Why Access to Health Technologies Is Crucial for Equity and Public Health
Vaccines Don’t Save Lives, Vaccination Does: The Importance of Delivery
- TB Detection Beyond Symptoms: The Game-Changing Role of AI and Molecular Testing
- India’s Evidence-Based Shift: From Symptom Screening to Technology-Led TB Diagnosis
- Made-in-India Innovations: The Journey and Impact of Truenat
- How Point-of-Care Testing at Point-of-Need is Saving Lives
- Challenges in Utilization: Are Our Diagnostic Tools Underused?
- Global Examples and Lessons: From Vietnam to Australia
The Way Forward: Urgency, Equity and Science Must Lead the TB Fight
Unless the best health technologies reach the people who need them most, desired public health outcomes will remain elusive. Learn how point-of-care tools like Truenat are transforming TB care by reaching underserved communities.
Point-of-care health technologies make a difference when deployed at point-of-need
Vaccines (sitting on a shelf) do not save lives, but vaccination does. Only when people can access vaccines and get vaccinated in a people-centred manner, can we yield desired public health outcomes. Same goes for medicines or diagnostics or other disease prevention tools.
“Unless best of health technologies reach those who are most underserved and need them most, how will we reduce human suffering and avert untimely deaths? Technologies must be made to serve those who need them most. If health technologies cannot be deployed in resource-constrained settings, then they would remain inaccessible to those in acute need. Point-of-care technologies are not enough, we need to deploy them too at point-of-need,” said Tariro Kutadza, a noted community rights activist and defender from Zimbabwe.
Insights from Global Health Leaders: Bringing Services to the People
Tariro Kutadza leads TB People (Zimbabwe) and also supports the Zimbabwe Network of People living with HIV. “Yes, we can end TB by bringing diagnostics and other lifesaving services to people’s doorsteps!” She was speaking with CNS ahead of the 2nd Asia Pacific Conference on Point of Care Diagnostics for Infectious Diseases (POC 2025), Thailand; 10th Asia-Pacific AIDS & Co-Infections Conference (APACC 2025); and 13th International AIDS Society Conference on HIV Science (IAS 2025), Rwanda.
Follow the science to serve the people
“Recent studies show that up to 50% of new TB cases would not have been diagnosed with TB symptom screening, as they had no symptoms at the time of TB screening and diagnosis. These were diagnosed when an X-Ray was done and an upfront molecular confirmatory test was offered,” said Dr Soumya Swaminathan, Principal Advisor of National TB Elimination Programme, Ministry of Health and Family Welfare, Government of India. Dr Soumya earlier served as Chief Scientist of the World Health Organisation (WHO) and Director General of the Indian Council of Medical Research (ICMR).
India’s National TB Prevalence Survey (2019-2021) showed that 43% of those diagnosed with TB would have been missed if X-ray was not done, as they were asymptomatic at the time of diagnosis. Similar findings came from several other TB prevalence surveys at sub-national level such as those in the states of Tamil Nadu and Gujarat.
If we can find people with active TB lung disease early on (such as when they are asymptomatic) then we can offer them the best of TB treatments. This will not only save lives but also prevent transmission of the disease as TB stops spreading within days of initiation of effective treatment therapy. So, finding TB early on remains critical if we want to stop the spread of infection and reduce human suffering and risk of TB death.
“We will not pick TB cases earlier with TB symptom screening alone. As till recently, our TB programme was based entirely on symptom screening, so straight away we were missing ~50% of active TB in the population,” said Dr Swaminathan.
Vietnam had done a study over a decade back which showed that when a TB molecular test was offered population-wide (regardless of symptoms) consistently, and those found with active TB disease were linked to the TB care pathway, TB rates dropped by over 70% in a 4-year period. Almost 50 years ago, Australia and other richer nations could test everyone (regardless of TB symptoms) and link those with TB to a care pathway and bring TB rates down to elimination levels within a span of few years.
Based on scientific evidence, the World Health Organisation (WHO) guidelines of 2021 endorsed the use of AI-CAD-based TB screening (without immediate need of a radiologist’s interpretation) and offering upfront molecular testing to all those with presumptive TB. This was game-changing because now trained healthcare workers with handheld, ultraportable, battery-operated and AI-CAD enabled tools can go to far and remote areas, closer to the communities or even literally at their doorsteps, and screen people for TB.
Foundational shift based on science to find more TB in India
Based on growing scientific evidence, the Indian government made a foundational shift on how it finds TB. From TB symptomatic screening, India moved to science-backed approach of screening everyone in high-risk populations (regardless of symptoms), offer upfront molecular testing (as far as possible) and linkage to care pathway, said Professor (Dr) Urvashi B Singh, Deputy Director General of Central TB Division, Ministry of Health and Family Welfare, Government of India. She is a widely recognised TB scientist and microbiologist and has served at India’s most prestigious and highest ranked public tertiary care hospital and medical college: All India Institute of Medical Sciences (AIIMS), Delhi.
She stressed upon research. “Research for validating new tools, designing new tools and relying on Made-in-India tools for screening and diagnosing TB and not depending on the outside, has made a phenomenal difference.”
“This was a global first where India offered WHO-recommended X-Ray screening for TB to key and other vulnerable populations, not only to those who were TB symptomatic, but also to those who were asymptomatic,” said Dr Singh.
When point-of-care tools are deployed at point-of-need, impact happens
India launched a massive 100-day campaign (7 December 2024 to 24 March 2025) to screen everyone among high-risk populations of 347 districts with ultraportable and handheld X-Rays, which were powered with artificial intelligence (AI) computer-aided detection (CAD) of TB capacities (as far as possible). The concept note of this campaign on a government website states that those with presumptive TB should be offered an upfront WHO-recommended molecular test, Truenat. Truenat is a point-of-care, decentralised, battery-operated, and laboratory-independent molecular test for TB.
The concept note of the 100-day campaign states that point-of-care screening tool (X-Ray) and diagnostic test (Truenat) should be taken in a ‘Nikshay Vahan’ van to point-of-need where high-risk populations reside.
In a span of 100 days, India could screen over 120 million people across the country from high-risk groups. More importantly, India found 285,000 people with active TB disease who had no symptoms (asymptomatic or sub-clinical TB). These people would not have been found with TB disease if an X-ray had not been done. Imagine the public health impact of finding 285,000 asymptomatic people with TB disease early on, and putting them on effective treatment, so that not only infection stop spreading to others but also they get on the path of healing and recovery.
Now, after 24 March 2025, India has expanded this campaign nationwide.
“We were the first country to actually position Indian indigenous technology (Truenat) to support the Gene Xpert molecular test. The investment and support by the government and agencies like the Indian Council of Medical Research (ICMR) was important in the initial days when the test (Truenat) was being standardised and undergoing multicentric validations, and then it was poised for the programme to adopt it. Based on evidence, the Indian government’s National TB Elimination Programme adopted Truenat in 2018. Today India has a network of over 9000 NAAT systems across the country – deployed at the level of primary health centres, community health centres and even at the block levels,” said Dr Singh.
Developing, standardising and validating made-in-India health technologies and deploying them “is about making the country self-reliant,” said Dr Singh. “Today, Truenat is in fact, getting exported to 82 countries. So, that is where our Indian indigenous technology, which was supported by ICMR, has reached.” Truenat is made by Molbio Diagnostics.
Develop health technologies that are user-friendly and deployable for those most in need
Sriram Natarajan is credited with developing the first point-of-care malaria rapid test over three decades ago. Sriram co-founded Molbio Diagnostics, whose flagship molecular test, Truenat, is already making a big difference in reaching the unreached populations in several low- and middle-countries worldwide.
“We wanted to create a technology that can go down to the grassroots. At the time when we began working on this technology, most of the molecular testing was very heavily centralised. So, it never became a clinically relevant tool because the turnaround time for the results used to be anywhere from 3 days to 1 week and no doctor or physician would wait that long to start treating a patient,” said Natarajan. Also, such centralised technologies were accessible to only a few, and from a public health point of view longer turnaround time for the reports was undesirable.
When Natarajan and team began working on developing Truenat (almost 20-25 years ago), there were fewer than a dozen biosafety level 3 laboratories with centralised molecular test facilities available in India. In 2025, ~9000 Truenat molecular tests are deployed at primary healthcare or block level across the country (and in 82 other nations globally). Truenat is not only deployable in remote settings but the test report also comes in around an hour.
“That is why we worked hard to decentralise molecular testing with a test that can be taken to the community or primary healthcare level. The development of Truenat was a completely grassroots kind of innovation. We had to see the real problems on the ground to build a product that can help bridge the gap. It took us almost 14 years to come up with a final solution. It is a long, grinding story as it requires a lot of grit, conviction and money,” says Natarajan while reflecting on Truenat’s journey over the past two decades. “We did everything we could because we believed deep within that the end was going to be very important and impactful.”
“Scaling up Truenat’s deployment was also not that easy. We got a lot of support from the Indian government. Scientist and microbiologist Dr Urvashi B Singh supported us from a very early stage when she helped us with all the validations. ICMR came forward and did a very large study for us (completely paid by the government of India) to further generate the scientific evidence. Gates Foundation funded the global validation process for Truenat. This support was very crucial, without which probably we would not be where we are today,” he shared.
Point-of-care tool at point-of-need for multiple disease testing
“We developed Truenat as a multi-disease testing platform. We started focusing on TB testing because that is where we saw an immediate need, and because every country was committed to ending TB by 2030. Just before the COVID-19 pandemic, we had supplied about 1,500 Truenat machines to the Indian government’s national TB elimination programme. So, when the COVID-19 pandemic happened, and ICMR validated Truenat for COVID-19 testing, all Truenat machines of the TB programme were deployed for COVID-19 testing. This speaks volumes for the impact technologies like Truenat can have in terms of pandemic preparedness,” said Sriram Natarajan.
As of April 2025, Truenat can test 26 different pathogens on the same machine. “As a company, Molbio Diagnostics is committed to health for all and trying to make sure everybody has access to essential health services with equity. Our full-time commitment is to ensure that our platforms become more user-friendly, deployable for the most in need, and also more affordable,” said Natarajan.
Point-of-care health technologies must be fully utilised too
While countries in the Global South deploy point-of-care health technologies at point-of-need, it is also important to ensure that these are optimally and fully utilised.
“If you look at any resource-constrained country, it is sad to see that it is not a problem of less, it is a problem of more. We have a lot of tools and equipment available, but when we do a capacity utilisation exercise, we find that most of these tools are hardly 10% to 30% utilised. So, why are these not utilised 100% when resources are constrained?” said Dr Sarabjit Chadha, FIND’s Director for Asian region. Dr Singh also referred to this: “When we did a diagnostic network optimisation, we found we have more than 3000 surplus NAAT tests available in Delhi alone.”
All experts quoted above were addressing sessions ofthe World Health Summit Regional Meeting in Delhi, India.
All governments have promised to end TB by 2030. With only 66 months left to deliver on the target, the urgency must drive science-based health responses to keep the promise and end TB.
Shobha Shukla
(Writer Shobha Shukla is the award-winning founding Managing Editor and Executive Director of CNS (Citizen News Service) and is a feminist, health and development justice advocate. She is a former senior Physics faculty of prestigious Loreto Convent College and current Coordinator of Asia Pacific Regional Media Alliance for Health and Development (APCAT Media) and Chairperson of Global AMR Media Alliance (GAMA received AMR One Health Emerging Leaders and Outstanding Talents Award 2024). She also coordinates the SHE & Rights initiative (Sexual Health with Equity & Rights)
