Changing Landscape for LTBI and Syndromic Testing Methodologies

Manoj engaged in a conversation with the India Pharma Outlook magazine in order to answer queries on the advancements in LTBI and Syndromic testing methodologies. He has more than 26 years of experience in transformational leadership, organizational growth, value building & development, strategic innovation, customer focus, access improvement, creating inclusiveness and developing productive teams. Currently, he is developing a vision for inclusive growth and a mission to enable the organization to reach its leadership objectives and enhance the footprint of QIAGEN.

What are the latest advancements in LTBI diagnostic methodologies?

First it needs to be understood what is active TB and what is TB infection before going into the advancements in the diagnostic methodologies. India has a huge number of notified active TB cases which usually affects the lungs and can also affect other parts of the body. Once affected by TB, a patient has symptoms like coughing, phlegm and at times, it can also be fatal. When a person has been exposed to TB germs, that person is most likely to be infected with TB. From this large pool of asymptomatic people, reports suggest that 5-10 percent of those infected with TB will develop symptoms and progress to active TB. Reports suggest that globally 10 million people are infected and 1 million die due to TB. 25 percent of the world's TB burden is in India and it is one of the huge problems that we have. Recognizing the need to addressing this, the government has taken steps as well by making the announcement that by 2025, India will be TB free for which it becomes very important that not only test for active TB is done but also the diagnosis and treatment of TB infection must also be done. QIAGEN is partnering with the Government of India for having several state screening programs to test for latent TB. Currently the tests that are very easily available are DST tests that has been there in some or the other form for quite some time. And the IGRAs also help the person through early detection and prevention of disease. The IGRA with additional detection of CD8 along with CD4 responses enables a very comprehensive assessment of a person's TB immune response to TB Infection.

What are the challenges associated with implementing new syndromic testing technologies in low-resource settings?

Syndromic testing has become a very relevant topic especially after the pandemic. We understand how challenging it can be in a country like ours where accurate and quick diagnosis is required. But there are challenges like huge geography, shortage of capital, lack in healthcare infrastructure and other socioeconomic disparities. Syndromic testing becomes extremely relevant when a patient is ill and time is of the essence. One needs to make sure that they have the right tests for the right pathogen and that's where the syndromic testing shines. It is a multiplex test with a combination of different panels which will give you the results for different pathogens in a single test and will make it clinically relevant for clinicians to take an informed decision. Instead of going for many different tests, one syndromic test can be done which will provide results for different pathogens within one hour. It can be a game changer for our country and will provide better patient outcomes.

What are the cost implications of adopting advanced LTBI and syndromic testing methodologies in healthcare systems?

In a country like India where people belong to different economic strata, cost of healthcare plays an important role during adoption of new technologies. At the same time accuracy and speed is very essential in modern treatment especially in case of infectious diseases. A quick versus a delayed diagnosis can make differences in the treatment and desired outcome. Diagnosis is the first step towards taking quick treatment decisions that need to be cost effective and sets the tone for the entire recovery process. In India, modern testing methods have been undervalued because of cost. However, during COVID-19 we saw a paradigm shift. India was one of the very few countries which had the vaccines ready, had deployed the COVID test and could contain the burden which otherwise would have gone out of control. All this was possible because of glocalization of technologies where global technologies were used on local conditions. More testing and early and targeted treatment decisions would also save money. The impact of diagnostics on clinical outcomes is more than 70 percent as per reports.

What are the ethical considerations surrounding the use of advanced diagnostic technologies for LTBI and syndromic testing?

It is of paramount importance that a patient gets the best available solution for diagnosis of a disease. Accurate diagnosis will make way for protective patient management by adoption of modern technologies. In this regard, the factors that need to be considered are whether the tests are certified, whether it is certified by authoritative bodies or endorsed by Health Organizations, whether they have the relevant sensitivity and specificity, reproducibility and repeatability. Tests are released in the market after going through a number of such kinds of processes. Tests should not be released in the market which has the probability to provide biased results.