March 4, 2024








June 29, 2023
By Peter Sands, Executive Director, Global Fund

In August 2022, Josphat Muoki, a father of four from Nairobi, Kenya, stopped at a pop-up screening station on a busy pedestrian bridge at Nairobi Central Railway Station when he discovered he had have tuberculosis. The bridge connects the city and the industrial area. Josphat, who works in procurement for an engineering firm in the city, often crosses the bridge to reach companies supplying spare parts.

The community health worker at the bridgehead stall tried three times to convince him to get tested, but he was too busy. But the fourth time he passed them, he coughed, so he decided to do it.

Screening took a few seconds. Yosfat answered a few questions on a touchscreen device that looked like a mini cash machine. Yes, he keeps coughing. Yes, he was often hot and sweaty at night. The machine printed out what looked like a receipt, telling him he likely had tuberculosis and needed to be tested.

Josfat, wearing a mask, was accompanied by a community health worker on foot across the bridge to a nearby laboratory for testing. Within an hour he had the results. He suffers from tuberculosis. He started treatment that day.

Six months of treatment was not easy. He stayed away from his family to prevent his family from being infected. His wife and children were tested as part of a contact tracing program and all came back negative. He wore a mask all the time, insisted on working, and kept a distance from his colleagues.

I met Yosfat nine months after he found out he had tuberculosis. He completed his treatment in March, tested negative and has now fully recovered and been reunited with his family. He returned to the screening station to thank the community health workers and tell anyone who passed why they should be screened.

The temporary booths equipped with “ATM” screening equipment are just one example of the innovative approach that partners such as SEMA Limited and Amref Health Africa are using to find TB patients in countries such as Kenya. Because the disease disproportionately affects working-age men, a high-traffic site like the Nairobi Railway Bridge is perfect. Five stalls like this one, spread across Nairobi, have identified 721 TB patients and helped them receive treatment, preventing more TB infections across the city.

Nikita Laureen, a community health volunteer at Kibera Health Center in Nairobi, Kenya, helps patients use TB ATMs. Photo: Global Fund/Brian Otieno

Finding patients with TB remains the biggest challenge in the fight against the ancient disease, which still kills about 1.6 million people a year, making it rival COVID-19 as the deadliest infectious disease. Tuberculosis is by far the biggest killer in low- and middle-income countries and among people of working age. The Global Fund, which provides 76% of external funding for TB programmes, continues to work with partners to pilot and scale up innovative approaches. In India, we have been using artificial intelligence to identify hotspots. With the Termination of Workplace TB Partnership, we engage companies such as Anglo American, Perenco or Kempinski Hotels for workplace screening and diagnosis. To date, this effort has reached 53 companies and more than 4 million employees. In countries like Timor-Leste or Tanzania, we use ultra-portable X-ray equipment in four-wheel-drive vehicles to screen and diagnose remote villages for TB. In other countries, including Nigeria and the Philippines, we combine TB testing with COVID-19 testing.

The nice thing about TB is that it is curable. If patients have a drug-resistant variant of the disease, treatment takes months and is more complicated and expensive, but if they stick to the drugs, patients will be free of the disease entirely. Unfortunately, untreated TB has a higher mortality rate than COVID-19 (drug-resistant TB has a much higher mortality rate), and untreated TB patients are likely to infect others. A single person with active, untreated TB disease can spread the disease to as many as 15 people in a year.

Innovations that help high-risk populations are critical to winning the fight against TB. Josphat’s experience is a good example of how well-executed relatively simple and low-cost innovations can make a difference. If left untreated, Yosfat’s health will gradually deteriorate and it is only a matter of time before he spreads the infection to his family or colleagues. Instead, he, his wife and children are healthy and back at work.

This column was first published on Forbes.