While medication treats an ailment, it is the rapid diagnosis of the ailment that is critical to saving many lives. With the rising rate of antibiotic-resistant infections, the need to diagnose quickly and correctly to facilitate accurate choice of medication has grown exponentially. The rapid diagnosis issue is compounded in resource-poor settings that are mired with lack of easy access to affordable healthcare and infrastructure.
Consider the example of tuberculosis (TB), a deadly infectious disease that can take up to six months or more to treat completely. In 2013, there were more than nine million new cases of TB. Most of these occurred in Africa and Asia. The standard-of-care diagnostic, a sputum smear, is slow and can take multiple health visits, which many people can ill afford. Additionally, the sensitivity of the test is variable and is worse when the patient is HIV positive, which almost 13 percent of TB patients are.
Now multiple-drug resistant TB (MDR-TB) infections, where most of the available antibiotics are no longer effective, are a huge concern. MDR-TB develops because of the incorrect use of antibiotics. The more rapidly TB is diagnosed and the more often correct treatment is prescribed, the less the incidence of MDR-TB and the less the chance of it spreading. As the ceiling of new antibiotic development is being pushed, drug-resistant infections urgently need to be controlled.
Rapid and accurate diagnosis is a necessity not just for TB but for everything ranging from malaria to diabetes. Both academics and the industry are hard at work to develop techniques that can provide results in a matter of hours. Some, especially those related to telemedicine like new iPhone blood glucose testing, can do this from the convenience of one’s home. However, the real conundrum has been how to make this cheap to manufacture, affordable to buy for resource-poor populations who need it and easy to use when there is no infrastructure in place.
Diagnostics For All is a nonprofit organization that aims to produce technology particularly for the 60 percent of the developing world that lack easy access to healthcare. Its projects range from a simple, easy-to-use liver function test to monitor the efficacy of HIV anti-retroviral therapy, to detecting micronutrient levels in children so that appropriate nutritional supplements can be provided. Its systems are based on a patterned paper technology developed at Harvard University. Since the paper takes up the test sample easily and micro channels made on the paper allow the sample to flow into tiny wells of chemical indicators, there is no need for any external power. The indicator changes color based on a component in the sample, allowing an easy read out. The patterned paper can be manufactured cheaply on large scale. Diagnostics For All supports its work with philanthropic grants and partnerships with the for-profit sector.
Foundation for Innovative New Diagnostics (FIND) is another international nonprofit organization that builds partnerships with enterprises and assists in developing novel diagnostic techniques through expertise and capacity building. It supports the discovery and scale-up of diagnostic tools bridging the gap between development and delivery, and ensures that these technologies are made available to high-burden countries at preferential pricing. It has developed several techniques among which are an HIV viral load detection system co-developed with California based, Cepheid and malaria and sleeping sickness diagnosis methods with Massachusetts based, Alere.
There are several other organizations out there, including those making strides in telemedicine, that are working to make diagnosis faster, cheaper and more accurate. As science makes progresses towards developing these new techniques, markets, nonprofit and for-profit business models, and governments all have to play their part in keeping up with strides being made and ensuring that these new methods are realized in practice.
– Mithila Rajagopal