As a procurement services agent (PSA), The Partnership for Supply Chain Management (PFSCM) supports the Global Fund to Fight AIDS, Tuberculosis and Malaria and other donors with supply chain-, procurement- and health logistics services to reduce the burdens of epidemics like HIV, malaria, and tuberculosis (TB) in low- and middle-income countries.
Effective supply chain services are critical in ensuring quality and affordable TB health products for screening and treatment are available when and where needed.
PFSCM has always been supplying quality-assured TB products to various health programs, but since 2020, we have been specializing in diagnostic products for TB. In the last three years alone, we have delivered 155 shipments of TB diagnostic products worth more than $34 million to 37 countries.
PFSCM stays true to our mission and works diligently to continue delivering TB health products to LMICs worldwide. Every year on World TB Day, we “take stock” and reflect on the progress made by public health programs.
Strengthening TB diagnostics services through the timely delivery of sustainable, best-value, best-quality screening products
Reflections from PFSCM Senior Laboratory Technical Advisor Bingi Tusiime
According to WHO, tuberculosis (TB) is the 13th leading cause of death globally. In 2021, an estimated 10.6 million people fell ill and 1.6 million died from TB. Although TB is curable and preventable, it remains a significant public health concern, with most cases occurring in sub-Saharan Africa, Eastern Europe, and Asia.
To address the TB burden, global health players have put significant resources towards strengthening health systems, including the scale-up, network support and optimization of diagnostic services.
Laboratory and diagnostic imaging services are a vital component of health care delivery, providing tools for the diagnosis, surveillance and monitoring of TB treatment.
Over the past few years, PFSCM has supported countries in strengthening TB-related diagnostic services. Sample referral networks have been improved through procurement of standard triple packaging products for both categories A and B. Access to TB diagnostic services has also been enhanced through procurement and delivery of several TB-related diagnostics, including near-patient multi-diagnostic molecular equipment (GeneXpert Edge Systems and GeneXpert MTB/RIF) that simultaneously detect both TB and rifampicin-resistance TB in less than two hours, allowing for same day testing and results delivery, and enrolment in a treatment program, thereby improving patient management.
PFSCM is also working to strengthen and increase access to diagnostic imaging services by procuring portable, mobile, and fixed X-rays, including CT scanners, for several countries. In addition, Next Generation Sequencing (NGS) is a new area that PFSCM supports to improve national, regional, and global surveillance capacity for TB and other infectious diseases.
The importance of portable, ultraportable, and AI CAD imaging solutions in expanding screening services to hard-to-reach regions and populations
Reflections from PFSCM Senior Medical Device Technical Advisor Sizar Akoum
TB programs are increasingly investing in screening vulnerable populations at elevated risk of acquiring TB infection to find missing cases. It could be difficult to reach out to specific populations in low-resource settings who often do not have access to healthcare and/or do not visit healthcare facilities. Such high-risk populations include the prison population, people living with HIV, coal miners, tribal communities in remote settlements, people living in densely populated urban slums and crowded refugee camps, in addition to people from higher socioeconomic sectors in LMICs who can also be missed by TB screening and diagnostic programs due to a lack of trust on the quality of health services being provided for TB screening and diagnosis.
The need for qualified human readers for chest X-ray (CXR) interpretation is one of the barriers to using CXR screening in TB programs in many high TB burden countries. Artificial intelligence-powered computer-aided detection (CAD) solutions were developed as a diagnostic aid because they permit a standardized interpretation of a CXR. Several studies have demonstrated that CAD solutions can achieve good diagnostic accuracy suggesting that CAD solutions can achieve an equivalent performance as human readers in identifying bacteriologically confirmed TB. WHO now recommends using CAD as an alternative to human readers to interpret CXR for screening and triaging pulmonary TB in individuals aged 15 or over.
The effectiveness of supply chains will likely impact the scale-up of the national TB programs’ coverage. Supply chain roleplayers must ensure timely procurement and delivery of innovative, safe, and quality imaging technologies.
Since 2020, PFSCM has been increasingly supporting countries in procuring portable and ultraportable digital x-ray systems and CAD solutions to increase coverage of remote areas, reach high-risk populations not accessing the health system, and boost the national TB programs’ screening and diagnostic activities at different levels of the health systems. In 2022, PFSCM assisted principal recipients (PRs) in Guinee-Bissau with the procurement of five portable X-ray units with CAD software from Qure.ai. PFSCM also supported Ghana, Zimbabwe, Nigeria, Mozambique, Guinee-Bissau, Malawi, Iraq, and Yemen with the procurement of CAD4TB software from Delf Imaging.