In a blog post initially published in Speaking of Medicine and now shared in the TB coommunity on GHDonline.org for member discussion, Dr Madhukar Pai looks into issues related to diagnostic test development for TB in India and the relationship between the industry and various actors.
“As more TB products get developed, it is not clear which agency or organization can conduct head-to-head validation studies to identify the best products for scale-up. More importantly, which agency or organization should take on a “honest broker” role to bring together key stakeholders that make up the complete value chain for TB innovations in India?” he writes.
Dr Madhukar Pai is professor and TB researcher based at McGill University, Montreal, Canada. He serves as co-chair of the Stop TB Partnership’s New Diagnostics Working Group, and as a consultant to the Bill & Melinda Gates Foundation.
Like many of BRAC’s programs, its community-based model for TB has garnered much praise: it’s been profiled in articles in the New York Times, documented in Harvard Business School case studies, received the Stop TB Partnership Kochon Prize, and hosted dozens of distinguished visitors. Some of its methods have brought them under fire, within conservative communities, with the public sector, and international donors—it was one of the first to treat patients with lay volunteers (called shasthya shebikas), all women, in the community. And while medications have always been provided for free by the government, BRAC requires patients to hand over a small deposit prior to beginning treatment that’s returned only when the patient completes the six months of treatment (this can be paid by the community or waived when necessary). Shasthya shebikas watch the patients take their medications every day (a strategy now called directly observed therapy, short-course or DOTS) at their homes, receiving a small payment upon treatment completion. When pressured to change its delivery strategy, BRAC has refused, with one argument amply supported by program data and rigorous research studies: this model works. With adherence as an Achilles’ heel for treating infectious and non-communicable disease alike, BRAC found a way to engage patients and motivate them to continue the full course of treatment, defended it, and then scaled up to one of the largest programs in the world.
