We reported earlier this month on a new Gates-funded tuberculosis (TB) test that reduces waiting times dramatically and is able to detect fierce drug-resistant strains of the communicable disease. In the story, we raised the concern about potential "bottlenecks" in the implementation and distribution of the test, given that cost concerns, corruption, and bureaucratic management often get in the way of smooth, timely delivery. And just this week, SciDev.net reported on the above-mentioned test and echoed our concerns about how efficiently this much-needed test will actually be transferred over to the hands of doctors and hospitals and those on the ground with the power to actually put the new innovation to use.
The test is a polymerase chain reaction-based test that can detect strains of TB that are notoriously resistant to powerful TB drugs, such as rifampicin. Such tests only detect, not solve, but with detection comes increased awareness and prevention opportunities. But SciDev's reporting echoes the implementation and distribution concerns we raised earlier.
The cost of a machine is around $18,000 and its utilization requires trained personnel, thus pointing to two pivotal challenges. Cost concerns are clear, but requiring trained personnel is an extremely burdensome requirement, implying a need for more funds to train and pay more workers involved.
Born out of a public-private partnership between the diagnostics firm, Cepheid, and the University of Medicine and Dentistry of New Jersey, the TB test performs with great accuracy, detecting about 98% of cases and 97% of the rifampicin-resistance cases. The test is thus a promising fit for a country like India, where TB rates are the highest in the world, but as with many innovations, the potential hiccups may entirely prevent or minimize the groundbreaking results that the tool is meant to generate.
"TB diagnosis and control is complex and improved diagnostic testing is only one small part of the solution," said U.K.-based TB diagnostics consultant, Alexander Yule. "Although the need for a sensitive test is indisputable, a very costly test would mean diversion of already scant resources from other components of TB management."
It will be another month before the WHO decides whether to formally approve the test or not—we just hope they provide some guidelines as to how to overcome the cost, personnel, and distribution challenges. Afterall, what's the use of new innovations if no one benefits from them? Again, we'll be watching the WHO to see how the institution lays out a plan to go from innovation to implementation.