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If we accept to end the TB epidemic, we charge reimagine how TB affliction is delivered. Today, this is accessible and achievable.
By. Dr. Madhukar Pai for Nature Microbiology
In his book To Repair The World, Paul Farmer warned us about the bigger claiming in all-around bloom – failures of imagination.
The best acute archetype of this abortion is how we administer tuberculosis. Even today, if you absolved into an boilerplate TB dispensary in an boilerplate aerial TB accountability country, you will see century-old accoutrement actuality acclimated to analyze and amusement the arch communicable analgesic of humanity. The photo collage beneath is fabricated up of absolute pictures that acquaint the story.
Chest radiology, tuberculin bark test, and sputum microscopy are accoutrement that date aback to the backward 1800s, aback antecedents like Wilhelm Rontgen and Robert Koch fabricated battleground discoveries of their era. BCG, the vaccine we use today, dates aback to the 1920s. We still use baneful drugs that accomplish patients deaf, and we still await on paper-based registers to accumulate clue of patients and numbers. It is not hasty that TB continues to annihilate over 1.6 actor bodies every year, and over 10 actor bodies advance the ache annually. If this is not a aggregate abortion of imagination, again I don’t apperceive what is!
In my added time, I adulation to actualize PowerPoint slides on what my dream TB dispensary would attending like. The clear beneath is my ‘dream TB clinic.’
My dream dispensary will accommodate a abundant bigger TB vaccine to anticipate new disease. A recent trial showed affiance for a vaccine applicant called M72/AS01E (GlaxoSmithKline), apparent in the clear above.
For those who advance TB symptoms, we will action a rapid, simple triage test. Efforts are underway to advance rapid, bargain triage tests using biomarkers, while computer-aided software algorithms (which use AI) can now apprehend agenda x-ray images and advice with accelerated screening.
Those with absolute triage analysis after-effects will get a point-of-care atomic diagnosis, followed by acknowledging drug-resistance testing application sequencing. Such accoutrement are already accessible (e.g. TrueNAT MTB by Molbio), or will anon be (e.g. GeneXpert Omniby Cepheid & Q-POC by QuantumDx) for point-of-care testing, while amazing advances are actuality fabricated in sequencing (e.g. MinION by Oxford Nanopore; iSeq by Illumina), which is acceptable added accessible and affordable by the day.
People diagnosed with TB will accept a abbreviate four-month advance of articulate medicines. Such abbreviate regimens (e.g. a dieting called BPaMZ by TB Alliance) are in trials, with agitative aboriginal results. In fact, shorter treatments for abeyant TB infection (e.g. 4 months of rifampicin, and once-weekly isoniazid-rifapentine for 12 weeks) are already available.
Patients will accept admission to agenda technologies that can advice them stick to their analysis plan and acquiesce them to accept absolute allowances or money transfers. Digital adherence technologies (DATs)—which accommodate affection phone–based and smartphone-based technologies (e.g. 99DOTS, SureAdhere Video DOT, Emocha) agenda pillboxes (e.g. Wisepill) and ingestible sensors (e.g. Proteus) —may facilitate added patient-centric approaches for ecology adherence. Call centers will be acclimated to animate patients to complete analysis and to articulation them to accessible services.
A avant-garde TB account will be chargeless of paper. And, acknowledgment to cloud-based advice and advice technologies (e.g. Everwell, Nikshay), TB affairs agents will be able to adviser the catching locally and nationally, as able-bodied as alms patients the alone affliction and abutment they need.
Is this avant-garde TB account an unrealistic dream? I don’t anticipate so. As I accept argued earlier, many such accoutrement and solutions already exist, in some anatomy or appearance (all the images I accept acclimated in the clear aloft are real!). They accept aloof bootless to appear to calm to serve those who charge them the most. And, for some accoutrement such as a bigger vaccine and a beneath biologic therapy, new investments are actively needed.
Yes, developing new accoutrement is activity to amount money — an added US$1.3 billion per year. But if the all-around bloom association can acquisition a way to action Ebola with avant-garde accoutrement and technologies, I see no acumen for the TB acreage to be unambitious.
We can totally science the bits out of TB! The innovations I accept declared appearance that it is possible. My dream dispensary could be up and active aural the abutting brace of years. For that to happen, we charge to adverse our failures of imagination, and be added ambitious.
Photo credits: Many of the images were taken by me. Some were acquired from chargeless online sources, or provided by agencies such as TB Alliance, Aeras, Everwell, SureAdhere, Cepheid, Molbio, Illumina and Oxford Nanopore.
Acknowledgements: This blog column is aggressive by a presentation I was asked to bear at the TB Innovation Summit in New York City, co-hosted by the Stop TB Partnership, Johnson & Johnson, World Economic Forum, UN Foundation, and the All-around Fund to Action AIDS, Tuberculosis and Malaria
Nature & Microbiology | TB conferences – we charge do better
October 25, 2018
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