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 real practical strategy in action which provides a pathway for other low- and middle-income countries to follow.
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 human expert TB interpretations. This was a game-changing moment in public health because X-Ray interpretation was no longer dependent on availability of super-specialist radiologists for expert interpretation - unless needed. In most healthcare settings, especially in remote areas, radiologists are seldom available or very occupied with clinical and research workload.
WHO guidelines 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 human expert TB interpretations. This was a game-changing moment in public health because X-Ray interpretation was no longer dependent on availability of super-specialist radiologists for expert interpretation - unless needed. In most healthcare settings, especially in remote areas, radiologists are seldom available or very 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 to get rid of diagnostic delays, catastrophic costs, and cut 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 those with presumptive TB can get a confirmatory TB report in the next hour or so - if WHO and ICMR recommended portable 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 the 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 WHO recommended upfront molecular test. Those with active TB disease should get latest TB treatment therapy with social support so that they can get cured.
TB infection also stops spreading when a person with the disease is on effective treatment.
Following science and evidence, the government of India launched a massive 100 days campaign (7 December 2024 to 24 March 2025) to find, treat and prevent more TB among high-risk groups in 347 districts initially. The campaign was later expanded to almost 500 districts out of around 800 in the nation.
India deployed AI to find TB among the most marginalised
Following science and evidence, the government of India launched a massive 100 days campaign (7 December 2024 to 24 March 2025) to find, treat and prevent more TB among high-risk groups in 347 districts initially. The campaign was later expanded to almost 500 districts out of around 800 in the nation.
As per the concept note of this 100 days #TBMuktBharat (#TBFreeIndia) government campaign, battery operated ultraportable and handheld X-Ray machines with artificial intelligence enabled computer-aided detection, along with 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 2019-2021 showed that almost half of TB patients would not have been found if upfront X-Ray screening was not done as they were asymptomatic. Other sub-national surveys also showed similar findings.
In 100 days, 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).
Not even one of the 285,000 asymptomatic people with active TB disease would have been found if upfront X-Ray was not done. “Given the success of 100 Days campaign, now it has been extended to all districts in the country,” 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.
Ground zero: Kangra’s efforts towards ending TB
Debunking oft-cited notion ‘public services are difficult to reach people living in mountainous terrains’, Kangra, the most populated district of the hilly state of Himachal Pradesh, has led from the front in taking public TB services closer to the communities or at their doorsteps.
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 stops the spread of infection, said Dr RK Sood.
Nagrota and Yol in Nagrota Bagwan block of Kangra district made a record on 3rd September 2025 by screening 605 people on the same day using 1 made-in-India (ProRad) AI-enabled ultraportable handheld X-Ray machine. Usually, 100-200 people get screened on 1 X-Ray machine in a day. But Kangra’s average is reaching between 200-500 X-Rays daily in recent months with accelerated efforts to find more TB.
Nagrota and Yol in Nagrota Bagwan block of Kangra district made a record on 3rd September 2025 by screening 605 people on the same day using 1 made-in-India (ProRad) AI-enabled ultraportable handheld X-Ray machine. Usually, 100-200 people get screened on 1 X-Ray machine in a day. But Kangra’s average is reaching between 200-500 X-Rays daily in recent months with accelerated efforts to find more TB.
Kangra broke the previous record of its Fatehpur block made on Sunday, 24th August 2025, when 581 people were screened on the same day by one X-Ray machine. Earlier, on Independence Day 2025, it was Bhawarna block of Kangra that had made a record of 471 X-Rays in a single day on one X-Ray machine.
"Antariksh, one of the radiographers, and other frontline healthcare workers worked from early morning hours till almost midnight to screen people for TB, offer upfront molecular test (made-in-India Truenat) to those found presumptive, and link those with active TB disease to free treatment. Those testing negative for TB and eligible for TPT (TB preventive Therapy), were offered Cy-TB test (for latent TB) and offered TB preventive therapy,” said Dr RK Sood.
"Antariksh, one of the radiographers, and other frontline healthcare workers worked from early morning hours till almost midnight to screen people for TB, offer upfront molecular test (made-in-India Truenat) to those found presumptive, and link those with active TB disease to free treatment. Those testing negative for TB and eligible for TPT (TB preventive Therapy), were offered Cy-TB test (for latent TB) and offered TB preventive therapy,” said Dr RK Sood.
Almost 100% upfront molecular testing becoming a reality
“99% of those with presumptive TB are screened with upfront molecular testing in Kangra district,” said Dr Sood. According to the latest India TB Report 2024 of Government of India, Himachal Pradesh state had 36% upfront molecular testing in 2023. India, as per the same report, had 21% upfront molecular testing in the same year. Globally, 48% of those with presumptive TB were tested with upfront molecular test in 2023.
All world leaders at United Nations High Level Meeting on TB 2023 had committed to completely replace microscopy (which majorly underperforms in diagnosing TB) with 100% upfront molecular tests by 2027. We need more accelerated progress to achieve this goal.
Kangra district has 3 ultraportable handheld X-Rays, but only one of them is AI-enabled. “National TB Elimination Programme is procuring more X-Rays and soon more will get deployed,” confirms Dr Sood. “We need more X-Rays and more trained human resource personnels to provide these services.”
Dr Sood also said that not only record-number of people are getting screened for active TB disease (and those confirmed for TB disease are being linked to treatment) but this is also the largest drive to find those with latent TB and eligible for TB preventive therapy. Those eligible are being offered the TB preventive treatment. This would help stop the spread of infection as well as stop people with latent TB from progressing to active TB disease. However, there were some initial hiccups due to supply chain issues of Cy-TB (test for latent TB) but these issues were resolved sometime back.
Dr RK Sood commended partnerships and support from different people in strengthening local TB response. For example, space to conduct X-Rays in remote settings, such as small space inside shops or offices, is voluntarily provided by the people. It also helps fight TB stigma. Covered space becomes more important with heavy mountain rains or thunderstorms.
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 Sood.
As world leaders are slated to meet next week at the 80th United Nations General Assembly High Level Meeting on Non-Communicable Diseases (NCDs), an important initiative was launched last week by Haryana Chief Minister in India. Former head of Indian government’s HIV and TB programmes Dr Kuldeep Singh Sachdeva (and President and CMO of Molbio) was also present to grace the occasion.
Kangra district has 3 ultraportable handheld X-Rays, but only one of them is AI-enabled. “National TB Elimination Programme is procuring more X-Rays and soon more will get deployed,” confirms Dr Sood. “We need more X-Rays and more trained human resource personnels to provide these services.”
Dr Sood also said that not only record-number of people are getting screened for active TB disease (and those confirmed for TB disease are being linked to treatment) but this is also the largest drive to find those with latent TB and eligible for TB preventive therapy. Those eligible are being offered the TB preventive treatment. This would help stop the spread of infection as well as stop people with latent TB from progressing to active TB disease. However, there were some initial hiccups due to supply chain issues of Cy-TB (test for latent TB) but these issues were resolved sometime back.
Dr RK Sood commended partnerships and support from different people in strengthening local TB response. For example, space to conduct X-Rays in remote settings, such as small space inside shops or offices, is voluntarily provided by the people. It also helps fight TB stigma. Covered space becomes more important with heavy mountain rains or thunderstorms.
Women healthcare workers are changemakers
Lab on wheels in Haryana
As world leaders are slated to meet next week at the 80th United Nations General Assembly High Level Meeting on Non-Communicable Diseases (NCDs), an important initiative was launched last week by Haryana Chief Minister in India. Former head of Indian government’s HIV and TB programmes Dr Kuldeep Singh Sachdeva (and President and CMO of Molbio) was also present to grace the occasion.
Nine integrated healthcare vans were flagged to reach girls and women with point-of-care diagnostics. These vans are equipped with:
- Ibreast - a US FDA approved handheld device enabling primary healthcare workers to identify breast lumps early, in just a few minutes, without any pain or radiation (made by UE Lifesciences). Haryana aims to screen 75000 women before 1st March 2026.
- Truenat - the only WHO recommended point-of-care, decentralised, battery-operated and laboratory independent molecular test for TB - as well as for over 40 other diseases, including HPV (Human Papilloma Virus linked to cancers including cervical cancer). Truenat is made in India by Molbio Diagnostics, Truenat is already exported and deployed in over 90 countries globally.
- ProRad - an ultraportable and handheld X-Ray with AI-enabled computer-aided detection for TB and other pathologies - made in India by Prognosys.
(Shobha Shukla is a feminist, health and development justice advocate, and an award-winning founding Managing Editor and Executive Director of CNS (Citizen News Service). She was also the Lead Discussant for SDG-3 at United Nations inter-governmental High Level Political Forum (HLPF 2025). She is a former senior Physics faculty of prestigious Loreto Convent College; current President of Asia Pacific Regional Media Alliance for Health and Development (APCAT Media); Chairperson of Global AMR Media Alliance (GAMA received AMR One Health Emerging Leaders and Outstanding Talents Award 2024); and coordinator of SHE & Rights (Sexual Health with Equity & Rights). Follow her on Twitter/X @shobha1shukla or read her writings here www.bit.ly/ShobhaShukla)
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