Latest news with #POC2025
Scoop
23-06-2025
- Health
- Scoop
Design Health Services Around People, Not The Disease
"We need to design services around people, not the disease," rightly said Dr Nittaya Phanuphak. Unless point-of-care health technologies are deployed for those who are most-in-need in a person-centred and rights-based manner, we would fail to deliver on the promises enshrined in #HealthForAll and SDGs goals and targets. "Point-of-care health technologies sitting in centralised laboratories are as good as centralised, lab-dependent ones - both remain inaccessible to those in acute need," said Shobha Shukla. "But when point-of-care tools are taken and deployed as close as possible to the communities to serve them with equity and human dignity, real change happens." Shobha and Dr Nittaya were speaking at the 2nd Asia Pacific Conference on Point-of-Care Diagnostics for Infectious Diseases (POC 2025) and in lead up to the 13th International AIDS Society Conference on HIV Science (IAS 2025). Dr Nittaya Phanuphak is the Convener of POC 2025; Executive Director of Institute of HIV Research and Innovation (IHRI) and Governing Council member of International AIDS Society (IAS). Shobha leads CNS (Citizen News Service) and Chairs Global Antimicrobial Resistance Media Alliance (GAMA). Community-led models proved same day "test and treat" for HCV is feasible and effective In India's Manipur, Community Network for Empowerment (CoNE) and partners did a path-breaking study to prove that same day "test and treat" is possible, feasible and effective for hepatitis C virus (HCV). They could do so because for the confirmatory test, the sample did not have to go for centralised laboratories but could be tested on WHO recommended point-of-care, decentralised, battery-operated (with solar power recharging capabilities) and laboratory independent multi-disease molecular testing platform, Truenat. So, when confirmatory test Truenat could be deployed closer to the communities, it became possible to screen people, and offer molecular test on Truenat to those who needed a confirmatory test on-spot. Result came back within an hour after which treatment initiation could be followed upon. Giten Khwairakpam, one of the study co-authors who works with amfAR's TREATAsia programme, was speaking at POC 2025. Truenat is made in India by Molbio Diagnostics, is the largest used molecular test for TB in India (and also deployed in over 85 countries globally), and over 9000 machines are deployed by the government (for TB) across India. This study enrolled 643 people (during November 2021 to August 2022) out of which 503 were screened - all were males and had a history of injection drug use. Community people who formerly had a history of injection drug use conducted the screening. 155 people were found to have viraemia, out of which 98% (153) were initiated on treatment on the same day (remaining 2 people also were initiated on treatment soon after). All (100%) completed the treatment. All (100%) those who tested negative were offered vaccination for hepatitis B virus. It is a powerful example from the communities which should inform national and global policies for improving hepatitis responses on the ground - in person-centred manner. Philippines' Bantayan offers another strong example when point-of-care tools are deployed at point-of-need In multiple islets of Bantayan in the northernmost part of Cebu, Philippines, only around one-third of the estimated TB cases could be notified before the pandemic. But after the introduction of new TB screening and diagnostic tools, now almost all the TB (99%) is found in 2024. Dr Samantha Tinsay, government Municipal Health Officer, Bantayan, Cebu, Philippines and her team made a major difference in bridging the gap between TB services and people who were left behind on islets of Bantayan. She took point-of-care and battery operated AI-CAD enabled X-Rays and Truenat (point-of-care, battery-operated, laboratory independent and de-centralised molecular test) - both kept safely in a moulded plastic box - loaded on a pump boat - and went from islet to islet - screening people for TB and offering confirmatory Truenat molecular test on the spot. Within an hour or so, those found with active TB disease were linked to TB treatment care pathway. New TB case notifications, as well as treatment success rate, increased manifold. But the journey was not easy - also due to inclement weather and stormy seas. Dr Samantha's untiring efforts have resulted in a tremendous increase in TB case finding: the number of persons screened for presumptive TB went up from 187 (in 2019) to 2506 (in 2022), 2027 (in 2023), and 5679 people in 2024. 'TB treatment success rate has also increased to 97% in 2023,' she confirmed. Average TB treatment success rate in the Philippines was 78% in 2023 as per the WHO Global TB Report 2024. Imagine the difference it can make in the Philippines' response to end TB if such interventions can be scaled up and become a norm. Dr Darivianca Elliotte Laloo, who has earlier served at the Stop TB Partnership and International Union Against Tuberculosis and Lung Disease (The Union) and currently leads Molbio Diagnostics as General Manager, chaired this session at POC 2025. She said that Truenat, which was validated independently by the Indian Council of Medical Research of the Government of India in 2017, offers PCR molecular testing for over 40 diseases (including current strains of COVID-19). Being WHO recommended battery-operated, laboratory independent, decentralised and point-of-care molecular test for TB with solar power charging capacities, it is increasingly getting deployed in peripheral areas of several high-burden countries now. Largest rollout of Truenat in Africa took place in Nigeria last December. Nigeria is home to largest number of people with TB in Africa. We need to close the gap between people-in-need and point-of-care standard diagnostics by taking services closer to them or at their doorstep, said Dr Laloo. Colossal cost of misdiagnosis on communities Noted #endTB activist Blessina Kumar who leads Global Coalition of TB Advocates (GCTA) shared a powerful real-life testimony of Meera, who survived one of the most serious forms of drug-resistant TB (Extensively Drug-Resistant TB or XDR-TB). If someone had XDR-TB in 2012, there were tools back then too, to test for TB and drug-resistant TB within 100 minutes. And after drug-susceptibility testing (to ensure that TB bacteria is sensitive to medicines used in the therapy), an effective treatment could have helped Meera towards cure. But misdiagnosis caused havoc: She had to endure the rigours of going through TB treatment for six years (2012-2018). She also had to spend around INR 300,000 (~USD 4000) as well which is a grim reminder that delayed or wrong diagnosis often results for catastrophic costs for people in need. She also had to be stay away from her 4 months old son because of TB. TB stigma and discrimination also did not spare her: she was not allowed in the kitchen or living room, and had to use separate utensils and clothes. She not only battled depression but also attempted suicide twice. Experts say that soon after initiation of an effective TB treatment, a person becomes non-infectious. But TB stigma and discrimination still lurks. After 6 years, Meera finally got the right diagnosis and treatment, and could get cured. She advocates for person-centred TB care since then. In 2025, if anyone has XDR-TB or any other form of drug-resistant TB, it should take an hour or two for confirmatory TB test (upfront molecular test) and treatment hopefully will be over in next six-months using the latest WHO recommended regimen - and with full health and social care and support. Imagine the difference it can make if we deploy science-based standard healthcare tools to serve the people where they are in person-centred manner. Inequities and injustices firewall most-in-need people from accessing standard care "It is not lack of TB diagnostic, treatment and prevention tools that are causing human suffering and killing people but inequity and injustices that plague our world. For example, rich nations like Australia could bring down TB rates to elimination level 50 years ago with whatever tools they had. In USA, lab on wheels with X-Rays were going to remote areas to find more TB in 1950s," said Shobha Shukla. "I have myself seen TB pins of 1940s and 1950s that were worn by people in USA to declare that they had taken an X-Ray to screen for TB." But, in the Global South, even after 50-70 years - it is not so common as it should be - to see lab on wheels taking an (AI-CAD enabled) X-Ray and molecular test closer to the unreached people with standard TB services. WHO called upon all governments in 2018 to replace microscopy with 100% upfront molecular testing for TB by 2027. All world leaders agreed to do so too in their Political Declaration of United Nations General Assembly High-Level Meeting on TB 2023. Despite this, out of those who got diagnosed, more than half (52%) did not get upfront molecular test in 2023 – rather they got microscopy or were not bacteriologically confirmed at all. Most of them would be in the Global South, wonders Shobha. "Early and accurate diagnostics is the ONLY entry-gate towards TB treatment care pathway. It reduces catastrophic costs faced by the most vulnerable, reduces avoidable human suffering and risk of TB death and helps stop the spread of TB infection," she said. 100 days campaign in India heralds a foundational shift on how we find TB based on science and evidence India's TB Prevalence Survey 2019-2021 showed that almost half of TB patients were asymptomatic. The Indian govt-led 100 days campaign from 7 December 2024 to 24 March 2025 was launched in 347 most affected districts to screen everyone regardless of symptoms among high-risk populations, including homeless and migrants. After 24 March 2025, given the impact, it was expanded to all 806 districts nationwide. As per government's concept note of 100 days campaign, vans were to go closer to high-risk groups with Artificial Intelligence Computer-Aided Detection (AI-CAD) enabled portable X-rays, Truenat molecular test machines for sputum testing, and other tests as required. 129.7 million people were screened and over 285,000 asymptomatic people with active TB disease were found – all of whom would have been missed if AI-CAD enabled X-ray was not done. "Imagine the public health impact of stopping TB spread, reducing human suffering and putting an additional nearly 300,000 to path of healing perhaps," said Shobha. Walk-the-talk on multi-disease elimination approach "As WHO multi-disease elimination approach is being finalised, we need to recognise that we have a lot of under-utilised multi-disease tools which we use for TB only. Truenat offers molecular testing for over 40 diseases. Likewise, artificial intelligence we use for TB detection, such as DeepTek's Genki and QureAI, both screen people within seconds for a number of diseases (DeepTek's Genki screens for more: 26 pathologies)," said Shobha. "Let us be responsible and fully optimally utilise diagnostic infra we have at point-of-need and scale them up too. It helps with pandemic prevention, preparedness and response too." And with regards to TB, follow the science – screen everyone in high-risk settings in people-centred manner. Bobby Ramakant – CNS (Citizen News Service) (Bobby Ramakant is part of CNS (Citizen News Service) and a World Health Organization (WHO) Director General's WNTD Award 2008. He is also on the Board of Global AMR Media Alliance (GAMA) and Asia Pacific Media Alliance for Health and Development (APCAT Media). Follow him on X: @bobbyramakant)
Scoop
22-05-2025
- Health
- Scoop
Point-Of-Care Health Technologies Make A Difference When Deployed At Point-Of-Needjob
Article – CNS Based on scientific evidence, World Health Organization (WHO) guidelines of 2021 endorsed the use of AI-CAD based TB screening (without immediate need of a radiologists interpretation) and offering upfront molecular testing to all those with presumptive … Vaccines (sitting on a shelf) do not save lives, but vaccination does. Only when people can access vaccines and get vaccinated in a people-centred manner, can we yield desired public health outcomes. Same goes for medicines or diagnostics or other disease prevention tools. 'Unless best of health technologies reach those who are most underserved and need them most, how will we reduce human suffering and avert untimely deaths? Technologies must be made to serve those who need them most. If health technologies cannot be deployed in resource-constrained settings, then they would remain inaccessible to those in acute need. Point-of-care technologies are not enough, we need to deploy them too at point-of-need,' said Tariro Kutadza, a noted community rights activist and defender from Zimbabwe. Tariro Kutadza leads TB People (Zimbabwe) and also supports Zimbabwe Network of People living with HIV. 'Yes, we can end TB by bringing diagnostics and other lifesaving services at people's doorsteps!' She was speaking with CNS ahead of 2nd Asia Pacific Conference on Point of Care Diagnostics for Infectious Diseases (POC 2025), Thailand; 10th Asia-Pacific AIDS & Co-Infections Conference (APACC 2025); and 13th International AIDS Society Conference on HIV Science (IAS 2025), Rwanda. Follow the science to serve the people 'Recent studies show that up to 50% of new TB cases would not have been diagnosed with TB symptom screening as they had no symptoms at the time of TB screening and diagnosis. These were diagnosed when an X-Ray was done and upfront molecular confirmatory test was offered,' said Dr Soumya Swaminathan, Principal Advisor of National TB Elimination Programme, Ministry of Health and Family Welfare, Government of India. Dr Soumya earlier served as Chief Scientist of World Health Organization (WHO) and Director General of Indian Council of Medical Research (ICMR). India's National TB Prevalence Survey (2019-2021) showed that 43% of those diagnosed with TB would have been missed if X-Ray was not done, as they were asymptomatic at the time of diagnosis. Similar findings came from several other TB prevalence surveys at sub-national level such as those in the states of Tamil Nadu and Gujarat. If we can find people with active TB lung disease early on (such as when they are asymptomatic) then we can offer them the best of TB treatments. This will not only save lives but also prevent transmission of the disease as TB stops spreading within days of initiation of effective treatment therapy. So, finding TB early on remains critical if we want to stop the spread of infection and reduce human suffering and risk of TB death. 'We will not pick TB cases earlier with TB symptom screening alone. As till recently, our TB programme was based entirely on symptom screening, so straight away we were missing ~50% of active TB in the population,' said Dr Swaminathan. Vietnam had done a study over a decade back which showed that when a TB molecular test was offered population-wide (regardless of symptoms) consistently and those found with active TB disease were linked to TB care pathway, TB rates dropped by over 70% in a 4-years period. Almost 50 years back, Australia and other richer nations could test everyone (regardless of TB symptoms) and link those with TB to care pathway and bring TB rates down to elimination levels within a span of few years. Based on scientific evidence, World Health Organization (WHO) guidelines of 2021 endorsed the use of AI-CAD based TB screening (without immediate need of a radiologist's interpretation) and offering upfront molecular testing to all those with presumptive TB. This was game-changing because now trained healthcare workers with handheld, ultraportable, battery-operated and AI-CAD enabled tools can go to far and remote areas – closer to the communities or even literally at their doorsteps, and screen people for TB. Foundational shift based on science to find more TB in India Based on growing scientific evidence, Indian government made a foundational shift on how it finds TB. From TB symptomatic screening, India moved to science-backed approach of screening everyone in high-risk populations (regardless of symptoms), offer upfront molecular testing (as far as possible) and linkage to care pathway, said Professor (Dr) Urvashi B Singh, Deputy Director General of Central TB Division, Ministry of Health and Family Welfare, Government of India. She is a widely recognised TB scientist and microbiologist and has served at India's most prestigious and highest ranked public tertiary care hospital and medical college: All India Institute of Medical Sciences (AIIMS) Delhi. She stressed upon research. 'Research for validating new tools, designing new tools and relying on Made-in-India tools for screening and diagnosing TB and not depending on the outside, has made a phenomenal difference.' 'This was a global first where India offered WHO recommended X-Ray screening for TB to key and other vulnerable populations, not only to those who were TB symptomatic, but also to those who were asymptomatic,' said Dr Singh. When point-of-care tools are deployed at point-of-need, impact happens India launched a massive 100-days campaign (7 December 2024 to 24 March 2025) to screen everyone among high-risk populations of 347 districts with ultraportable and handheld X-Rays which were powered with artificial intelligence (AI) computer-aided detection (CAD) of TB capacities (as far as possible). The concept note of this campaign on a government website states that those with presumptive TB should be offered an upfront WHO recommended molecular test Truenat. Truenat is a point-of-care, decentralised, battery-operated, and laboratory independent molecular test for TB. The concept note of 100 days campaign states that point-of-care screening tool (X-Ray) and diagnostic test (Truenat) should be taken in a 'Nikshay Vahan' van to point-of-need where high-risk populations reside. In a span of 100 days, India could screen over 120 million people across the country from high-risk groups. More importantly, India found 285,000 people with active TB disease who had no symptoms (asymptomatic or sub-clinical TB). These people would not have been found with TB disease if an X-Ray was not done. Imagine the public health impact of finding 285,000 asymptomatic people with TB disease early on, and putting them on effective treatment – so that not only infection stops spreading to others but also they get on the path of healing and recovery. Now, after 24 March 2025, India has expanded this campaign nationwide. 'We were the first country to actually position Indian indigenous technology (Truenat) to support the Gene Xpert molecular test. The investment and support by the government and agencies like Indian Council of Medical Research (ICMR) was important in the initial days when the test (Truenat) was being standardised and undergoing multicentric validations, and then it was poised for the programme to adopt it. Based on evidence, Indian government's National TB Elimination Programme adopted Truenat in 2018. Today India has a network of over 9000 NAAT systems across the country – deployed at the level of primary health centres, community health centres and even at the block levels,' said Dr Singh. Developing, standardising and validating made-in-India health technologies and deploying them 'is about making the country self-reliant,' said Dr Singh. 'Today, Truenat is in fact, getting exported to 82 countries. So, that is where our Indian indigenous technology, which was supported by ICMR, has reached.' Truenat is made by Molbio Diagnostics. Develop health technologies that are user friendly and deployable for most in need Sriram Natarajan is credited for developing the first point-of-care malaria rapid test over three decades ago. Sriram co-founded Molbio Diagnostics, whose flagship molecular test, Truenat, is already making a big difference in reaching the unreached populations in several low- and middle-countries worldwide. 'We wanted to create a technology which can go down to the grassroots. At the time when we began working on this technology, most of the molecular testing was very heavily centralised. So, it never became a clinically relevant tool because the turnaround time for the results used to be anywhere from 3 days to 1 week and no doctor physician would wait that long to start treating a patient,' said Natarajan. Also, such centralised technologies were accessible to only a few, and from a public health point of view longer turnaround time for the reports was undesirable. When Natarajan and team began working on developing Truenat (almost 20-25 years ago), there were less than a dozen bio-safely level 3 laboratories with centralised molecular test facilities available in India. In 2025, ~9000 Truenat molecular tests are deployed at primary healthcare or block level across the country (and in 82 other nations globally). Truenat is not only deployable in remote settings but the test report too comes in around an hour. 'That is why we worked hard to decentralise molecular testing with a test that can be taken to the community or primary healthcare level. Development of Truenat was completely a grassroot-up kind of an innovation. We had to see the real problems on the ground to build a product that can help bridge the gap. It took us about almost 14 years to come up with a final solution. It is a long grinding story as it requires a lot of grit, conviction and money,' says Natarajan while reflecting on Truenat's journey over the past two decades. 'We did everything we could because we believed deep within that the end was going to be very important and impactful.' 'Scaling up Truenat's deployment was also not that easy. We got a lot of support from the Indian government. Scientist and microbiologist Dr Urvashi B Singh supported us from a very early stage when she helped us with all the validations. ICMR came forward and did a very large study for us (completely paid by the government of India) to further generate the scientific evidence. Gates Foundation funded the global validation process for Truenat. This support was very crucial without which probably we would not be where we are today,' he shared. Point-of-care tool at point-of-need for multiple disease testing 'We developed Truenat as a multi-disease testing platform. We started focussing on TB testing because that is where we saw an immediate need and because every country was committed to end TB by 2030. Just before the COVID-19 pandemic, we had supplied about 1,500 Truenat machines to the Indian government's national TB elimination programme. So, when COVID-19 pandemic happened, and ICMR validated Truenat for COVID-19 testing, all Truenat machines of TB programme were deployed for COVID-19 testing. This speaks volumes for the impact technologies like Truenat can have in terms of pandemic preparedness,' said Sriram Natarajan. As of April 2025, Truenat can test 26 different pathogens on the same machine. 'As a company, Molbio Diagnostics is committed to health for all and trying to make sure everybody has access to essential health services with equity. Our full-time commitment is to ensure that our platforms become more user-friendly, deployable for the most in need, and also more affordable,' said Natarajan. Point-of-care health technologies must be fully utilised too While countries in the Global South deploy point-of-care health technologies at point-of-need, it is also important to ensure that these are optimally and fully utilised. 'If you look at any resource constraint country, it is sad to see that it is not a problem of less, it is a problem of more. We have a lot of tools and equipment available but when we do a capacity utilisation exercise, we find that most of these tools are hardly 10% to 30% utilised. So, why are these not utilised 100% when resources are constrained?' said Dr Sarabjit Chadha, FIND's Director for Asian region. Dr Singh also referred to this: 'When we did a diagnostic network optimisation, we found we have more than 3000 surplus NAAT tests available in Delhi alone.' All experts quoted above were addressing sessions of World Health Summit Regional Meeting in Delhi, India. All governments have promised to end TB by 2030. With only 66 months left to deliver on the target, the urgency must drive science-based health responses to keep the promise and end TB. Shobha Shukla – CNS (Citizen News Service) (Shobha Shukla is the award-winning founding Managing Editor and Executive Director of CNS (Citizen News Service) and is a feminist, health and development justice advocate. She is a former senior Physics faculty of prestigious Loreto Convent College and current Coordinator of Asia Pacific Regional Media Alliance for Health and Development (APCAT Media) and Chairperson of Global AMR Media Alliance (GAMA received AMR One Health Emerging Leaders and Outstanding Talents Award 2024). She also coordinates SHE & Rights initiative (Sexual health with equity & rights). Follow her on Twitter @shobha1shukla or read her writings here
