Disrupting Global TB Care and Control

Transcription

1 Disrupting Global TB Care and Control Peter Small Rockefeller Foundation Fellow April 12,

2 Disclosures No relevant financial relationships

3 Today s Talk Traditional Approaches to Global Health An Expert s Perspective on Problems A Consumer s Framework to Solve Them Improving the patients pathway to cure Tools Services Implications for the future Disruption 3

4 Traditional Approaches to Global Health Scientist Clinician Public Health Practitioner 4

5 A GH Expert s Perspective on Disease Control 5

6 A GH Expert s Framework: Health Systems Strengthening Building Blocks of HSS

7 A Patient s Perspective on Care

8

9 Pr N op ot er fo ty r R of ep Pr ro es du en ct te io r n Framework: Patient s Pathway to Cure Broken pathway to cure (country specific) Optimal pathway to cure (policy and scale-up) Healthy Healthy Sick X Seek Care X Get Care X Cure Patient time to treatment and cure Sick Innovative tools and services Seek Care Get Care Cure

10 Antiquated and Inadequate Tools DIAGNOSTIC Sputum smear microscopy Discovered 1882 VACCINE BCG Developed 1920s TREATMENT 1st-line TB drugs Discovered

11 Discovery Proof of Principle Development Product R&D and optimization with industry Produc t in box FIND: Foundation for Innovative New Diagnostics Evaluation Regulatory -quality laboratory and field trials Efficacy data CRITICAL PATHWAY Demonstration Large-scale projects measuring the impact of test use in NTPs Effectiveness data Programmatic use Initial Award $ 30,000,000

12 An Imperfect Breakthrough: GeneXpert 2012 Bill & Melinda Gates Foundation 12

13 Critical Diagnostic Issues Growth vs molecular DST Bad POC vs Good Instrumented tests Systems to move patients or samples Single test vs reflex DS testing Diagnosis of incipient disease

14 Critical Drug Issues Standardized vs Individualized therapy Access vs rational use Speed vs Risk in trial design Race against DR

15 Critical Vaccine Issues MVA85A Failed M72/ASO1 with 54% efficacy in difficult trial H4 vaccine quickly achieves an uninterpretable endpoint Do we finally have an immunologic signal and a rapid human trial?

16 Diagnosis and Treatment of Latent TB Lack of gold standard for diagnosis Sensitivity vs Specificity PPD and IGRA Predictive power for active TB 16 gene Risk Signature Clinical trials Heterogeneity biologic plausibility Safety profile Cost

17 The leaky patient pathway to TB cure, India 2013 Source: Subbaraman R, et al, PlosMed Oct 2016

18 Patient Pathway to Care Implications Government focused on public sector Patients seek care in private sector Telling private doctors to refer patients to public isn t working Need: Improve care in the private sector

19 WORKING WITH PRIVATE PROVIDERS How do they think? How to partner? Doing both at scale? Private/ Private missing notification yields incentives & free TB drugs/test Public/ 45% loss Call center issues vouchers & tracks adherence e-vouchers for drugs/tests Private quality of care improvement program Early TB diagnosis & sustained Rx Bill & Melinda Gates Foundation 19

20 WHAT S BEEN ACHIEVED IN INITIAL PRIVATE PILOTS Increase Private Provider Engagement Improve Case Finding India now has digital TB registry that tracks adherence and transfers benefits Use technology to amplify reach & integrate with RNTCP

21 Exponential Technology

22 US Health Care is Being Disrupted US health care is being disrupted from Smart phones Social media AI IOT Gig Economy Blockchain Major trend is AI enabled concierge medicine What about Global TB Care and Control?

23 Who Will Disrupt Global Health? Not Governments, WHO, USAID, BMGF, PATH, PSI or NGOs Private enterprise might Huawei? Telcos? WhatsApp? Apple? Uber? Others???

24 Pr N op ot er fo ty r R of ep Pr ro es du en ct te io r n If I could have just one thing to improve global health

25 Inclusive Business Model for Global Health Care An investable (commercial return on investment) inclusive (help the bottom of the pyramid) business model that improves in health care delivery

26 Impact Investments 100 trillion dollars E.g. Social Impact Bonds But Verification Monetization Limited investors New opportunities Technology can verify Block chains can track Financial markets can buy/sell impact 26

27 In Conclusion: 1. TB is a wily foe and a big problem 2. Perspectives constrain your solutions 3. Innovative products and services help 4. Disruption is coming 1. Business models 2. Investable markets 27

28 How can I do Global Health? 1. Get out in the real world and find a great need 2. Do great science 3. Invent a life saving device 4. Start a company and actually deliver products 5. Understand finance and figure out how poor people can pay for it 6. Learn about policy and create demand 28