Tuberculosis (TB) is often forgotten as a global health threat, but recent advances in molecular technology have health officials optimistic about the future.
It is estimated that one-sixth of all annual deaths caused by infectious diseases result from TB. The second-largest killer behind HIV/AIDS, the disease kills an estimated 4,000 people a day. Sub-Saharan Africa experiences the worst of it, as the infectious disease is the most common cause of death among HIV-positive people. Estimates say that over 1,000 people with HIV die from TB every day.
One of the biggest problems when it comes to TB is detection. Currently, HIV-associated TB is being detected in only half of the estimated number of people who have it. Another issue that arises is weak healthcare coverage, which places an economic burden on poor people. Additionally, a lack of healthcare coverage has an effect on people’s vulnerability to TB and health outcomes from the disease.
However, progress in the fight against TB has been seen over the past two decades. The TB mortality rate fell between 1990 and 2013 by an estimated 45%. In that time, over 60 million people were cured from the disease and 37 million lives were saved. Most of the success has been attributed to a rise in new technology. In fact, such interventions are said to not only save lives, but to be cost-effective, because for every dollar spent there is an estimated $30-$43 return.
Cepheid Inc., a diagnostics company based in California, created one such revolutionary piece of technology. Dubbed GeneXpert, the automated molecular technology has been said to be one of the most significant achievements in decades in regards to TB research.
The device is more accurate and faster than traditional diagnosis methods, such as the out-of-date smear microscopy, which was created a century ago. GeneXpert works by allowing health workers to place gathered sputum samples in cartridges, which in turn are connected to a computer. As a result, the DNA of TB bacteria can be detected within two hours. The device can also identify multidrug-resistant forms of TB.
In addition to being endorsed by the World Health Organization, it attracted the attention of global donors. Many poured in donations to help distribute it around the world.
In May, a study conducted in India showed that by using GeneXpert, the number of bacteriologically confirmed cases increased by 39%.
The problem with the technology, however, is its expense.
Poor people in the developing world, those who are most likely to need GeneXpert, have trouble getting necessary access to the technology. While donors across the world are taking care of the $17,000 price tag associated with each machine, countries are struggling to pay for the cartridges. Each cartridge costs $10, meaning some countries cannot purchase them on a large scale because of a lack of funds. Additionally, GeneXpert requires access to electricity, computers and refrigeration, a difficulty for many TB-prevalent areas.
Even with some of these issues, health officials are still excited with the recent activity. The creation of GeneXpert, as well as rather large investments in the device, have led to more companies starting to develop diagnostic technologies. The hope is that some of these technologies will eliminate the downsides of GeneXpert. According to a report by UNITAID, a global health initiative, there are currently 81 manufacturers running tests with almost 200 potential new products having to do with TB diagnostics.
One such company is Alere Inc. The diagnostics company, based in Massachusetts, is working on a transportable test that would be powered by batteries, giving it the capability of being used portably for an entire day. With the test being portable, the company says that health workers would then have the ability to decide about treatments on the spot, the same place where the diagnosis was made.
The company, which received a $21.6 million grant from the Bill and Melinda Gates Foundation, is also working to make the costs of its machine and cartridges less expensive than GeneXpert.
While questions still remain, as Alere has yet to run any type of trials on its technology, those devoted to the fight against TB are still hopeful about the future. Through boosted investments and partnerships between public and private sectors, revolutionary technology has, and will continue to, aid the fight against tuberculosis.
– Matt Wotus