hroughout much of the first half of the 20th century, mobile tuberculosis (TB) units crisscrossed the US and Europe on the hunt for TB cases. Streetcars, buses, trains, planes and boats equipped with x-ray machines offered free exams. Those with suspicious results were asked to cough up sputum for smear microscopy to identify the pathogen. Family members of people sick with TB were also identified, tested and, if necessary, treated as well.
This three-part strategy – search for TB cases, treat the sick, and stop the disease from progressing using preventive treatment – was key to the virtual elimination of TB from wealthy industrialized countries around the world over the past 70 years. The annual TB rate in the United States today is under three cases per 100,000 people. In Canada, it’s two per 100,000.
But the numbers are astronomically higher in many poor countries where these same measures were not applied. In Peru, for example, the annual rate is 117 cases per 100,000. That’s why, almost every day, two blue vans from Socios En Salud, a branch of the global health organization Partners In Health, find a strategic place to park in the Carabayllo district of Lima. Its logo designed in consultation with local residents, each van features people holding a hand up in the universal halt! gesture, and the phrase “alto a la TB” – stop TB. Nearby are blue tents they’ve set up for various screenings. Speakers blast the latest trendy music as well as a jingle about TB screening that was created for this campaign by local artists and regularly plays on local radio.
Like their 20th-century predecessors, these are mobile units searching for TB cases. Now they’re equipped with digital x-ray machines, whose results are screened by AI, and vials for collecting sputum to take to a lab for rapid genetic analysis. Another team carries tubes of tuberculin, to conduct skin tests, and the QuantiFERON-TB Gold Plus test, and visits persons who have been exposed to tuberculosis to screen them. Socios En Salud even has an x-ray backpack for home visits in areas where the hills are too steep and the roads too rugged for the vans.
Red and white vans are doing the same work thousands of miles away in Pakistan, which has one of the highest TB burdens in the world, with 263 cases per 100,000.