In many HIV high-burden settings, the hardest TB to catch is the one you can’t hear, auscultate, or even X-ray easily: extrapulmonary TB. That’s where FASH (Focused Assessment with Sonography for HIV-associated TB) steps in—a pragmatic, low-cost, bedside ultrasound protocol designed for low-resource environments. On the GUSI Blog, Marcela Osorio, MS4, explores how frontline clinicians in Lesotho, Zambia, and Malawi are using FASH to speed diagnosis, guide treatment, and restore confidence in clinical decision-making—while still wrestling with gaps in equipment, mentorship, and longitudinal support.
This post distills those insights—and adds how GUSI’s ScanOne and ScanHub platforms are helping transform individual skills into program-level capacity.
Why FASH matters in HIV/TB care
People living with HIV are at higher risk for extrapulmonary TB, which often hides beyond the reach of sputum tests or chest X-rays. FASH offers a repeatable, teachable framework to look for the sonographic signatures commonly associated with HIV/TB, including:
- Pericardial effusion
- Pleural effusion
- Ascites
- Abdominal lymphadenopathy
- Focal splenic or hepatic lesions
In practice, that means earlier recognition, more confident referrals, and more targeted treatment—especially where labs, radiology, or specialist consults are scarce or delayed.
Voices from the frontlines: Lesotho, Zambia, Malawi
Clinicians featured in Osorio’s article describe three recurring wins:
- Reduced diagnostic delays – FASH narrows the uncertainty window, allowing clinicians to initiate treatment or escalate care faster.
- Provider empowerment – Structured ultrasound protocols give non-radiologists a standardized, guideline-aligned pathway to act decisively.
- Better conversations with patients – Visual evidence supports shared decision-making, adherence, and trust.
But they’re also clear about the hurdles:
- Equipment scarcity & maintenance (few probes, fewer backups)
- Limited protected time for mentorship & QA
Data fragmentation—images and interpretations often live in silos, making program evaluation and quality improvement difficult
How GUSI is closing the gap: Education, mentorship, and systems
The Global Ultrasound Institute (GUSI) is committed to POCUS education, training, and capacity building that’s context-aware, equity-driven, and sustainable. That means:
- Competency-based training that maps to real clinical pathways (like FASH)
- Longitudinal mentorship—not one-off workshops
Trust, governance, and transparency (see: GUSI’s growing infrastructure for QA, security, and compliance)
The digital backbone: ScanOne (for learners & clinicians) + ScanHub (for programs)
To turn skill into system-level impact, GUSI pairs hands-on teaching with digital tools purpose-built for global ultrasound:
ScanOne (mobile/desktop app for clinicians & learners)
- On-device FASH protocol guidance: step-by-step checklists and structured forms reduce variability.
- Structured reporting templates: capture consistent data for QA, mentorship, and research.
- Offline-first design: clinicians can scan and document without connectivity, then sync later.
- Integrated QBank & pathology gallery: continuous learning at the point of care.
- Mentor loop: secure, asynchronous feedback from expert reviewers.
ScanHub (program & institution layer)
- Cohort-wide dashboards: track uptake, accuracy, turnaround times, and training progression.
- Bulk uploads & device integrations (e.g., Butterfly): simplify data ingestion from the field.
- Quality assurance workflows: tag cases, track inter-rater reliability, and close the loop with trainees.
- Governance & auditability: role-based access, encryption, and transparent data trails to meet partner and funder requirements.
Together, ScanOne + ScanHub make FASH teachable, trackable, and improvable—at scale.
What it will take to go further
- More probes, more power, more permanence
Affordable devices are great; sustainable supply chains, maintenance plans, and device rotation are better. - Protected mentorship time
QA and case review must be built into program design and budgets, not bolted on. - Data for equity
Standardized, de-identified data streams (via platforms like ScanHub) enable impact measurement, policy advocacy, and continuous improvement. - Local ownership
FASH programs work best when local clinicians lead the agenda—with global partners enabling, not prescribing.
The takeaway
FASH is more than a protocol—it’s a bridge between syndromic suspicion and actionable evidence in HIV/TB care. With POCUS training, mentorship, and digital infrastructure (ScanOne and ScanHub), frontline providers can shorten diagnostic delays, build durable skills, and generate the data needed to drive health equity.
🔗 Read Marcela Osorio’s full article on the GUSI Blog: https://lnkd.in/e6vfiTCi
Let’s keep building diagnostic equity—together.
If you’re running an HIV/TB program and want to integrate FASH, structured POCUS education, or digital QA pipelines, reach out to the GUSI team. We’ll meet you where you are—and help you scale what works.
