A TB breakthrough: The “espresso” machine

MANILA, Philippines — The machine didn’t look like much. It was a little bigger than a breadbox and had a bunch of clear vials on top.

But that small box inside the TB Laboratory at the Lung Center of the Philippines represents a remarkable achievement: The GeneXpert device can detect multi-drug resistant TB (MDR-TB) in two hours instead of the old way of growing cultures that took two months.

On one day last week here, the lab tested 14 samples of sputum given by patients suspected of having MDR-TB. By late afternoon, of the 12 results in, four came back positive for MDR-TB. A technician immediately sent text messages of the results to the patients’ doctors. The doctors would start appropriate treatment the next morning.

“We call it the coffeemaker,” Chris Romano, a medical technologist in the lab, told me. “It makes espresso.”

Some might say these are revved up times in the world of TB. This is the first stop in a three-country tour for photographer Riccardo Venturi and me; the next trips will be to Estonia and Peru. We are traveling at the invitation of the Japanese company Otsuka Pharmaceutical to look at the human impact of TB and what different innovations in treatment mean for patients. On this journey, during which we are acting independently, we have met with scientists, doctors and patients to explore the scope of the struggle to fight MDR-TB.

TB is often called one of the Big Three in global health diseases, joining HIV/AIDS and malaria as drawing the most attention and funding for infectious diseases. But TB (and malaria to a lesser extent) is really a poor cousin to the Big One, AIDS. Just look at the Obama administration’s global health budget request this year: $7.1 billion for AIDS (which includes $1.3 billion for the Global Fund and some of that money goes to TB and malaria), $691 million for malaria, and $236 million for TB.

More from GlobalPost: Introducing the E-Nose, a sniffer test for tuberculosis

Put another way, under the Global Health Initiative request for $9.8 billion, TB receives roughly 3 percent, while AIDS receives somewhere around 65 to 70 percent.

And yet, the fight against TB seems on the verge of advances. One reason is investment in so-called product development partnerships, or PDPs, which match industry and university researchers and add in money from governments and foundations. That has contributed to developing new pipelines for drugs, vaccines and diagnostic tools. One of those is the espresso maker, or GeneXpert, which grew out of a collaboration among partners put together by the Foundation for Innovative New Diagnostics in Geneva. Other PDPs are developing new TB drugs and vaccines.

“On a global scale in research, we are seeing many promising developments,” said Dr. Rosalind Vianzon, director of the National TB Control Programme in the Philippines. “For now, we believe GeneXpert will help us prevent deaths. We’re just getting started with it, but it’s a lot quicker than what we had.”

With financial help from the Global Fund to Fight AIDS, TB, and Malaria, the Philippines has purchased 20 GeneXpert machines and has begun to distribute them to provinces around the country. The Lung Center here already has been running the device for a while, but the experience hasn’t been flawless. One issue is the lack of a local distributor and dedicated long-term funding to pay the machine’s tests, which cost $17 apiece. In January, the TB Lab ran out of the cartridges for the machine, and the new batch didn’t arrive for nine months. The lab had to revert to a much slower diagnostic process during those months.

“We can produce results within two hours now,” said Elsie Dela Cruz, a medical technician in the lab. “Doctors are happy – thrilled actually – to get results in two hours.”

Innovation here, though, isn’t limited to just the laboratory. In the tiny TB world, the Philippines is famous for its model of care of treating TB patients outside under tents instead of putting them in hospitals for long periods. TB is an airborne contagion, a bacterium living in the throat or lungs that upon a cough or a sneeze can be shot through the air and spread to another person in close proximity. But the danger is greatly reduced with proper ventilation; in the tropics, such as the Philippines, it makes complete sense to treat patients outside.

The Philippines now is trying to decentralize and expand services deeper into rural areas. Health officers want to directly observe TB patients take their drugs every day, which generally requires them to come into a clinic or hospital, pick up their drugs and swallow them in front of watchful eyes. But now with patients who are no longer infectious, health officials here are allowing them to go to much smaller health clinics near their homes. 

“It means they can go back to their homes, instead of renting an apartment in a city,” said Hernando Caseria Jr., 23, a nurse at the Lung Center. “It also means they save money on transportation. When I give them the news, they are so happy. They bring us food.”

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TB clinic in the Philippines are social places. Patients often linger. They have developed close friendships with others who face the same challenges, notably the difficulties in taking drug therapy that for drug-resistant TB lasts at least 18 months and can make them vomit, cause their skin to itch, and create hallucinations in their mind.

On Wednesday, a group of patients stayed late to plan a Christmas party for all the drug-resistant patients. 

Roland Torres, 53, a former teacher, said that rich and poor patients showed great caring for each other. “We are all equal here,” he said.

“There is no rich or poor here when it comes to how we treat each other,” said Denice Dela Cruz, also a teacher. “It’s all about empathy with each other.”

Dela Cruz had brought in rice to share for lunch. Conchita Castro brought tilapia, a local fish. Joyce Garcia contributed a mix of squash, ocra, eggplant, and string beans. And Angelito Miranda made fish buro, which was a mix of rice, tomato, bits of fish, ginger, and vinegar.

They passed the fish buro over to me. I liked it. I liked experiencing their camaraderie even more.

Coming next: What happens when you get deadly XDR-TB – twice?