On March 24 1882, German physicist Dr Robert Koch announced that he had discovered the bacteria that causes tuberculosis, paving the way for diagnosis and a possible cure. Every year, this day is observed as World TB Day. Nearly 140 years on, and this highly contagious disease continues to prevail. In 2019, 1.4 million died of TB. Each day, nearly 4,000 people die of this disease, which is actually preventable and curable. 

In the past few years, India's medical industry has made huge technological advances. The immense strain on the healthcare sector needs to be offset by supporting medical staff with devices and solutions that can address crucial aspects of monitoring and screening. The rise of technologies like AI and IoT in healthcare, further accelerated by advanced and high speed wireless networks and cloud computing solutions, has led to the renaissance of healthcare today. And this is the kind of intervention that could greatly help limit the spread the infectious diseases like tuberculosis. 

Madhav Joshi, CEO, India Health Fund

India Health Fund, a collective of Tata Trusts and the Global Fund, was set up in 2017 to lead collaboration with public and private sectors to develop and scale innovative solutions, business models and financing solutions to improve outcomes in diagnosis, treatment, prevention, and eventual elimination of infectious diseases. CEO Madhav Joshi joined INDIAai in an exclusive video interview ahead of World TB Day 2021 where he spoke about the fund's explicit focus on mitigating infectious diseases through technologies like AI, and why these diseases still prevail despite the country having made tremendous progress in the past seven decades since independence. "One of the reasons effective treatment of infectious disease has suffered is due to market failures. These diseases, once widespread, soon began retreating to rural areas where sanitation levels are low and access to medical care is a challenge. Moreover, diseases like TB are mostly seen in developing nations, which lack structured government-led disease eradication campaigns and rely on not-for-profits or charities. These are models lack a significant RoI so they eventually fizzle out, leaving the affected populations in the lurch," explains Joshi. 

India Health Fund is attempting to address the continuity challenge in treatment of infectious diseases by supporting entities that are innovating in healthcare and developing financial solutions that can improve outcomes significantly and can wean off excessive reliance on external funding or tech support. Some of the startups and companies India Health Fund is working with include Hemex (which provides a rapid diagnostic test for malaria), Qure.ai (which uses AI to screen TB and now COVID patients with 99% accuracy), Truenat (which uses molecular diagnostics to detect TB within a day), Valetude Primus Healthcare (for safe collection of sputum samples of TB patients) and TMEAD for drug-resistant TB patients.

Tech for Effective Dual Screening of TB and COVID

In addition to delayed treatment, the processes involved while screening patients for infectious diseases is also antiquated. For instance, TB diagnosis still largely relies on microscope analysis, and this technology is atleast a 100 years old. "There are significant gaps in scientific and technological intervention for infectious diseases. A sustainable R&D engine needs to be built for this purpose," adds Joshi. 

India Health Fund has collaborated with Mumbai-based Qure.ai, to enable faster screening and diagnosis of TB, without a trained technician, which is specially relevant in low-resource settings. A smartphone app linked to AI algorithms that analyse an analog chest X-ray to enable faster screening and diagnosis, which will also reduce the number of missed cases, false positives and additional confirmatory tests. "Not only is this an innovative, cutting-edge AI solution but also one that can be deployed in low-resource settings with minimal cost. This is the ideal trifecta of effectiveness in healthcare solutions we are aiming to deliver," adds Joshi. 

When the COVID19 outbreak started last year, Maharashtra was one of the worst affected states and unfortunately, continues to see a high number of cases in what appears to be the start of the second wave in India. India Health Fund partnered with the Municipal Corporation of Greater Mumbai (MCGM) to deploy Qure.ai's qXR for COVID-19 screening and triaging as well as progression monitoring. This particularly was helpful for frontline health workers as the app guided them to direct patients for swab testing/ quarantine within a minute of taking the chest X-Ray. India Health Fund enabled the deployment of qXR in nine hospitals and a mobile van partnering with MCGM. The fund mobilised external grant funding from ACT Grants for 25,000 qXR scans at MCGM sites. 

The consequence Joshi is particularly enthused by is the nimble and agile deployment of platforms for managing different diseases. Qure.ai, while was initially built for effective TB testing, has been particularly successful in detecting chest films affected by coronavirus. The swift adaptability of the AI algorithms to read chest X-rays to detect COVID19 with a high accuracy, in a short turnaround time, was a critically timed response in the early days of the pandemic. As medical resources were re-routed to manage COVID, the attention turned away from TB detection. The Stop TB Partnership revealed that lockdowns and reallocation of medical resources to tackle COVID19 had led to a 23% drop globally in TB diagnosis and treatment - and could set the world back by 12 years in the fight to eradicate this global killer. Joshi says, "While we tackle one pandemic, we cannot forget that other diseases are still prevalent and require attention. Maharashtra has the second highest number of TB cases in the country. With healthcare workers stretched to the limit, relying on adaptable tech platforms is the need of the hour." While Qure.ai was deployed for COVID19 testing following some modifications with algorithms, another company, supported by India Health Fund, called TrueNat was able to repurpose its RT-PCR test for TB in a short time to screen COVID19-positive patients and asymptomatic ones. TrueNat became the second Indian RT-PCR test to be approved by ICMR last year to test for COVID19. India Health Fund along with municipal hospitals in Mumbai were essentially screening for COVID19 and TB at the same time, with one solution - making it one of the largest bi-directional test deployments in the country. 

With healthcare receiving top billing in this year's union budget, the role of technology in managing and even preventing diseases cannot be undermined.

Click here to watch the interview with Madhav Joshi on the INDIAai YouTube channel.