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FIND and Operational Research in HIV-Associated Tuberculosis
Rick O’Brien
Foundation for Innovative New Diagnostics, Geneva
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• FIND was established in 2003 with a grant from the Bill and Melinda Gates Foundation
• FIND is based in Geneva as a Swiss tax-exempt foundation
• FIND is the only public / private partnership wholly dedicated to improved diagnostic technologies for infectious disease endemic in developing countries
• FIND’s initial focus is on tuberculosis
Background and History
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FIND’s mission
FIND’s mission is to accelerate the development, evaluation, and appropriate use of high-quality yet affordable diagnostic tools for infectious diseases in developing countries.
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Market access and distribution
Discovery and research
FIND SCOPE OF ACTIVITIES
FIND’s focusUpstream Downstream
-
Development
Facilitate,co-fund,
co-develop
Evaluation
Regulatory-quality
lab & fieldtrials
DemonstrationLarge-scale
projectsmeasuring
feasibility andimpact on
disease control programs
Proof of principle
Product in box
EfficacyData
EffectivenessData
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Create network of public and private partnerships to create effective tests and demonstrate their effectiveness
FINDACTIVITY
Research
Liaison with funders, pharmaceutical and biotechnology companies, researchinstitutes and academia
Development
Evaluation
Regulatory quality lab and field trials
Demonstration Access
Liaise with funders, NGO’s, health ministries and agencies, e.g., GDF and GFATM
FIND focus
Industry approach
Proof of principle Product in box Efficacy data Effectiveness data
Facilitate, co- fund and co- develop
Large scale projects to measure feasibility and impact on disease control programs
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diagnostic question healthsystem level
1. Detection• Who shall be treated?• Is patient responding
2. Resolution• Change treatment for failure?
• Is the strain resistant?
3. Surveillance• Are programs effective?• Are there new strains?
Central lab• QC procedures & policies• strain typing
District lab • fill detection gap • resolve unclear cases• resistance testing
Health Center
(Clinic)
• Yes–No answer • medical monitoring
• easy & robust lab procedures • support for multiple health problems• universal platforms
• easy & robust lab procedures • support for multiple health problems• universal platforms
• dedicated POC devices• minimal skill requirements
• dedicated POC devices• minimal skill requirements
segmentation - diagnostic question vs. health system level
DETECTIONmore sensitive than smear !
RESOLUTIONfaster than
culture !
FIND product timeline
2005 2006 2007 20092008
Health center
District lab
Central labCurrent NAAT
TK
Fastplaque
Robust NAAT
MGIT
Breath test
Adapted AFB
Ag detection
Serology
Automated AFB
Simple NAAT
Devel
Development
Fea
Demonstration
Demonstration
Feasibility Development Evaluation
Demonstration Access
Feasibility Development Evaluation
Feasibility Development Evaluation
Feasibility Development Evaluation
Feasibility Development Evaluation
Feasibility AccessDevelopment Evaluation Demonstration
Evaluation Demonstration Access
Evaluation Demonstration
Access
Development Evaluation
Access
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FIND-BD MGIT Demonstration Projects
• Formal agreement with BD Dec 04– FIND to undertake CF and DST demo projects – BD to supply MGIT equipment/reagents at
“affordable” price to public sector in HBCs
• FIND objectives– Demonstrate feasibility and impact of MGIT – Provide data for WHO recommendations
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FIND-BD MGIT TB/HIV Case-Finding Demonstration Projects
• FIND-CREATE MOU Dec 04– MGIT culture in support of studies in Zambia,
South Africa, and Brazil
• Under discussion– GAP/PATH/Tanzania NTLP– WHO/CDC/RIT-JICA/FHI/Cambodia MOH– AMPATH (Eldoret, Kenya)
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