, India is combining advanced technology with fundamental community approaches to reach the unreached with standard WHO-recommended public health services. This is a practical strategy in action that provides a pathway for other low- and middle-income countries to follow.

WHO endorsed AI-enabled X-rays for TB screening

WHO guidelines in 2021 endorsed artificial intelligence (AI) enabled computer-aided detection of TB with X-rays. AI-enabled computer-aided detection was non-inferior for most TB interpretations. This was a game-changing moment in public health because X-ray interpretation was no longer dependent on the availability of super-specialist radiologists for expert interpretation unless needed.

In most healthcare settings, especially remote areas, radiologists are seldom available or occupied with clinical and research workload.

AI-enabled X-rays are changing how diagnosis happens on the ground. Taking X-rays closer to the communities is one way of getting rid of diagnostic delays, catastrophic costs & cutting down on screening time.

It takes a minute to get screened by X-ray and get the report (from AI-enabled computer-aided detection). Then, for those with presumptive TB, they can get a confirmatory TB report in the next hour or so — if portable WHO and ICMR-recommended molecular test Truenat is used in the same TB screening and testing camp.

Ending TB warrants not only finding all people with TB — with early and accurate diagnosis — and linking them to care, but also about breaking down those critical diagnostic logjams and bottlenecks that make healthcare services inaccessible for most marginalised.

WHO, as well as India’s guidelines, clearly state that all those found with presumptive TB using X-rays (or symptomatic screening) should be offered the WHO-recommended upfront molecular test. Those with active TB disease should get the latest TB treatment therapy with social support so that they can be cured.

TB infection also stops spreading when a person with the disease is on effective treatment.

India deployed AI to find TB

Following science and evidence, the Government of India launched a massive campaign to find, treat and prevent more TB among high-risk groups in 347 districts initially. Later, it was expanded to almost 500 districts out of around 800 in the nation.

As per the concept note of the #TBMuktBharat (#TBFreeIndia) government campaign, battery-operated ultraportable and handheld X-Ray machines with AI-enabled computer-aided detection and highly sensitive portable, battery-operated and laboratory-independent molecular test Truenat (made in India by Molbio Diagnostics) machines were to be taken in a van closer to the TB high-risk groups.

This was a game-changing shift from screening those who had TB symptoms to screening everyone in high-risk settings – because almost half of TB patients are asymptomatic if we find them with X-Ray early on.

India TB Prevalence Survey 2019-21 showed almost half of the TB patients would not have been found if upfront X-Ray screening was not done, as they were asymptomatic. Other sub-national surveys showed similar findings.

In 100 days, the Indian government’s efforts found over 285,000 asymptomatic people (among high-risk groups) with active TB disease and linked them to treatment. In 100 days, over 12 crore people were screened for TB (mostly by using X-rays).

Ground zero: Kangra’s efforts towards ending TB

Kangra is making records (and breaking its previous records) to do the maximum AI-enabled X-rays of high-risk people in a single day at the block level.

Debunking the notion that ‘public services are difficult to reach people living in mountainous terrains’, Kangra, the most populated district of Himachal Pradesh, has led from the front in taking public TB services closer to the communities or at their doorstep.

Despite heavy mountain rains and thunderstorms, landslides, power-cuts, or weekends or public holidays, frontline healthcare workers have been working tirelessly to find more TB among those most at risk, and link those with the disease to lifesaving treatment. Finding TB early and accurately and treating TB also helps stop the spread of infection, said Dr RK Sood.

Women healthcare workers are changemakers

Women healthcare workers are making a big difference in spearheading the fight against TB in Kangra at all levels. Be it frontline workers like ASHA workers or others, or radiographers, nurses or other healthcare and paramedical and medical staff, said Dr Rajesh Kumar Sood, District TB Officer (DTO) of National TB Elimination Programme (NTEP) and District Health Officer, National Health Mission, Government of India.

Banner image by Pachon in Motion: https://www.pexels.com/photo/a-3d-model-of-a-ball-on-ice-26545224/