“We are trying to ensure that new TB diagnostic tools are accessible & affordable”

The Foundation for Innovative New Diagnostics (FIND) is working on advancing progress towards ending tuberculosis (TB) epidemic in line with Sustainable Development Goal (SDG) targets set for next one decade. In an exclusive interaction with the BioVoice, Dr Sanjay Sarin, Country Head, FIND India shares the detailed insights on the efforts of his organization. Read on:

In your view, where does India stand currently in its fight against tuberculosis? Are we doing enough?

Over the last few years, India has made significant progress in its efforts on TB control ranging from the introduction and scale up of new and more sensitive TB diagnostic tools, expansion of the program for management of drug resistant TB, introduction of new TB regimens, schemes for the benefit of TB patients as well as renewed efforts to engage the private sector. There is a strong political will and aggressive TB elimination targets backed by increased funding allocation to TB control from the domestic TB budget. India has not only committed to ending TB five years before the global goal of 2030, our country is also taking the lead on critical initiatives such as a national Essential Diagnostics List.

Is the goal of ending TB by 2025 realistic one? Do actions on the ground match with the planning?

There is no doubt that the government has set an ambitious TB elimination target, but it is heartening to see that this ambitious goal is backed by a robust National Strategic Plan. There is an increased operational rigour in the implementation of the national strategic plan, openness to experiment and scale up new TB control strategies, willingness to engage the private sector, strengthening and expansion of TB lab diagnostic capacity and introduction of new anti-TB drugs (like bedaquiline and delaminid), improved efforts to drive patient adherence to TB treatment and ensuring successful treatment outcomes for both drug-sensitive and DR-TB, all of which point towards the fact that the government is committed to its goal of ending TB by 2025.

How is the FIND playing a role in the EndTB campaign and advancing progress towards ending the disease in line with the SDGs? Please share few ground-level experiences during the efforts to contain TB?

FIND has been the lead implementing partner of the RNTCP in its lab strengthening activities. Over the last 8-10 years, FIND has played a pivotal role in the evaluation of at least 5 new and more sensitive WHO approved diagnostic technologies and is generating the much-needed country evidence to enable policy change resulting in the introduction of these technologies into the RNTCP’s national TB diagnostic algorithm. Additionally FIND, through the support of donors like UNITAID, USAID, Global Fund and CDC and in partnership with RNTCP, has been engaged in the downstream implementation of lab strengthening activities resulting in the development of more than 50 culture and DST as well as molecular diagnostic laboratories, establishment of genome sequencing capabilities, design and development of mobile vans equipped with GeneXperts for facilitating active TB case finding.

“At FIND, our immediate priorities in TB are to driving forward the development of tools that can close the case detection gap”

FIND has also contributed towards the improvement of human resources capability by training more than 600 lab personnel over the last 5 years in the use of these advanced TB diagnostic technologies. It has also been implementing a pediatric project through the support of USAID in 10 Indian cities since April 2014. Under this project, we have so far screened more than 80,000 children (0-14 years) using the more sensitive GeneXpert technology as an upfront diagnostic tool. Our work has facilitated a national policy decision mandating the use of GeneXpert as the first line of diagnostics for diagnosing TB in Children under RNTCP.

What do you consider as challenges in the way of eradication of TB in India? How do we overcome these?

The challenges include increasing access to more sensitive diagnostic tools to the population at large at the point of care, reducing loss to treatment follow-up and improving adherence to therapy and subsequent treatment outcomes.
In order to overcome these, it is critical to continue investments in the development and scale-up of new and more sensitive diagnostic tools, introduction of shorter drug regimens and ICT based tools for monitoring adherence to treatment as well as ensuring linkage to social benefit schemes.

Do we have enough funds available for the defined goal? What have been the immediate priorities and long-term goals of your organization?

There are still significant gaps with regards to global TB funding – both in general and for TB research and development. For example, in 2016 funding for product R&D was $726 million. This is only about 30 percent of the nearly 2 billion in annual funding that is needed according to the Global Plan to Stop TB.

At FIND, our immediate priorities in TB are to driving forward the development of tools that can close the case detection gap – currently there are about 4 million people living with TB who have not been diagnosed and notified to health systems – as well as to develop tests that can guide appropriate care decisions for patients with drug-resistant TB. We are also working on tools that enable the delivery of preventative therapy by identifying which cases of latent TB – about a third of the world population has latent TB—are likely to develop into an active form of the disease.

Alongside product development, FIND is working to ensure that new tools are accessible and affordable to those that need them. From this perspective, we are continually refining service delivery strategies in partnership with national governments, as we have been here in India. All of these efforts will be hampered without adequate R&D funding.