Decentralizing TB Diagnosis: Community Perspectives on Point-of-Care Testing for Tuberculosis Screening in a Resource-Limited Island Municipality in the Philippines

Background: Point-of-care (POC) molecular diagnostics for Tuberculosis (TB) such as Truenat have the potential to shorten time-to-diagnosis and improve case detection in geographically isolated settings, but most existing evidence on Truenat implementation focuses on diagnostic accuracy or urban and mainland contexts. Little is known about how communities, persons with TB, and health workers in island municipalities perceive and experience decentralized testing relative to centralized, laboratory-based testing. Bantayan, Cebu, a fishing and agricultural municipality in Central Visayas, exemplifies this gap: its Rural Health Unit serves a dispersed population reachable only by sea or unpaved roads, specimen referral can take days, and TB notification remains below national targets.

Methods: This qualitative study will conduct semi-structured individual interviews with three stakeholder groups in Bantayan: persons with TB (diagnosed via Truenat and via other methods), community members, and healthcare workers (n=15-20). Interviews will explore lived experiences of TB diagnosis and treatment initiation; perceived advantages, disadvantages, and barriers of POC versus centralized testing, including stigma, travel burden, and time off work; and participant-generated suggestions for improving testing acceptability and access. Objective Truenat performance metrics (turnaround time, result distribution) will be analyzed alongside qualitative findings.

Implications: Data collection is scheduled to complete in July 2026, with analysis and manuscript preparation completed by September 2026, prior to this conference. Findings are expected to surface community-prioritized barriers and facilitators to TB testing and treatment initiation, and to generate practical, community-informed recommendations for the National TB Program on decentralizing molecular diagnostics. This study is intended to serve as a model for implementing POC TB testing in similarly resource-limited island settings in a way that communities accept and engage with, in support of TB elimination goals.