Priority Diseases

iLEAD’s innovation mandate is focused on the Laboratory/Clinic interface which means that the diseases we focus on are broad, spanning a range of infectious diseases as well as non-communicable diseases like cancer and diabetes. Our systems approach seeks to strengthen the laboratory systems and their interface with the clinician and the patient. This means that in time we aim to improve the quality and accessibility of laboratory services in general with the linked impact on national, regional and global health.

The diseases that iLEAD focuses on are based on the current and emerging healthcare and disease trends on the African continent. HIV/AIDS, Tuberculosis and Malaria remain in the spotlight, although there are many emerging diseases that require the attention of healthcare workers and laboratory diagnosticians alike.

These emerging priorities include:

Hepatitis

In 2015 Viral Hepatitis caused 1.34 million deaths worldwide. This number is roughly comparable to the number of deaths associated with Tuberculosis and higher than the number of HIV/AIDS deaths1. In 2017, the WHO estimates that 325 million people worldwide are living with chronic Hepatitis B virus (HBV) or Hepatitis C virus (HCV) infections2. For HBV a highly effective vaccine is available as well as relatively inexpensive treatments, while for HCV a new drug that cures the infection has been developed. The challenge for most of those infected by these Hepatitis viruses in access – both to testing and treatment. iLEAD will leverage the experience of our teams in the HIV/AIDS sphere to impact on laboratory testing for Hepatitis B and C.

Human Papilloma Virus and its role in Cervical Cancer

Cervical cancer is the second most common cancer in women living in less developed countries. Infection with Human Papilloma Virus (HPV) has been shown to cause cervical cancer. HPV is quite a common virus with over 100 sub-types of which 13 have been identified as cancer-causing3. In the past, cervical cancer screening was performed using cytology in a test called a Pap smear. This technique is time-consuming and has been shown to lack sensitivity. Newer molecular biology methods are able to identify the HPV virus and can improve the screening and diagnosis of cervical cancer. There are many challenges however in implementing this molecular screening in resource limited settings. iLEAD will focus on a systems approach to cervical cancer screening and diagnosis employing our knowledge from other large-scale Molecular roll-outs for HIV and TB while also addressing innovation within the Histopathology space for diagnosis of cancers including cervical cancer.

Antimicrobial resistance

Antimicrobial resistance (AMR) occurs when microorganisms including bacteria, fungi, parasites and viruses develop resistance to antimicrobial drugs that they are exposed to. Sometimes called “Superbugs”, these represent an increasingly serious threat to global health, food security and development. The impacts of AMR can be far-reaching: major surgery and cancer chemotherapy can become high-risk leading to increased morbidity and mortality; the cost of healthcare for patients with resistant microorganisms can be higher further stretching poor healthcare budgets in low resource settings; and infections that in the past were relatively easy to treat, like pneumonia or gonorrhea, are becoming potential health threats again as antibiotics become less effective. Currently, iLEAD’s focus on AMR is linked to Tuberculosis where Multidrug Resistant (MDR) and Extreme Drug Resistant (XDR) TB requires improved diagnosis, however in time we will expand this focus to include broader AMR laboratory topics.

Non-communicable diseases

Non-communicable diseases accounted for 3.1 million deaths in Africa in 20154. These deaths include cardiovascular diseases, diabetes and cancer. While infectious diseases like HIV, TB and Malaria have stolen the spotlight on the African continent for the last two decades, changes in demographics with increases in urbanization and the rise of the African middle-class, the ratio of non-communicable disease deaths to those caused by infections is growing. These increases have an impact on the socio-economics of healthcare and will demand increasing focus in resource limited settings. iLEAD will focus on innovations that mitigate the skilled staff shortages within the cancer sphere while investigating the utility of sophisticated precision healthcare to impact on non-communicable disease in the public sector.

Emerging and Re-emerging Infections

SARS, Ebola, Zika – these are names often associated with disease outbreaks and are good examples of emerging diseases. Re-emerging diseases are those which may have been tackled and controlled in the past that are re-emerging in new geographies or in populations where the disease was in the past controlled. Examples are Dengue Fever, Yellow Fever, Cholera and Tuberculosis. As their name implies, outbreaks are hard to predict meaning that improved disease surveillance and capacity for rapid mobilization need to be developed. iLEAD’s focus in this area is on improving the use of Big Data and ICT integration to improve surveillance capabilities while reviewing and developing a systems approach to laboratory outbreak response.

References

1. http://www.afro.who.int/health-topics/hepatitis
2. Global Hepatitis Report, 2017. World Health Organization.
3. http://www.who.int/mediacentre/factsheets/fs380/en/
4. https://africacheck.org/factsheets/factsheet-africas-leading-causes-death/

The key focus for the iLEAD African hubs in South Africa, Mozambique and Senegal includes the following diseases

Human Immunodeficiency Virus (HIV)
Tuberculosis (TB)
Malaria
HBV/Hepatitis C virus (HCV)
Human Papilloma Virus (HPV) in cervical Cancer
Non-communicable diseases (NCDs), including Cancer and diabetes
Anti-Microbial Resistance (AMR)
Emerging diseases and Re-emerging Diseases