Innovating tuberculosis diagnostics for the point of care
Nora Engel (Maastricht University)
Paper short abstract:
This paper traces attempts to innovate TB diagnostics from global to local levels. It will contrast the production of evidence on the global pipeline and on feasibility for public TB control in India with local diagnostic practices in homes, communities, clinics, laboratories and hospitals in India.
Paper long abstract:
New diagnostics that can detect tuberculosis (TB) at the point-of-care are urgently needed. After decades of neglect the search for new diagnostics has received new global attention, actors and resources. As a result, pipelines are filled and the WHO has endorsed several new diagnostic tests, some of which have been heralded to revolutionize TB control, promising to overcome diagnostic delay and loss of patients from testing and treatment pathways. Yet, laboratory capacities are often too weak, the new tests too costly and/or dependent on sophisticated equipment or additional manpower. What is more, it is unclear how to design tests that fit into complicated local diagnostic eco-systems where a diversity of actors, materials, understandings, interests and relations are at play. Drawing on fieldwork in India and at international conferences, this paper traces attempts to innovate TB diagnostics from global to local levels. To which extent do these attempts address the underlying issues of poverty on which TB strives? How do these efforts relate to other attempts of controlling TB (treatment, prevention)? What are implications for the role of anthropologists/science and technology studies scholars in these innovation processes? I will examine the production of evidence on the global diagnostic pipeline and on feasibility of new diagnostics for public TB control in India, and contrast this with local diagnostic practices in homes, communities, clinics, laboratories and hospitals. The results reveal an urgent need to improve underlying processes of innovation and an important role for ethnographic studies on how diagnostics are made to work.
Infectious disease and wealth: exploring the links between tuberculosis and the political economy