30 June 2022 | Opinion | By Dr Manbeena Chawla
Contrary to popular opinion, tuberculosis (TB) has not been eliminated in Singapore. In fact, TB is an endemic disease, and in 2020, Singapore detected 1,370 cases of active TB. The burden of active TB cases in Singapore has continued to hover around 30-40 cases per 100,000 persons each year for the past decade, and nearly 80 per cent of the new cases of TB, in 2020, are from persons born in Singapore. QIAGEN recently collaborated with the Tuberculosis Control Unit (TBCU) of Singapore to light up the TBCU building in support of the "Light up RED for TB" campaign. QIAGEN’s goal is to gradually shift the focus in the direction of preventive testing and treatment in order to protect individuals from TB reactivation, and therefore prevent the spread of TB to others. To find out more about the company’s initiatives towards TB detection in APAC, BioSpectrum Asia spoke to Patrick Che, Sales Development Manager, QuantiFERON, South East Asia, QIAGEN.
How is QIAGEN helping to reduce the growing burden of TB in APAC?
QIAGEN promotes TB prevention (Test and Treat strategy for individuals who are at risk of developing active TB) as a means to reduce overall active TB burden in APAC. It is estimated that 1.5 million people died from TB in 2020 and over 1.4 billion people are currently infected with TB. The US CDC (Centers for Disease Control and Prevention) estimates that 1 in 10 with TB infection will go on to develop active TB disease at some point in their lifetime. It is important to emphasise that preventive treatment for TB, particularly for individuals who carry a higher than normal risk of developing active disease, is the only way to stop TB before it spreads to others. The World Health Organisation (WHO) also identifies Latent TB Screening (LTBI) as a key pillar in their global EndTB Strategy.
Each country in the APAC region presents unique challenges for TB control programmes due to many variables such as government policies, demographics, international travel, and most recently, the COVID-19 pandemic. The WHO recognised, in their 2021 Global TB Report, that many countries in the APAC region faced many challenges during the COVID-19 pandemic such as reduction of access to TB preventive therapy.
South East Asia includes many countries on the WHO list with the highest TB burden in the world (apart from Africa). Most countries in the region remain focused on case finding and treatment for active TB disease and the National TB programmes do not have policies or clinical practice guidance to support TB prevention.
COVID-19 presented unique challenges to TB control programmes across the region due to the shift in government spending away from TB and other diseases in order to support the management of COVID-19. In the midst of the pandemic situation, we have developed and launched the QIAreach QFT solution, which is an interferon-gamma release assay (IGRA) developed in partnership with Ellume. The solution was designed with many of the regional challenges in mind, specifically to support decentralised TB infection screening in high TB burden and low resource countries.
What are the major products developed by QIAGEN to enhance TB detection?
QuantiFERON-TB Gold Plus (QFT-Plus) remains the flagship IGRA test which is globally recognised as the market leader for supporting TB infection screening and contact tracing programmes. QIAreach QuantiFERON-TB (QFT) is the latest product developed by QIAGEN to improve access to IGRA technology in high TB burden and low resource countries.
Are you planning to launch new products in 2022 for the APAC region?
We are launching QIAreach QFT in the APAC region this year, with country level registrations on-going. Apart from QIAreach QFT, we are also launching NeumoDx – a high-throughput automatic PCR platform - and a number of other products supporting the detection of other infectious diseases.
What are the current challenges facing the TB diagnosis market in APAC?
Government resources allocated to public health have been redirected to support the management of the COVID-19 pandemic. In most countries, the resources continue to be focused on this area even as the countries are gradually relaxing their restrictions and international travel is slowly returning to the “new normal”. Allocation of resources to support TB control programmes remains a challenge as spending on TB had dropped to 2016 levels in 2020 and up till now has not recovered.
Improving access to the latest diagnostic technologies in high burden and low resource settings where access to centralised laboratory infrastructure is limited, remains challenging. This is why QIAreach QFT was developed – to provide a more decentralised testing option while still offering most of the benefits from our QuantiFERON technology platform.
Most TB control programmes continue to focus on active TB case finding and treatment. The challenge is to change the mindset to favour TB prevention as a way to reduce active case burden.
Are you planning new investments or collaborations to increase availability of TB detection assays?
StopTB Partnership is supporting lower pricing for public health and broader access to TB screening technology via the Global Drug Facility (GDF) catalogue.
Ending Workplace TB is promoting TB elimination and prevention in the workplace.
Results Australia is working with local NGO to call on the government to take action and promote TB elimination efforts through education and TB preventive screening.
Each country in the region has specific focus areas for TB prevention, and local activities depend on the demographic of the country and the segments which the local government and associations are interested to support. Generally speaking, across SEA, we are collaborating with local organisations for TB education/awareness in high risk patient segments (i.e. diabetes, pediatrics, dialysis patients (ESRD), migrant workers, occupational health (including healthcare workers), and PLHIV), with the goal of promoting TB preventive screening and treatment as a means to reduce TB burden.
The QIAreach QFT test was developed in partnership with Ellume, a diagnostics company based in Brisbane, Australia. QIAGEN is always interested in exploring novel ways (including collaborations) to leverage our technology and platform expertise to support the development of better tests and technologies which can lead to better patient outcomes and more efficient disease management.
Which other infectious diseases are a priority area for QIAGEN? What are the plans in the coming years?
QIAGEN has a very broad portfolio of solutions spanning life science/research, next-generation sequencing, to molecular IVD solutions. Within the QuantiFERON family, apart from tuberculosis, the IGRA technology has also been expanded to include immunoassays for SARS-CoV2 (COVID-19), cytomegalovirus (CMV), lyme disease, as well as innate/adaptive immunity. Note that not all products are available in the APAC region. The introduction of the NeumoDx platform will further expand QIAGEN’s ability to support detection of other infectious diseases.
Dr Manbeena Chawla