MDR-TB Treatment & Prevention
TB diagnostics market dynamics
Dear All,
Dr Madhukar Pai, MD, PhD, Associate Professor at the Dept of Epidemiology & Biostatistics at McGill University, Canada, sent the following new articles and comments for members of this community:
1. Widespread use of serological tests for tuberculosis: data from 22 high-burden countries.
J. Grenier, L. Pinto, D. Nair, K. Steingart, D. Dowdy, A. Ramsayf and M. Pai. ERJ February 1, 2012 vol. 39 no. 2 502-505
http://erj.ersjournals.com/content/39/2/502.extract (Extract only. Full text with subscription or HINARI access http://www.who.int/hinari/en/)
The paper in ERJ shows that serological tests (which WHO has recommended against) are widely used in many high burden countries, and the problem extends beyond India. 17 of the 22 highest TB burden countries have these tests on the market. All in private sector. Respondents from 11 (65%) out of 17 countries reported that serological tests were used as the basis for initiating therapy for active TB; those in India, Indonesia and South Africa reported that this happened ‘‘often’’ in the private sector. Respondents from 12 (71%) out of 17 countries perceived their regulatory agencies as being ‘‘weak’’, and 11 acknowledged that such weakness may allow for the importation and/or use of serological tests.
2. Why are inaccurate tuberculosis serological tests widely used in the Indian private healthcare sector? A root-cause analysis
Szymon Jarosławski, Madhukar Pai. Journal of Epidemiology and Global Health. Available online 31 January 2012
http://www.sciencedirect.com/science/article/pii/S2210600612000032 (Abstract only. Full text with subscription or HINARI access http://www.who.int/hinari/en/)
The paper in Journal of Epi and Global Health is a “root cause analysis” on what market dynamics made these tests so popular in the Indian private sector, and what lessons can be learnt that we can apply for scale-up of validated, WHO-endorsed products. The “freakonomics” of TB serology is discussed in the paper (who makes money off these tests along the value chain?). The paper also provides an analysis on why sputum smears are not popular in the Indian private sector, and if a new test has to succeed in the Indian market, what characteristics it should have (target product profile).
Please share your thoughts here. (Feel free to email me .)
Best, Sophie
Sandeep Saluja
An important aspect is lack of proper means to educate doctors.For most clinicians,the source of continuing medical education is what is dished out by commercial companies with personal axes to grind.
11:40 PM, 3 Feb 2012 | Permalink
Shelly Batra, MD
The papers provide valuable insights. I have had the pleasure of meeting Madhukar in India few months ago, and was very impressed by his knowledge.
I must add another dimension. Often, doctors are so busy with private practice that they have no time to educate themselves. So who does the education? Those who represent pharmaceutical companies and laboratories, they are the ones going to doctors with 'evidence' of new research, and request to prescribe so-and so drug or test. This practice is so widespread that suddenly we find a particular test has become very popular, and doctors, in an attempt to 'keep up with the Joneses', all follow suit. In India patients have become tech-savvy. We have patients coming and demanding fancy tests, after reading articles on the internet, so doctors comply with the request, and all are happy.
But suboptimal diagnosis is making matters worse, and suboptimal therapy compounds the problem. I wonder if any study has been done to evaluate adherance in patients treated on the basis of serological tests.From an epidemiological perspective, it would be valuable to know how many continued with full regimen, how many defaulted, and what percentage developed MDR TB.
12:44 AM, 4 Feb 2012 | Permalink