This is a repost of an article by Angela Mitcham, one of the members of our team participating in the kick off of clinical studies for a new Point of Care screening device for Tuberculosis made by Nanosynth Sensors. The team was; Jason Young, MD-Nanosynth CEO; Andrew Pages-Data Mural Program Manager; David D’Angelo-DataMural Operations, and Angela Mitcham-Nanosynth & DataMural Integration.

For the Super Bowl this year I deviated from my normal routine of chips and salsa with friends and traveled 8298 miles to tackle one of the planet’s biggest killers — tuberculosis. I left my hometown of 8,058 residents and landed in a city with 21,534,544. Mumbai, nestled along the western coast of central India, continues to grow as one of the most populous cities in the world. Currently ranked 4th, it’s estimated to reach the #1 spot by 2020 with an anticipated 24 million people.

In the last 20 years, Mumbai’s population has nearly doubled from 12.5 million in 1991. The rapid expansion has wreaked havoc on the city. Public health, housing, and other critical infrastructure have been unable to keep pace. Since 2007, housing prices have increased some 800% — yet income and employment have not grown at the same rates. With such disparity, 9 million residents (nearly half) live in slums. Dharavi, the world’s third largest slum, is home to approximately 1 million people — in just .92 square miles, or about 18 city blocks.*

From young children to the elderly, Dharavi’s residents live with limited access to safe water and sanitation, nutrition, healthcare, education, and basic personal safety. What happens when one of those people, perhaps a small child, picks up an infection like TB then sneezes or coughs on her friend living inches away from her — then coughs again on her mother, brother, grandfather, uncle?

You get the point — the obvious answer is outbreak. Now add the challenge that the person likely has little or no money to seek medical care. Beyond this, in Mumbai, missing a day of work could mean missing a day of food.

And what about the cost of actual treatment? Do you know that a TB patient needs heavy, daily, multi-drug doses for a minimum of 6 months, with adverse side effects? More severe cases may require this costly daily regimen for up to 24 months. This would be challenging for anyone, but especially so for those hit hardest by poverty.

The difficulty of adhering to such a rigorous regimen has caused new strains of TB to develop, called MDR, XDR and TDR TB (multi-drug resistant, extensively drug resistant, and totally drug resistant TB). These alarming new strains are highly contagious and even potentially impossible to treat. Two physicians in Mumbai have died this year from MDR. This week, one physician said to me, “It’s very difficult. As a physician I can’t turn them away, but MDR is the new HIV. There is stigma, and treating the patient may mean death for the physician.”

That two physicians have died might not seem too shocking, but here in Mumbai, TB has long been considered a disease of the poor, a disease limited to those who belong to the very lowest socio-economic classes (think leprosy, or lice on steroids). The educated and middle classes have been able to dismiss TB with, “That couldn’t happen to me.” But TB is becoming increasingly less picky about who it infects, and its rampant nature is becoming an issue for all classes in Mumbai, not just the 9 million living in slums. An additional barrier is the social stigma of the disease: no one wants to admit they have it, further inhibiting the government’s ability to intervene in the public health crisis.

Let me give you just a few more staggering stats on TB. Nearly 1/3 or 2 billion of the earth’s human population is infected with latent TB. Of those infections, about 13.7 million have become active (this is the when it becomes highly communicable). Compare this with the estimated 33 million people living with HIV and the 247 million infected with malaria. In terms of deaths, HIV claims the most lives at 2.5 million annually; TB is second with 1.7 million deaths. Malaria, despite the high infection rate is more treatable, and takes about 1.3–3 million lives a year. India, with its massive populations, bears a disproportionate burden of the disease with the world’s largest TB epidemic.

I’ve spent my Super Bowl week collaborating with some of the top minds tackling India’s TB problem. I offer this summary of the current strategy to defeat TB by 2035:

1) Develop new and better drugs — Current drugs, especially considering the new resistant trains, aren’t effective and long, costly treatment regimens aren’t keeping pace with (much less outpacing) infection rates.

2) Develop better diagnostics and screening tools — Currently, screening and diagnosing TB is arduous and expensive, sometimes taking weeks to get results. No wonder Gates, WHO, and other groups are so excited about theNanosynth POC Screening device. (Oh, in case I didn’t mention it, I’m in Mumbai launching the feasibility trial for the Nanosynth device — I’m slightly biased. More on that to come).

3) Ensure adherence — Until better treatments are available, we must, mustmake sure patients stay on their meds through the entire term. DOTS is the current solution.

4) Slow outbreaks by ensuring notification, quick intervention, and resource availability — Enter Data Mural — the other company I’m working with which maps outbreaks and intervention logistics. More on that to come, too.

In my next posts, I’ll talk more about Nanosynth, Data Mural and the local government responses to TB.

David C Robinson

As stewards your data, it is our job to use the information we create to find solutions – to show you where to look. As we started to think about the concept of creating a Data Mural we really wanted to focus on painting a picture with data that could help to solve some of the world’s big problems. We thought about the kind of problems we could solve by more effectively integrating data across a wide spectrum to give researchers the tools to find solutions that might be a bit out of the box - giving you a different and more comprehensive view of the world your data captures.

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