Disruptive innovation can root out TB, says India Health Fund CEO

Manoj Kumar talks about his contribution to challenging TB and the use of technology aggregation in it

Manoj Kumar is chief executive officer of the India Health Fund (IHF) and architect of Social Alpha, an initiative to strengthen the science and technology start-up ecosystem in India. He is an alumnus of Harvard Business School and has been an investment banker. He tells Aditi Phadnis about his contribution to challenging TB and the use of technology aggregation in it

India had 2.7 million of the world’s 10 million people diagnosed with the disease in 2017. Some 135,000 had the drug-resistant form of TB, a quarter of the world’s total. Despite so much money poured into TB elimination programmes, why is it so difficult to fight this disease in India?

The approach should be focused not only on funding TB elimination programmes. The annual loss caused by TB to the Indian economy is almost $23.7 billion. There is a need to raise awareness about how deadly TB is. There are several socio-economic factors that make it difficult to eliminate this disease. According to the World Health Organization (WHO), crowded and poorly ventilated living and working environments are often associated with poverty and are direct risk factors in TB transmission. Almost 40 per cent of TB cases are missed by the health systems because of poor accessibility.

Furthermore, the stigma within the TB community acts as a barrier to ending the disease. People do not have correct information about TB, especially that it is an airborne disease and is likely to spread among people living in close proximity.

TB is not just about the disease, it is also because of contributory factors like lack of nutrition, housing, and insanitary conditions. How do we tackle this?

It is important to understand and identify the comorbidities in people diagnosed with TB. There are medical conditions that could be risk factors for TB and lead to poor TB treatment results. According to WHO, people living with HIV are 15-22 times more likely to develop TB than people without HIV. Similarly, the risk of TB among people with diabetes is two-three times higher than among those without diabetes.

Undernutrition is also one of the key determinants of TB. While TB treatment often helps normalise nutritional status, many TB patients are still malnourished at the end of treatment. Nutritional assessment and counselling, and managing malnutrition based on the nutritional status are an important part of TB treatment. For instance, the Revised National Tuberculosis Control Programme (RNTCP) has started the “Nikshya Poshak Yozana” under the National Health Mission (NHM), where a financial incentive of Rs 500 per month is provided for nutritional support to each notified TB patient under treatment.

Steps should be taken to improve working conditions in setting such as factories and prison.

There has been out-of-the-box thinking on tackling TB. Tell us about it.

At the India Health Fund (IHF), we feel that “disruptive innovation” is the need of the hour. The IHF has been fortunate to have worked with innovators who are constantly working on addressing TB. Some of them have used data science and artificial intelligence (AI) and other technologies to create diagnostic kits. For instance, CisGEN Biotech Discoveries has come up with an innovative solution that uses a combination of native and recombinant antigens to detect bovine TB. Qure.ai has used AI and deep learning technology in radiology imaging for quick and accurate diagnosis of TB. Similarly, Valetude Primus Healthcare (VPH) has developed an immuno-magnetic cell capture technology, which can be used at the community level to replace sputum smear microscopy for diagnosing tuberculosis.

The Centre for Health Research and Innovation (CHRI) is creating an ecosystem for faster diagnosis and treatment initiation for TB patients through Molbio’s Truelab Real Time quantitative micro-PCR system and focusing on its execution. Similarly, Innovators in Health (IIH) has started a programme of treating TB by providing health care facilities for communities. They are implementing door-step health care, strengthening public institutions, and empowering women through investing in female community health care workers (CHWs). For improving adherence, Sensedose Technologies has developed the Tuberculosis Monitoring Encouragement Adherence Drive (TMEAD), which is a medicine dispenser that aims at leveraging the power of physical alarm based and digital notification-based reminders to make sure patients never forget to take medicines.

Early diagnosis can help control and eliminate disease. Right now, the most prevalent way of diagnosis is the sputum test. But more sophisticated technologies are available…

An accurate diagnosis of the disease is the first step towards eliminating TB. To speed up this process, India has adopted technologies such as the GeneXpert. Compared to the sputum tests that exist now, GeneXpert is different because it can diagnose a person with TB, and if the TB bacterium has resistance to one of the common TB drugs, Rifampicin. Another tool, the CB-NAAT test, takes nearly 100 minutes as compared to the cultural way of sputum collection, which takes one-eight weeks.

The TrueNat machine, developed by Molbio Diagnostics, helps in rapidly detecting TB bacteria using the polymerase chain reaction (PCR) technique. The machine looks for the DNA specific to TB bacteria. If the machine detects it, it uses PCR to copy (amplify) small segments of DNA and use it for different laboratory procedures. TrueNat can remarkably change TB treatment since it is an indigenous, cost-effective and sensitive device that can detect TB and MDR-TB and give results within an hour while the conventional tests take 24 to 48 hours.

When will your work begin to show results?

The IHF has always recognised and supported new organisations and entrepreneurs who are curating ground-breaking technologies in TB. However, these innovations take four-five years to develop, which is followed by clinical validations, testing, pilots, and regulatory approvals. It is not our aim to rush through the process of innovation but create an innovation that is relevant, validates the need by mapping to a problem area, and can be easily adopted in the country.

A team of scientists and medical practitioners are guiding and mentoring innovators. The IHF is creating a platform for these innovators through mobilising resources and building public-private partnerships.

Experts disagree on whether preventing the disease in the first place, improving housing and nutrition, removing the stigma attached to the disease, facilitating better diagnosis, convincing patients to keep taking medicines, better access to new drugs or developing a TB vaccine are the most important factors to achieve the target. What is your view?

All these need to be given priority. One can execute diagnosing and treatment programmes, but it won’t be efficient without strengthening the socio-economic conditions of the people, especially those of marginalised sections. Clinical programmes and developing strategies for strengthening societal factors are both equally important.

We need corporations, civil society, philanthropists, and individuals to come together and contribute funds. The IHF is designed to act as the aggregation platform for such funds.