In a busy Netrokona clinic, Musharrof, an aging farmer stands within the clinic premises with an air of surety. A few hours ago, he was told he was diagnosed with drug-resistant tuberculosis – news that would have otherwise required weeks to be confirmed in the not-too-distant past. “I can start fighting this disease today,” he reflects, still clutching his prescription. “My family won’t have to watch me get sicker while waiting for answers.”
Since 2015, Bangladesh has been writing an incredible success story in combatting TB, a 35% reduction in TB deaths – even exceeding the ambitious goals of WHO. Yet beyond these statistics lies the constant challenge: every year, 2 million people with TB symptoms need tests, but only a quarter of them can access rapid diagnosis during their initial visit.
These statistics point to a small yet powerful device driving the story: Truenat. Since August 2022, the Stop TB Partnership and USAID iNTP have set up 38 portable TB testing machines in healthcare facilities across 16 districts, from Rangpur to Rajshahi.
“The numbers tell an extraordinary story,” explains Dr. Rahman, a programme coordinator. “In ten months, we tested over 59,000 people and found 4,446 TB cases. More importantly, we found 58 people like Musharrof with drug-resistant TB- people who would’ve been given the wrong treatment without the presence of this technology.”
The overall impact has been huge. One rapid molecular test advancement went up twenty-fold in the past year. “But statistics don’t capture the relief on a mother’s face when she gets results the same day,” says Fatima, a lab technician in Dhaka. “They don’t show you the lives saved because we were able to begin the treatment immediately.”
It has been a steep learning curve for Rajshahi-based medical technologist Md. Aheduzzaman is familiarising himself with this new technology. “At first, it seemed daunting,” he said with a smile. “But with training and practice, I grew confident and now I can’t imagine working without it.”
The rollout of Truenat itself was challenging. In the early days, between 20% and 30% of samples had to be discarded for multiple reasons related to quality or handling. High temperatures threatened the integrity of the test materials, and the team found it difficult to be precise with their measurements. Yet solutions arose through partnerships that were strengthened even further – a WhatsApp group connecting users countrywide to share hints and troubleshoot in real-time proved to be a timely resolution.
“We learned to adapt,” observes Salma, with training towards the preparation of 12 master trainers who then trained 38 medical technologists. “When we saw the wastage of samples, we increased the training related to collection techniques. When the reagents were on the verge of warming, we ensured that every facility had refrigerators.”
Preparation was meticulous. Each of the 38 sites were chosen and assessed with an eye for detailed considerations – was there reliable electricity? Ample trained staff? Presence of required infrastructure? Every possible contingency was thought of and addressed. . All existing reporting systems that were to receive the new data were modified in a manner ensuring that no single result may be lost during the transition period.
Supported by the Global Fund, the National TB Control Programme of Bangladesh is poised to to add another 112 Truenat systems and 200,000 tests. “We’re not just adding machines,” clarifies Dr. Fatima, the Programme Director. “We’re building on a foundation of trained supervisors and proven processes.”
At a rural clinic, a young mother is watching her sputum sample being processed. Unlike the others before her, she wouldn’t have to take more than one trip, wasting time and money she cannot afford. By tomorrow evening, she will know whether she has TB and of which type- basis which the further course will be charted to recovery.
“Every person who starts treatment today instead of weeks from now means fewer infections in their community. Every drug-resistant case we catch early means one less family facing the nightmare of a failed treatment,” says Dr. Rahman, talking of the subtle yet vital impact Truenat was playing in their community.
As the country glides to meeting its objective of eliminating TB, these small machines in clinics all over Bangladesh do far more than just testing samples – they are giving people hope, one result at a time. Musharrof recovering back at home words, “It’s not just about getting better faster. It’s about knowing that your life matters enough for someone to bring this kind of care to your doorstep.”
This article was first published in iNTP Case Study: Truenat (December 2023), Introducing Truenat Testing in Peripheral Facilities: Lessons Learned from Bangladesh, issued by the Introducing New Tools Project (Stop TB Partnership/USAID).
