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Kampala, 22 Oct 2012 Ajay Thirumala MDR TB Diagnostics.

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Presentation on theme: "Kampala, 22 Oct 2012 Ajay Thirumala MDR TB Diagnostics."— Presentation transcript:

1 Kampala, 22 Oct 2012 Ajay Thirumala MDR TB Diagnostics

2 Our strategy 1.Accelerate diagnostic innovation along a value chain: ISO certification for project management and clinical trials. (Focus: TB, Malaria and HAT) 2.Leverage investment against preferential prices for low and middle income countries. (Affordable) 3.Strengthen Local Laboratory facilities to ensure new technologies are Accessible to everyone (Focus: Public Health Facilities). 4.Produce Development Partnership: Build and sustain effective partnerships- currently 200 active partners in 61 countries.

3 The impact of diagnostics  Reduced disease transmission  Effective disease control, including DRTB  Decreased morbidity/mortality  Credible health system Tuberculosis The slow path to diagnosis for patients with cough: Grzybowski, et al. Bull Int Un Tuberc 1975;50:90 More and more slow path: Drug resistant TB detection and treatment

4 TB Malaria HAT / OND Liquid culture; rapid speciation Line probe assay LED-based fluorescence microscopy Automated NAAT (Xpert MTB/RIF) RDT product testingBlood transfer device mAECT production in DRC Rapid screening test prototype developed Implementation of WHO endorsed tests and capacity building Round Round 2 Round 3 Key advancements in the diagnostics - FIND’s role Implementation support (training, job-aids, SMS reporting) LED-based fluorescence microscopy

5 Pipeline for New Diagnostics for TB and MDR-TB, July 2012

6 Drug resistant TB Multidrug resistance- MDR TB –Isoniazid and Rifampicin Extensively drug-resistance- XDR –MDR + fluoroquinolones and at least one of injectables: amikacin, capreomycin or kanamycin MDR-TB*: Uganda

7 Expandx TB Project Overall grant (GLI, GDF, FIND): 90.5 Mio (incl. 2 Mio for Xp) Funding for FIND: 21.2 Mio (including 1.5 Mio OGAC) Duration: Dec Dec 2013 Project goal: Expand access to MDR-TB dx in 27 countries Key deliverables: Identify 129,000 MDR cases; Impact market dynamics (price, # suppliers) Progress: –MOUs with 22/27 countries –Initial assessments for 24/27 countries –>10,000 MDR-TB patients diagnosed by end 2011

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9 Expandx TB Uganda July: MOU with Min. of Health, Uganda July: 1 st Lab Assessment – GLI-FIND combined Sep/Oct: Civil work initiated at Mulago Referral Hospital for point-of-care MDR-TB lab May: New diagnostic equipment installation at the Lab 2011 July-Sep- Standardization of technology, trainings and orientations to staff 2011 Nov- Lab started testing for patients; and is provided 5 start SLAMTA accreditation as part of NTRL

10 Civil works - Ward 5&6-Mulago Hospital, NTRL, Kampala, UGANDA Main entrance Ramp

11 Equipment installation The Republic of Uganda MINISTRY OF HEALTH

12 Lab showing air-extraction ducts The Republic of Uganda MINISTRY OF HEALTH Tuberculosis Rapid Diagnostics Lab at Mulago

13 Entry door for containment room Anteroom entry to containment room View of containment room from anteroom

14 Containment room The Republic of Uganda MINISTRY OF HEALTH

15 Heating block for DNA extraction Pre-amp room view Microfuge-DNA extraction

16 Hands on trainings for LPA

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18 Line Probe Assay (LPA) for detection of MDR-TB NTRL, Uganda (15 th Mar th Oct 2012) YearMDR*All SusceptibleTotal** Total *- MDR- Patients showing resistance to both Isoniazid and Rifampicin **- Includes other than MDR drug resistant patients

19 GeneXpert (Xpert MTB/RIF) for Diagnosis of TB and rifampicin resistant TB - Two hours cartridge based test. - Automated - Possible at district level. - Peripheral Lab and clinical staff can run it - Can detect Smear negative TB- problem of HIV patients - Challenge in POC facilities-Electricity?

20 Details of Mfg: Solar Panels: Dulas Solar (http://www.dulas.org.uk/index.cfm)http://www.dulas.org.uk/index.cfm Solar Charge Controller: Tarom, Steca GmbH (http://www.stecasolar.com/index.php?Steca_Tarom_en)http://www.stecasolar.com/index.php?Steca_Tarom_en Inverter: Local Kampala market- Chinese make Solar batteries: Local Kampala market- Luminous India make Technician: Local Kampala school pass-out Capacity: 3 Gx-4 runs/ day Expected sun- hours: /year Started in: April 2011 Approx Cost: 3600 USD Capacity: 3 Gx-4 runs/ day Expected sun- hours: /year Started in: April 2011 Approx Cost: 3600 USD Local innovations: GeneXpert works with Solar power- Luwero HC IV Early Evidence for scale up Grant: Dutch Government FIND March-2011

21 Early scale-up of Xpert for TB in HIV positive patients at six sites under NTLP Grant: TB reach Wv2, STOP TB Partnership (0.6 million USD)

22 Results of Xpert roll-out in Uganda (Nov June 2012) Xpert site TB Negative MTB positive very Low MTB positive Low MTB positive Medium MTB positive HighTOTAL TASO, Entebbe Fort Portal RRH Jinja RRH Lira RRH Masaka RRH Soroti RRH TOTAL *3 rifampicin resistance cases out 596 TB cases: two confirmed at NTRL, and one died

23 Thank You 23 National TB & Leprosy Program MOH, Uganda

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25 Bunyaazi Island Around 30 nautical miles south of Entebbe Entebbe Bunyaazi Lake Victoria Client visit : beneficiary of FIND-TBR Wv 2 project –Xpert MTB/RIF test Visit 20-June-2012 (FIND, NTRL (MoH), TASO) UGANDA

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