Implementing computer‑aided detection for TB active case finding: A qualitative study of feasibility and acceptability in Tondo, Manila
7 affiliations
- 1Epicentre, Interventional Epidemiology and Training Department, Paris, France
- 2Médecins Sans Frontières, Operational Center Paris, Tondo Project, Manila, Philippines
- 3Médecins Sans Frontières International, Amsterdam, Netherlands
- 4Médecins Sans Frontières, Operational Center Paris, Paris, France
- 5Research Office, Manila Health Department, Manila, Philippines
- 6TB Prevention and Control Section, Manila Health Department, Manila, Philippines
- 7Médecins Sans Frontières Operational Center Paris, Section Japan, Tokyo, Japan
Abstract
Tuberculosis (TB) remains the leading cause of death from a single infectious agent, with over 1.23 million deaths globally in 2024. Despite available treatment and prevention strategies, timely and accurate detection remains challenging, particularly in high-burden settings such as the Philippines, which accounted for 6.8% of the global burden of TB in 2024. Computer-aided detection (CAD) software integrated with digital chest X-ray offers enhanced screening capacity, but its success depends on feasibility and acceptability within local health systems. This qualitative study explored perceptions and experiences of CAD integration during a Médecins Sans Frontières community-based TB active case finding campaign (ACF) in Tondo, Manila. In-depth interviews, focus group discussions, and direct observations were conducted with MSF staff, health center physicians, TB program personnel, ACF participants, and community leaders between January and April 2023. Thematic analysis identified four main themes: (1) Operational functionality and efficiency: Staff reported CAD increased screening capacity, supported clinical decision-making, and streamlined workloads; ACF participants reported a convenient process. (2) Human resources and role adaptation: Staff perceived role redistribution as initially challenging, highlighting the need for adequate capacity building and technical support; (3) Technical feasibility and system design: project managers and staff emphasized understanding CAD’s capabilities and limitations to plan infrastructure, set thresholds, and compensate for inherent limitations. (4) Community acceptability and ethical considerations: community participants expressed mixed views on the reliability of novel “high-tech” tools and stressed the importance of aligning with local healthcare needs. This study demonstrates that implementing CAD in TB ACF is both feasible and acceptable when supported by careful planning and adaptation to local contexts. Sustainable implementation hinges on technical support and the meaningful involvement of healthcare workers and communities, whose insights help ensure ethical and effective digital health innovation. The experience in Tondo offers lessons on deploying CAD in high-burden, resource-constrained settings.
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BibTeX
@article{phillips2026implementing,
title = {{Implementing computer‑aided detection for TB active case finding: A qualitative study of feasibility and acceptability in Tondo, Manila}},
author = {Emelie Yonally Phillips and Ma. Danica Katrina P. Galvan and Juno Min and Cathy Hewison and Carmina Duyala and John Carlo Palmado and Sheryl N. Peral and Olivier Camelique and Mary Ruth C. Roxas and Marve D. Duka and Gina F. Pardilla and Maria Julieta C. Recidoro and Richard H. Castro and Farah Hossain and Helena Huerga and Valentina Carnimeo},
journal = {PLOS Global Public Health},
year = {2026},
month = oct,
doi = {10.1371/journal.pgph.0007429},
url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007429},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Implementing computer‑aided detection for TB active case finding: A qualitative study of feasibility and acceptability in Tondo, Manila
AU - Emelie Yonally Phillips
AU - Ma. Danica Katrina P. Galvan
AU - Juno Min
AU - Cathy Hewison
AU - Carmina Duyala
AU - John Carlo Palmado
AU - Sheryl N. Peral
AU - Olivier Camelique
AU - Mary Ruth C. Roxas
AU - Marve D. Duka
AU - Gina F. Pardilla
AU - Maria Julieta C. Recidoro
AU - Richard H. Castro
AU - Farah Hossain
AU - Helena Huerga
AU - Valentina Carnimeo
PY - 2026
DA - 2026/10/08
JO - PLOS Global Public Health
DO - 10.1371/journal.pgph.0007429
UR - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007429
AB - Tuberculosis (TB) remains the leading cause of death from a single infectious agent, with over 1.23 million deaths globally in 2024. Despite available treatment and prevention strategies, timely and accurate detection remains challenging, particularly in high-burden settings such as the Philippines, which accounted for 6.8% of the global burden of TB in 2024. Computer-aided detection (CAD) software integrated with digital chest X-ray offers enhanced screening capacity, but its success depends on feasibility and acceptability within local health systems. This qualitative study explored perceptions and experiences of CAD integration during a Médecins Sans Frontières community-based TB active case finding campaign (ACF) in Tondo, Manila. In-depth interviews, focus group discussions, and direct observations were conducted with MSF staff, health center physicians, TB program personnel, ACF participants, and community leaders between January and April 2023. Thematic analysis identified four main themes: (1) Operational functionality and efficiency: Staff reported CAD increased screening capacity, supported clinical decision-making, and streamlined workloads; ACF participants reported a convenient process. (2) Human resources and role adaptation: Staff perceived role redistribution as initially challenging, highlighting the need for adequate capacity building and technical support; (3) Technical feasibility and system design: project managers and staff emphasized understanding CAD’s capabilities and limitations to plan infrastructure, set thresholds, and compensate for inherent limitations. (4) Community acceptability and ethical considerations: community participants expressed mixed views on the reliability of novel “high-tech” tools and stressed the importance of aligning with local healthcare needs. This study demonstrates that implementing CAD in TB ACF is both feasible and acceptable when supported by careful planning and adaptation to local contexts. Sustainable implementation hinges on technical support and the meaningful involvement of healthcare workers and communities, whose insights help ensure ethical and effective digital health innovation. The experience in Tondo offers lessons on deploying CAD in high-burden, resource-constrained settings.
SN - 2767-3375
ER -