Submission ID 131632
| Issue/Objective | In many low- and middle-income countries, tuberculosis (TB) programmes are among the most established components of the health system; however, a substantial burden of non-TB respiratory disease remains undiagnosed, particularly among populations facing occupational, environmental, and social vulnerabilities. This reflects both missed diagnostic opportunities and structural inequities in access to timely care. This study evaluates whether integrating lung health screening into existing TB outreach platforms can expand access to underserved populations, improve diagnostic yield, and enhance efficiency within real-world programme settings in Pakistan. |
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| Methodology/Approach | An integrated TB and lung health screening model was implemented across Pakistan from January to December 2025, targeting underserved and high-risk populations including coal miners, brick kiln workers, textile workers, transgender communities, incarcerated populations, and residents of informal settlements. The model combined symptom screening, AI-assisted digital chest X-ray, portable spirometry, and clinical evaluation, delivered through decentralized community outreach camps and linked to public-sector referral systems to reduce geographic and financial barriers to care. A comparative programmatic evaluation design was applied, with effectiveness defined as total respiratory cases detected. Costs were estimated from a provider perspective. Programmatic data from integrated screening (2025) were compared with TB-only active case finding (2024). |
| Results | A total of 33,215 individuals were screened across 315 outreach camps. Pulmonary TB was diagnosed in 243 individuals (0.73%), while 9,846 individuals (29.6%) were identified with other lung conditions, demonstrating a substantial previously unmet burden of respiratory disease. The most prevalent conditions included chronic obstructive pulmonary disease (8.3%), asthma (7.5%), pneumoconiosis (4.8%), and pneumonia (3.3%), reflecting the impact of occupational and environmental exposures. A total of 17,765 spirometry tests were conducted, with a 95.2% success rate and average duration of 12-15 minutes. Provider acceptability exceeded 79% across usability and workflow integration domains, and patient completion rates exceeded 95%. Integrated screening demonstrated significantly greater efficiency, with a cost per case detected of USD 4.6 compared to USD 34.1 in TB-only models. The incremental cost-effectiveness ratio was USD 4.1 per additional case detected. |
| Discussion/Conclusion | Integrating lung health into TB outreach platforms transforms vertical disease programmes into more equitable, person-centred entry points for primary health care. By decentralizing diagnostics and leveraging community-based delivery models, this approach expands access for populations traditionally excluded from facility-based services and addresses a broader spectrum of unmet health needs. The findings demonstrate that integrated screening not only improves diagnostic yield but also enhances efficiency, offering a scalable pathway for optimizing resource use in constrained settings. Aligned with national TB programme structures, this model provides a practical, system-level approach for strengthening primary health care delivery, advancing equity, and supporting the transition from disease-specific programmes to integrated, resilient health systems. |
| Presenters and Affiliations | Kinz Ul Eman Dopasi Foundation Usman Rasool Dopasi Foundation |
