Tuberculosis (TB) remains a major health challenge in Africa, with funding uncertainties threatening progress. In this interview, Dr. Nii Hanson-Nortey, a leading TB expert from Ghana, shares insights on adapting TB programs, optimizing resources, and leveraging technology to improve care.
Good morning Dr. Nii Hanson-Nortey. Can you please introduce yourself to our readers?
Dr. Nii: I am Dr. Nii Hanson-Nortey a medical doctor, and TB expert. I was Deputy NTP Manager for Ghana for 11 years during which period I led the implementation of TB/HIV collaborative activities, the development of 2 national TB strategic plans and Global Fund proposals for Ghana. I was the Vice Chair of Ghana Country Coordinating Mechanism (CCM) from 2021 to 2022. I have also been a Global Fund Technical Review Panel (TRP) TB expert since 2022.
ACB: Dr. Nii, African countries are facing significant challenges due to shifts in the funding landscape for TB. How do you see this affecting TB programs on the ground?
Dr. Nii: I believe it’s crucial to provide clear and factual information to all stakeholders, including government officials and donors. They need to understand exactly what their funding supports and what the real-world impact of funding cuts would be—on clinics, healthcare workers, and, most importantly, on patients’ lives. Currently, limited TB funding is leading to the deaths of people who have TB diseases and have not been diagnosed yet.
ACB: Many organizations are working to raise awareness about this issue. Let’s do a scenario exercise. What if funding for TB programs were to be significantly reduced, say reduced by 50% ? How should TB programs adapt?
Dr. Nii: If that happens, we will need to rethink our screening strategies. Right now, we recommend using the GeneXpert test for symptomatic individuals—those with a persistent cough lasting more than two weeks, possibly accompanied by chest pain, fatigue, weight loss, fever, or night sweats. However, the GeneXpert test is expensive, costing up to $15 per test, depending on the country.
To optimize resources, we could introduce a more cost-effective two-step screening process that uses digital chest X-ray imaging with artificial intelligence (AI) evaluation to first screen symptomatic individuals at a much lower cost per exposure before testing all persons with high-risk images with GeneXpert test to confirm TB diagnosis. This reduces the wastage associated with testing large numbers of low-risk symptomatic persons (negatives) with GeneXpert. This will save a lot of money associated with the excessive use of GeneXpert cartridges. The chest X-ray images do not need to be printed. This approach would significantly reduce costs while maintaining diagnostic accuracy. The incorporation of AI technology reading chest X-rays further enhances efficiency.
Additionally, we should consider alternative molecular tests, such as Truenat System, a fully automatic real-time quantitative micro PCR analyzer, which functions in a way similar to GeneXpert the TB LAM antigen test which is very effective in persons with HIV.
ACB: That’s an interesting approach. Some experts also suggest that integrating TB services with other healthcare programs could improve both efficiency and quality of care. What’s your take on this?
Dr. Nii: Integration is a viable solution, but it must be done strategically. For instance, TB screening could be incorporated into outpatient department services, following the optimized screening process we just discussed.
We should also take advantage of emerging technologies. AI tools can enhance diagnostic accuracy, improve workflow efficiency, and support clinical decision-making.
Furthermore, we need to do more advocacy and negotiations with the international companies that are producing the TB tests we use to reduce the prices of these tests to the realistic $5 price tag, especially for low-income countries. This will ensure that low-income countries can procure large volumes of these tests.
ACB: is there a role for community health workers in this scenario of 50% reduction of available funding for TB?
Dr Nii: Yes, Community Health Volunteers remain very important for case detection and treatment support. Community volunteers and Community Health workers can help with symptom screening in the community and also in facilities to support early screening of symptomatic people. These people can then be forwarded for X-ray screening. As much as possible volunteers must receive some compensation for their work to commit them even more and track their work with a keen purpose of accountability.
ACB: Finally, what message would you like to leave our readers with?
Dr. Nii: TB is both widespread and curable, yet it remains one of the leading causes of death in Africa. In 2021, TB was the fourth-leading cause of mortality on the continent, the first being pneumonia, which may itself include undiagnosed TB cases.
Unlike some other infectious diseases, TB is not linked to any specific behaviour—anyone who breathes is at risk. This makes it a neutral but urgent health issue.
We must continue advocating and engaging with policymakers and donors to improve secured financing for TB control programmes globally. This will ensure that the results of years of invested resources do not get erased.
ACB: Thank you, Dr. Nii, for your insights.
Interview conducted on 20 March, 2025 by Djesika Amendah PhD, Head of Policy Research and Country Support-ACB
