# Improving Native American Health Through Community-based Screening and Diagnostic Testing for Tuberculosis

> **NIH NIH R21** · UNIVERSITY OF WASHINGTON · 2024 · $398,580

## Abstract

ABSTRACT
Among Alaska Natives in Alaska, Tuberculosis (TB) remains endemic in communities and is a leading cause of
morbidity and mortality. Alaska Native communities continue to have the highest rates of TB disease in the U.S.,
and most TB cases occur in villages that remain far from health centers. The approach for diagnosing TB, which
includes airlifting people with TB-related symptoms to regional centers for chest radiography and sputum
collection, is difficult and expensive to implement effectively. Through our research in TB-endemic countries, we
have identified screening and diagnostics testing modalities that are well-suited for efficient TB case finding in
remote communities of Alaska. First, portable chest x-ray devices capture digital images that can be analyzed
by computer-aided diagnostic (CAD) artificial intelligence programs for real-time interpretation. Second, as
collecting sputum specimens has been a major diagnostic barrier for community-based diagnosis, we have
recently demonstrated the high accuracy of tongue swab sampling for nucleic acid amplification testing of
Mycobacterium tuberculosis (Mtb) among adults in South Africa. We also have strong data, using cultured Mtb
specimens, demonstrating high accuracy on next-gen, high-throughput molecular testing systems, which have
automated processes for analyzing thousands of samples at lower costs compared to conventional lab-based
PCR systems. The objective in this application is to leverage our existing health infrastructure in south-western
Alaska, expertise in clinical TB and diagnostic testing, and strong relationships with Alaska Native communities,
to evaluate two novel community-based screening and diagnostic tools in TB-endemic regions of the United
States. Our central hypotheses are: 1) portable chest x-ray devices using CAD interpretation will be accurate
and feasible to implement in Alaska, and 2) tongue swab testing will be accurate when tested on an automated,
high-volume molecular platform, as compared to conventional sputum-based molecular testing. We will test our
hypotheses through the following two specific aims: (1) to determine if a portable, digital chest x-ray with real-
time CAD can be accurate for TB screening, and feasible for use in community settings, within TB-endemic
regions of Alaska; and (2) demonstrate the accuracy of tongue swab sampling with molecular testing using an
automated high-throughput system, compared to current sputum-based molecular testing, among adults and
children (≥5 years old) who have presumed pulmonary TB disease in Alaska. The research will be innovative by
expanding the possible tools for community-based screening and diagnostic testing in TB-endemic communities
in Alaska and elsewhere. This proposal is highly responsive to PAR-20-214, which seeks novel “Research to
Improve Native American Health.” These results will inform a subsequent clinical research trial to evaluate the
clinical impact and cost-effectiveness for conducti...

## Key facts

- **NIH application ID:** 10840552
- **Project number:** 1R21NR021233-01
- **Recipient organization:** UNIVERSITY OF WASHINGTON
- **Principal Investigator:** Paul K Drain
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $398,580
- **Award type:** 1
- **Project period:** 2024-06-12 → 2027-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10840552

## Citation

> US National Institutes of Health, RePORTER application 10840552, Improving Native American Health Through Community-based Screening and Diagnostic Testing for Tuberculosis (1R21NR021233-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10840552. Licensed CC0.

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