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Global Landscape of IVDs
Rosanna W Peeling Professor and Chair, Diagnostic Research
London School of Hygiene & Tropical Medicine
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• Lack of access
Although high-quality diagnostics are available for many infectious diseases, they are neither affordable nor accessible to patients in the developing world
• Lack of regulatory oversight Tests are often sold and used without evidence of effectiveness,
discouraging companies with quality products from competing
• Lack of quality standards for test evaluations Claimed accuracy on product inserts often misleading
• Lack of investment Little industry interest in developing quality diagnostics for
diseases prevalent in the developing world, due to a perceived lack of return for investment. Fragmented landscape, no coordination.
Diagnostics Landscape in the Developing World
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• Lack of access
Although high-quality diagnostics are available for many infectious diseases, they are neither affordable nor accessible to patients in the developing world
• Lack of regulatory oversight Tests are often sold and used without evidence of effectiveness,
discouraging companies with quality products from competing
• Lack of quality standards for test evaluations Claimed accuracy on product inserts often misleading
• Lack of investment Little industry interest in developing quality diagnostics for
diseases prevalent in the developing world, due to a perceived lack of return for investment, and lack of investment by MOHs
Diagnostics Landscape in the Developing World
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The 2004 Health Development Report cited the lack of access and unaffordability as two major reasons why services fail
Distance to Nearest Medical Facility for
the Poorest 5th of the population:
Country Distance (km)
Benin 7.5
Bolivia 11.8
Chad 22.9
Haiti 8.0
Madagascar 15.5
Niger 26.9
Tanzania 4.7
Uganda 4.7
Zimbabwe 8.6
Selected from the 2004 World Health Report, p.22
Affordable Access to Diagnostics
% treated
Pregnant women with syphilis
% who access ANC
% who access ANC early in pregnancy
% given test results
% tested for syphilis
75%
50%
25%
18%
15%
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HAITI: >300,000 screened
CHINA: >8,000 screened
TANZANIA: 58,249 screened, 6% +
ZAMBIA: 11,460 screened, 9.2%+
BRAZIL: 45,971 screened, 1.3% syphilis +
PERU: 15,985 screened, 0.9% +
UGANDA: 13,131 screened, 5.3% +
> 440,000 screened for syphilis in 7
countries using rapid tests
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Screening for HIV and Syphilis in Amazonas, Brazil
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Rapid Test Project in Brazil
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HIV/AIDS Global Targets
• Place 15 million people on ART
• Reduce TB deaths among PLHIV by 50%
• Eliminate new HIV infections in children
• Intensify HIV prevention
United Nations General Assembly High Level Meeting on AIDS, 2011
Investments of at least US$
22 billion are needed by 2015
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Progress of estimated ART coverage in low- and middle-
income countries (2003-2010)
3 000 000
6 000 000
9 000 000
12 000 000
15 000 000
2003 2004 2005 2006 2007 2008 2009 2010
PL
HIV
in
need
of
AR
T
Treatment gap
Receiving antiretroviral therapy
Estimated gap: patients with CD4 cell
count ≤ 350/mm3 but not on ART
Patients receiving ART
47%
3%
WHO, 2011
53%
97%
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• Lack of access
Although high-quality diagnostics are available for many infectious diseases, they are neither affordable nor accessible to patients in the developing world
• Lack of regulatory oversight Tests are often sold and used without evidence of effectiveness,
discouraging companies with quality products from competing
• Lack of quality standards for test evaluations Claimed accuracy on product inserts often misleading
• Lack of investment Little industry interest in developing quality diagnostics for
diseases prevalent in the developing world, due to a perceived lack of return for investment, and lack of investment by MOHs
Diagnostics Landscape in the Developing World
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Lack of Regulatory Oversight for Diagnostics
In Vitro Diagnostic Devices
Regulated
No
52%
Yes
48%
Yes No
In Vitro Diagnostic Devices Regulation By
Region
No 11 9 5 2 2 15
Yes 4 9 4 14 3 7
AFRO AMRO EMRO EURO SEARO WPRO
WHO/TDR survey 2002
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Regulation of In-vitro Diagnostics: Top 10 Challenges
1. Regulatory landscape highly variable
2. Approval process lengthy, especially for imported tests
3. Path to approval is not transparent
4. Most approval process lack quality standards
5. Clinical trials often not required or lack rigour
6. Limited success with standardisation and harmonization in spite of global efforts
7. Tests are sold and used in the developing world without evidence of effectiveness
8. Companies with quality tests unable or unwilling to compete in market flooded with low quality tests
9. Cost of regulatory approval pass onto end-users
10. Companies often do not bother registering in small countries or countries with small markets because of lack of return for investment
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• Lack of access
Although high-quality diagnostics are available for many infectious diseases, they are neither affordable nor accessible to patients in the developing world
• Lack of regulatory oversight Tests are often sold and used without evidence of effectiveness,
discouraging companies with quality products from competing
• Lack of quality standards for test evaluations Claimed accuracy on product inserts often misleading
• Lack of investment Little industry interest in developing quality diagnostics for
diseases prevalent in the developing world, due to a perceived lack of return for investment, and lack of investment by MOHs
Diagnostics Landscape in the Developing World
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Performance of Dengue IgM Rapid Tests
Accuracy (%)
Test Sens Spec
Core 100 100
Diazyme NS NS
Globalemed 80 >99
Minerva NS NS
PanBio 70 100
Standard 93 100
Tulip 100 100
Manufacturers’ claims
Accuracy (%)
Sens Spec
23 99
18 98
63 69
9 100
65 98
22 99
6 99
WHO evaluation
Blacksell et al. Clin Infect Dis 2006;42:1127
NS = not stated
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• Lack of access
Although high-quality diagnostics are available for many infectious diseases, they are neither affordable nor accessible to patients in the developing world
• Lack of regulatory oversight Tests are often sold and used without evidence of effectiveness,
discouraging companies with quality products from competing
• Lack of quality standards for test evaluations Claimed accuracy on product inserts often misleading
• Lack of investment Little industry interest in developing quality diagnostics for
diseases prevalent in the developing world, due to a perceived lack of return for investment, and lack of investment by MOHs
Diagnostics Landscape in the Developing World
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Diagnostic Targets
Product Prototype
Lab & field evaluations
Test adoption
Policy and guidelines for use
Proof of Principle
Technology platform
Bench-to-Bedside Pathway for Diagnostics R&D: Fragmented Landscape, Lack of Coordination & Synergy
Regulatory Approval: 2-5 years
Valley of Death:
Target Product Profile
Policy & Uptake 5-7 years
R & D: 2-10 years; $ 10-100 million
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5 20 80 500-1000 Samples per shift
Xpert MTB/RIF
GeneXpert: A multi-disease, Random Access Platform based on Real-time PCR
MTB/RIF CT/Ng HIV Viral Load
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How many TB patients will die waiting for an affordable and effective diagnostic test?
WHO estimates:
• 9.27 million new cases in 2007
• 1.8 million deaths a year
• Up to 50 million are infected with drug-
resistant forms of M. tuberculosis
(MDR-TB)
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What is on the Horizon?
– capture key health metrics and diagnose 15 diseases
– Maximum weight 2.2 kg
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23
POC Dx Initiative Goals
• Develop an open point of care instrument platform capable of delivering optimum performance
• Establish interoperability standards to encourage menu expansion by competing companies/sources
• Reduce barriers to entry into global health markets by eliminating the need for expensive instrument development
• Achieve a harmonized regulatory environment
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24
Bill & Melinda Gates Foundation- Grand Challenges Canada
POC DX Platform Options
24
Platform 1 Platform 2 Platform 3
TB TB HIV HIV Malaria Malaria Fever Fever
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North-South innovation networks
Training fellowships
African Network for Drug and Diagnostic Innovation: Fostering
DEC-led Product Development
ANDI promotes:
•capacity/infrastructure building
•coordinated & result-driven effort
•leveraging existing activities
•generation & management of IP
•public-private partnership
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Technology Transfer and Local Production: Dual Path
Technology: HCV/HIV/Syphilis Assays
HCV, HIV and Syphilis Test
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Readers: Linking POC Testing Results to Surveillance
Facilities in Health Care
System
National/regional Surveillance
Data Aggregation
Monitoring trends & Impact of
interventions
Evidence for interventions/ policy change
Diagnostic Testing
Data Capture
Linkage to Care
& Treatment
Monitoring quality &
Supply Chains
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Diagnostic Targets
Product Prototype
Lab & field evaluations
Test adoption
Policy &
Guidelines
Proof of Principle
Technology platform
The 3Rs of Partnerships for Affordable Access
Regulatory Harmonization
Shared Rewards
Product Specifications
Shared Resources
Shared Risks
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Advanced Course in Diagnostics Annecy France, Sept 2011
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Summary • Access to affordable IVDs are urgently needed to improve global health
and save lives
• Need to maximize the potential of the next generation of diagnostic
technologies to develop innovative models of service delivery to
achieve global health targets
• Connectivity from diagnostic equipment/readers can link test results to
central databases for surveillance and monitoring quality and supply
chains
• Need to have a platform for communications and synergies between
public private efforts at test development, to shorten time to market by
streamlining and harmonizing regulatory approval processes, and to
maintain quality standards of health products
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Global Health Diagnostics
www.globalhealthdiagnostics.org
Open Access Forum for: • Sharing information • Enhancing collaboration • Promoting best practice • e-learning
E-communities: • Discussion rooms • Workspaces
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Thank you!