Recovery from the Tuberculosis Crisis

Dr Peter Small, Chief Medical Officer, Hyfe, explains why the G20 must bring the urgency and digital technology of the COVID-19 response to fight TB.

Recently, I had the privilege of addressing the participants of the G20 Summit in Indonesia at their health meeting about tuberculosis. This was an important event given that G20 countries account for around half of the global TB burden. These countries also have an even higher percentage of opportunities and responsibilities in the global fight against TB. The G20 is uniquely positioned to shape and scale transformational data-driven digital solutions in their countries and ensure these solutions are made available to the rest of the world.

Looking at the current sad situation with TB, it’s easy to forget that 2019 was a golden year in which new tools and increased financial commitments showed that TB could be solved. A comprehensive assessment by a Lancet commission has once again shown that TB diagnosis and treatment are the most cost-effective interventions of any disease studied. For every dollar invested in TB treatment, there was an estimated $24 return in benefits. Realizing these returns on investment had become even more likely because the TB community was beginning to embrace the use of better data and pilot a variety of digital tools to improve the quality and cost-effectiveness of TB care.

For example, using AI to read chest x-rays and identify tuberculosis has been shown to significantly improve screening and triage. Evaluations from the Stop TB Partnership and others have clearly shown that AI outperforms radiologists. Based on this evidence, the World Health Organization has recommended automated X-rays for tuberculosis screening and triage.

It was also revealed that the ability to digitally connect molecular diagnostic instruments to software like Aspect and DataToCare could better link diagnosis to care and in doing so, speed up testing, reduce stock-outs and increase trust between providers. laboratories and programs. Mobile apps have been developed to help frontline healthcare workers and empower communities. DiMagi’s CommCare enabled local developers to quickly create custom mobile software that improved the quality and efficiency of frontline workers. OneImpact, developed by the Stop TB Partnership, Dure Technologies and TB communities collects, analyzes and acts in real time to identify and remove barriers to accessing TB care.

Digital compliance technology has been introduced to help patients take their medications. Technology such as Wisepill’s and video observation therapy providers have also helped foster a global shift in the mindset of TB programs towards a more patient-centered model of care. TB REACH has shown digital membership technology to be feasible, acceptable and impactful.

TB programs have started using digital approaches to integrate and improve service delivery. Everwell Health Solutions supported India‘s TB program to develop, deploy and scale a national data system. By enabling real-time dashboards, integrating government payments with patient banks, and integrating this with both public and private healthcare delivery, Nikshay has improved the speed of national data from months to minutes.

Despite all of this, TB care and control around the world is currently in crisis. COVID has had devastating effects on all aspects of global health, but TB services have been disproportionately affected. Over the past two years, the number of undiagnosed and untreated tuberculosis cases has skyrocketed. And for the first time in a decade, mortality from tuberculosis has increased.

They say that with the right perspective, crises are opportunities in disguise. The silver lining of COVID is that the G-20 has clearly shown how quickly a health system can muster a response to a health threat if the power of digital and health data is embraced.

At the heart of the COVID response was the use of digital tools such as Praekelt’s HealthConnect and WhatsApp. When combined, these platforms have enabled early detection, mapping, and management of patient care while increasing patient empowerment through self-triage and diagnostic tools. Together, these digital systems have improved resource allocation, patient care, contact tracing and infection control. This simply could not have happened without the adoption of cell phones, the power of digital data and advanced technology.

COVID has shown us the impact of patient empowerment and how people can and will self-test. TB programs need to double down on trends and technologies for patient empowerment, remote patient monitoring, and care delivery in patients’ homes.

TB programs need to be better integrated into mobile phone apps used by community health workers to engage all providers to consider TB when treating chronic cough and perform the correct assessments. Perhaps we can even achieve the holy grail of integrating TB screening and case finding into primary health care. Public health dashboards that have been developed for COVID should be expanded to include event-generated TB data, such as that from AI-enabled CXR machines and connected diagnostic instruments.

By embracing digital technology, TB care and control can hitch its wagon to the exponential engine of global innovation. One such innovation, whose potential has gone completely untapped, is ambient sound, which can help us understand, diagnose, treat and monitor health conditions. The ubiquity of smartphones is spawning the new field of acoustic epidemiology, which is the use of sound to understand disease distribution and control.

After a career as an academic and philanthropic funder, I recently left the public sector to join Hyfe, a small start-up whose ambition is nothing less than to change the way the world manages the cough. The current approach to coughing is rather pathetic. Cough is essential for identifying, diagnosing and treating TB patients, yet we do not measure it. Working with the Gates Foundation and Global Health Labs, Hyfe has created an app that anyone in the world with a smartphone can download and use for free.

This application allows patients to monitor their cough while maintaining their privacy in a passive and discreet way. This technology will help individuals quantify their cough, know if their TB is resolving with treatment, and quickly recognize if their treatment is failing.

Several multinational research teams are also working on technology that can help diagnose tuberculosis based on the sound of coughing alone. If this happens, imagine a world in which anyone with a phone can diagnose their own TB. Hyfe isn’t alone in believing mobile phones will become the workhorse of global health and his cough app is just one of thousands of digital technologies in development that have the potential to to help solve the problem of tuberculosis.

This path is not without obstacles, but the G-20 is uniquely positioned to overcome them. A recent study by Stop TB and the Global Fund showed that countries have the ambition to go digital, but many will need significant technical and financial support.

We must call on the G-20 to bring the same sense of urgency and focus on data and digital technology demonstrated during the pandemic to other global health threats, starting with tuberculosis. Failure to do so will perpetuate chaotic and inefficient spreads of non-impacting technology and ultimately cost billions of dollars and millions of preventable deaths. With the leadership and strategic funding of the G-20, we can move TB from crisis to exponential progress.

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