Affordable Healthcare in India
The objective of this scheme is to fund translational research projects to deliver safe and effective healthcare products for India - and potentially other markets - at affordable costs.
A key feature of the scheme is to encourage innovations that bring together researchers from both the public and private sectors to extend access of such innovations to the greatest numbers of beneficiaries, without compromising on quality. Projects covering any aspect of technology development for healthcare will be considered, including diagnostics, therapeutics, vaccines, medical devices and regenerative medicine. Proposals drawing on the disciplines of the physical sciences, maths and engineering, as well as biomedicine, are equally encouraged.
Affordable mechanical ventilation for emerging market
Respiratory illness is a leading cause of hospitalisation and death in emerging nations. Each year thousands of patients die in rural community hospitals because of lack of access to mechanical ventilation. Influenza is especially devastating, affecting newborns and the elderly disproportionately.
Despite improvements in infrastructure and economies, ventilators remain out of reach for many hospitals. OneBreath is a Silicon Valley start-up conquering one of the most difficult problems in rural critical care: delivering high precision, high reliability and low cost in a mechanical ventilator. Vaatsalya is a healthcare company focused on delivering quality healthcare services across semi-urban and rural India. Together, Dr Ashwin Naik of Vaatsalya and Dr Matthew Callaghan of OneBreath are developing a novel ventilator specifically addressing the needs of hospitals serving India’s lower income populations.
Despite improvements in infrastructure and economies, ventilators remain out of reach for many hospitals. OneBreath is a Silicon Valley start-up conquering one of the most difficult problems in rural critical care: delivering high precision, high reliability and low cost in a mechanical ventilator. Vaatsalya is a healthcare company focused on delivering quality healthcare services across semi-urban and rural India. Together, Dr Ashwin Naik of Vaatsalya and Dr Matthew Callaghan of OneBreath are developing a novel ventilator specifically addressing the needs of hospitals serving India’s lower income populations.
Insecticide Quantification Kits (IQK) for Vector Control Programmes in India
Visceral leishmaniasis (Kala Azar) and malaria are deadly diseases that are widespread in the Indian subcontinent. Since they are transmitted by sandfly and mosquito vectors respectively, insecticides are the most effective way to control these diseases, but only if the correct amount of insecticide is deposited on the sprayed surfaces.
Too little and the sand flies and mosquitoes will survive and become resistant to the insecticide, too much and human health and the environment can suffer. Unfortunately, monitoring insecticides is an expensive process involving sophisticated equipment or complex biological assays. Therefore, it is not routinely done, putting populations at increased risk of disease.
Dr Pradeep Das and his team at the Rajendra Memorial Research Institute of Medical Sciences in Patna (RMRI) are involved with the eradication of Kala Azar in northern India and bordering countries. Simple visual assays (quantification tests) for the rapid and reliable monitoring of DDT, carbamate and organophosphate, the classes of insecticide commonly used against sand flies and mosquitoes, have been developed by Dr Paine and colleagues at the Liverpool School of Tropical Medicine (LSTM),using funding obtained through the Innovative Vector Control Consortium (IVCC). RMRI and LSTM have been awarded Affordable Healthcare Funding to join forces in developing these assays further and establishing them as convenient tools (Insecticide Quantification Kits) for monitoring the quality of indoor residual spray programmes against insect borne diseases in India and elsewhere. This will involve assay refinement, kit development and field trials to demonstrate kit effectiveness, practicality and reliability. The goal is to provide field operatives with simple visual rapid tests for the precise monitoring of insecticides to maximise the benefits from vector control and minimise the risks to public health and the environment.
Too little and the sand flies and mosquitoes will survive and become resistant to the insecticide, too much and human health and the environment can suffer. Unfortunately, monitoring insecticides is an expensive process involving sophisticated equipment or complex biological assays. Therefore, it is not routinely done, putting populations at increased risk of disease.
Dr Pradeep Das and his team at the Rajendra Memorial Research Institute of Medical Sciences in Patna (RMRI) are involved with the eradication of Kala Azar in northern India and bordering countries. Simple visual assays (quantification tests) for the rapid and reliable monitoring of DDT, carbamate and organophosphate, the classes of insecticide commonly used against sand flies and mosquitoes, have been developed by Dr Paine and colleagues at the Liverpool School of Tropical Medicine (LSTM),using funding obtained through the Innovative Vector Control Consortium (IVCC). RMRI and LSTM have been awarded Affordable Healthcare Funding to join forces in developing these assays further and establishing them as convenient tools (Insecticide Quantification Kits) for monitoring the quality of indoor residual spray programmes against insect borne diseases in India and elsewhere. This will involve assay refinement, kit development and field trials to demonstrate kit effectiveness, practicality and reliability. The goal is to provide field operatives with simple visual rapid tests for the precise monitoring of insecticides to maximise the benefits from vector control and minimise the risks to public health and the environment.
Affordable, battery operated, digital screening devices for preventable blindness
The World Health Organisation estimates that there are nearly 285 million people globally who are visually impaired, and at least 75% of them have conditions that are reversible, treatable and/or preventable. Nearly 90% of these individuals are in small towns and villages in many of the developing nations, including India.
Many of the current diagnostic tools available for screening are centralised in their availability, are expensive and often difficult to use in resource or infrastructure-starved areas. In order to tackle this, Remidio, a product design and development company headquartered in Bangalore has developed a battery operated, handheld, digital and non-digital ophthalmoscope, with several unique features. The company involves key stakeholders during the product development process – clinicians, patients, technicians and community health workers, with a view to designing easy-to-use, product solutions that work within the constraints of a developing nation context. Affordability, robustness for everyday use in the field, portability, battery operation, and a customer-driven simplicity of use, differentiate the products Remidio brings to market.
The retinal imaging products from Remidio are based on a fundamental illumination technology patent. The novel illumination design enables high quality, reflex-free retinal imaging in a compact, portable format, with minimal number of optical elements. The digital systems have been designed to allow for remote review of captured images, allowing for the implementation of scalable models for the decentralised screening and detection of diseases as diverse as Diabetic Retinopathy, AMD, and Glaucoma. This project aims to complete the development and evaluation of the clinical performance of the digital imaging systems. These devices aim to fill a critical unmet-need in public-health screening for preventable blindness.
Many of the current diagnostic tools available for screening are centralised in their availability, are expensive and often difficult to use in resource or infrastructure-starved areas. In order to tackle this, Remidio, a product design and development company headquartered in Bangalore has developed a battery operated, handheld, digital and non-digital ophthalmoscope, with several unique features. The company involves key stakeholders during the product development process – clinicians, patients, technicians and community health workers, with a view to designing easy-to-use, product solutions that work within the constraints of a developing nation context. Affordability, robustness for everyday use in the field, portability, battery operation, and a customer-driven simplicity of use, differentiate the products Remidio brings to market.
The retinal imaging products from Remidio are based on a fundamental illumination technology patent. The novel illumination design enables high quality, reflex-free retinal imaging in a compact, portable format, with minimal number of optical elements. The digital systems have been designed to allow for remote review of captured images, allowing for the implementation of scalable models for the decentralised screening and detection of diseases as diverse as Diabetic Retinopathy, AMD, and Glaucoma. This project aims to complete the development and evaluation of the clinical performance of the digital imaging systems. These devices aim to fill a critical unmet-need in public-health screening for preventable blindness.
Designing and validating an optimum drug combination, from the pool of existing anti-infectives for the treatment drug sensitive and resistant tuberculosis (TB)
TB is a bacterial infection that claims around 1.4 million lives a year worldwide. An estimated one-third of the world's population is infected. The disease is treatable with drugs; however, cases of multidrug-resistant TB (MDR-TB) are rising and new treatments are urgently needed.
Current therapies for TB are based on creating combinations of three to four drugs and cycling through ad-hoc regimens, which are largely ineffective against MDR-TB. The new collaboration will see Cellworks and AstraZeneca pull from a pool of existing anti-infective drugs and attempt to find an effective combination with better efficacy and lower toxicity than the treatment regimens provided today. The traditional process of designing an ideal drug combination is lengthy and expensive because there are several thousand possible combinations and the search space is too large to be handled by conventional techniques.
Under the collaboration, Cellworks will use its proprietary predictive platform to model MDR-TB and rationally identify 'synergistic combinations' that might have the highest efficacy and lowest possible toxic burden of available combinations. AstraZeneca will validate the top ten most effective combinations identified by Cellworks, both in the in vitro and in animal models of the disease.
Current therapies for TB are based on creating combinations of three to four drugs and cycling through ad-hoc regimens, which are largely ineffective against MDR-TB. The new collaboration will see Cellworks and AstraZeneca pull from a pool of existing anti-infective drugs and attempt to find an effective combination with better efficacy and lower toxicity than the treatment regimens provided today. The traditional process of designing an ideal drug combination is lengthy and expensive because there are several thousand possible combinations and the search space is too large to be handled by conventional techniques.
Under the collaboration, Cellworks will use its proprietary predictive platform to model MDR-TB and rationally identify 'synergistic combinations' that might have the highest efficacy and lowest possible toxic burden of available combinations. AstraZeneca will validate the top ten most effective combinations identified by Cellworks, both in the in vitro and in animal models of the disease.
Development and impact assessment of an mHealth package for rural India focusing on reproductive, maternal and child health, in support of the Government of India National Rural Health Mission
FRHS, Columbia University and WHO have been awarded translational funding to develop and create an “mHealth Package” to facilitate and support various aspects of rural health workers’ work and enabling a flow of communication between community members, health workers and health facilities.
India's rural, economically poor populations depend on health care provided by outreach and facility-based workers. But the current health management information system (HMIS) under the National rural Health Mission (NRHM) is failing to optimise these workers' performance: significant weaknesses in the predominantly paper-based HMIS are resulting in inefficiencies, inaccuracies, data under-utilisation and, crucially, missed opportunities for worker support, motivation and improvement, resulting in poor health outcomes. Mobile technologies offer the promise of enormous advances in such environments, with the potential to empower health workers through instantaneous communication and feedback, delivery of up-to-date educational content, alerts and reminders, remote support from experts and performance monitoring.
This project, to be piloted in Karnataka state, under the supervision of Dr Nirmala Murthy, will develop an "mHealth Package" - a strategic mix of mobile technology applications and support materials - to support NRHM reproductive, maternal and child health (RMCH) services. The technology will emphasise ease of use by low-literacy individuals, will be provided free of charge, and is envisaged for massive scale-up following rigorous pilot testing, impact assessment and revision. The resultant intervention will empower rural health workers and their clients along the continuum of RMCH care, integrating and streamlining data with existing HMIS standards for enhanced provider performance and population health outcomes.
India's rural, economically poor populations depend on health care provided by outreach and facility-based workers. But the current health management information system (HMIS) under the National rural Health Mission (NRHM) is failing to optimise these workers' performance: significant weaknesses in the predominantly paper-based HMIS are resulting in inefficiencies, inaccuracies, data under-utilisation and, crucially, missed opportunities for worker support, motivation and improvement, resulting in poor health outcomes. Mobile technologies offer the promise of enormous advances in such environments, with the potential to empower health workers through instantaneous communication and feedback, delivery of up-to-date educational content, alerts and reminders, remote support from experts and performance monitoring.
This project, to be piloted in Karnataka state, under the supervision of Dr Nirmala Murthy, will develop an "mHealth Package" - a strategic mix of mobile technology applications and support materials - to support NRHM reproductive, maternal and child health (RMCH) services. The technology will emphasise ease of use by low-literacy individuals, will be provided free of charge, and is envisaged for massive scale-up following rigorous pilot testing, impact assessment and revision. The resultant intervention will empower rural health workers and their clients along the continuum of RMCH care, integrating and streamlining data with existing HMIS standards for enhanced provider performance and population health outcomes.
Development of Smart Cane, an affordable above-knee obstacle detection and warning system for the visually impaired
The Indian Institute of Technology (IIT) Delhi has developed the 'Smart Cane', a navigation and mobility aid for visually challenged people. The Smart Cane is an innovative device that can be mounted on a traditional white cane to enhance its functionality, resulting in improved mobility and safety, while reducing dependence on sighted assistance.
White canes are currently the most commonly used visual mobility aid; however, a white cane can only detect certain types of obstacles within a limited range and cannot detect obstacles that are above the knee (e.g. a steel bar on the road) or protruding (e.g. a tree branch or an open window).The Smart Cane device uses ultrasonic sensors to detect obstacles up to 3m away, and the range of the detected obstacles is conveyed using vibratory signals with different vibration characteristics. It is designed as a user-detachable unit and is powered by rechargeable Li-ion battery. The design emphasis has been on making an affordable device, and it is currently expected to cost less than Rs 2000 (£30) to the end user.This project targets the design of a manufacturable device, optimising it based on user feedback from field trials and making it ready for regulatory approvals and certification. It has been proposed that extensive user trials should be carried out at multiple locations in the next 18 months. The project is being jointly undertaken by IIT Delhi with an industrial partner, Phoenix Medical Systems (P) Ltd, Chennai. The third partner in the project is Saksham Trust, New Delhi, who have domain expertise and links to the network of organisations working for the visually impaired.
White canes are currently the most commonly used visual mobility aid; however, a white cane can only detect certain types of obstacles within a limited range and cannot detect obstacles that are above the knee (e.g. a steel bar on the road) or protruding (e.g. a tree branch or an open window).The Smart Cane device uses ultrasonic sensors to detect obstacles up to 3m away, and the range of the detected obstacles is conveyed using vibratory signals with different vibration characteristics. It is designed as a user-detachable unit and is powered by rechargeable Li-ion battery. The design emphasis has been on making an affordable device, and it is currently expected to cost less than Rs 2000 (£30) to the end user.This project targets the design of a manufacturable device, optimising it based on user feedback from field trials and making it ready for regulatory approvals and certification. It has been proposed that extensive user trials should be carried out at multiple locations in the next 18 months. The project is being jointly undertaken by IIT Delhi with an industrial partner, Phoenix Medical Systems (P) Ltd, Chennai. The third partner in the project is Saksham Trust, New Delhi, who have domain expertise and links to the network of organisations working for the visually impaired.
Chest compression device for patients with sudden cardiac arrest
Professor Bhargava and his colleagues at the All India Institute of Medical Sciences (AIIMS), New Delhi, have developed a preliminary prototype of a novel chest compression device that uses compression and decompression cycles uniquely.
Sudden cardiac arrest (SCA) is the abrupt cessation of heart pump function. This causes an inadequate blood supply to the vital organs of the body. If corrective measures are not taken immediately, this condition rapidly progresses to death. Manual compression of the centre of the chest (sternum) during cardiopulmonary resuscitation (CPR) is the 'gold standard' for managing such patients.Improving cerebral and coronary perfusion still remains a challenge during CPR. Professor Bhargava and his colleagues at the All India Institute of Medical Sciences (AIIMS), New Delhi, have developed a preliminary prototype of a novel chest compression device that uses compression and decompression cycles uniquely. The [Affordable Healthcare] funding will be used in two phases. In phase-I, the concept will be refined and a prototype will be developed. In phase-II, feasibility studies and validation will be performed in animal models.
Sudden cardiac arrest (SCA) is the abrupt cessation of heart pump function. This causes an inadequate blood supply to the vital organs of the body. If corrective measures are not taken immediately, this condition rapidly progresses to death. Manual compression of the centre of the chest (sternum) during cardiopulmonary resuscitation (CPR) is the 'gold standard' for managing such patients.Improving cerebral and coronary perfusion still remains a challenge during CPR. Professor Bhargava and his colleagues at the All India Institute of Medical Sciences (AIIMS), New Delhi, have developed a preliminary prototype of a novel chest compression device that uses compression and decompression cycles uniquely. The [Affordable Healthcare] funding will be used in two phases. In phase-I, the concept will be refined and a prototype will be developed. In phase-II, feasibility studies and validation will be performed in animal models.
Development of a synthetic biodegradable cell carrier membrane for the transplantation of cultured cells or freshly excised autologous tissue (limbal segments or oral mucosa) for diseases of the cornea
The researchers describe their work.
The LV Prasad Eye Institute in Hyderabad, in partnership with Sheffield University, has been awarded funding to develop and use new biocompatible materials for a stem-cell-based therapy to restore sight in eyes where the cornea has been damaged by chemical injury or burns.
This advanced tertiary eye care centre in Hyderabad offers high-quality, comprehensive eye care on an equitable basis, to millions across the state of Andhra Pradesh, through its pyramidal network that involves 17 secondary eye care centres in towns and 65 primary care centres in large villages, in remote rural areas. The centre at Hyderabad has so far provided limbal stem-cell-based therapy to over 700 patients.
The researchers describe their work.The LV Prasad Eye Institute in Hyderabad, in partnership with Sheffield University, has been awarded funding to develop and use new biocompatible materials for a stem-cell-based therapy to restore sight in eyes where the cornea has been damaged by chemical injury or burns.
This advanced tertiary eye care centre in Hyderabad offers high-quality, comprehensive eye care on an equitable basis, to millions across the state of Andhra Pradesh, through its pyramidal network that involves 17 secondary eye care centres in towns and 65 primary care centres in large villages, in remote rural areas. The centre at Hyderabad has so far provided limbal stem-cell-based therapy to over 700 patients.
The international programme to evaluate the Polycap in a large randomised controlled clinical trial in a primary prevention setting
Cadila Pharmaceuticals Ltd are investigating the concept of a combination pill for the control of cardiovascular disease in the primary prevention setting, through a Phase III clinical trial.
The pill (Polycap) will comprise a mixture of three blood pressure reducing agents - a diuretic (hydrochlorothiazide), an ACE inhibitor (ramipril) a beta blocker (Atenolol), and a cholesterol lowering statin (simvastatin). All of the agents were chosen based on the evidence of their reducing cardiovascular disease risk and their generic drug status.Cadila’s pioneering work in this area has been to develop stable pharmaceutical compositions in a Polycap formulation. They will work with a group of experienced clinical collaborators including Salim Yusuf, Professor of Medicine at McMaster University, to undertake a study with 5000 subjects (without a history of previous heart attack or stroke) over five years. The proposed placebo-controlled study will recruit individuals (men over 55 and women over 60) with a INTERHEART risk score (obtained through a questionnaire based on family history and lifestyle factors) greater than a threshold value with a estimated yearly primary event rate of 0.75 to 1 per cent. The primary outcome will be a composite of CV death, non-fatal MI and non-fatal stroke.
The pill (Polycap) will comprise a mixture of three blood pressure reducing agents - a diuretic (hydrochlorothiazide), an ACE inhibitor (ramipril) a beta blocker (Atenolol), and a cholesterol lowering statin (simvastatin). All of the agents were chosen based on the evidence of their reducing cardiovascular disease risk and their generic drug status.Cadila’s pioneering work in this area has been to develop stable pharmaceutical compositions in a Polycap formulation. They will work with a group of experienced clinical collaborators including Salim Yusuf, Professor of Medicine at McMaster University, to undertake a study with 5000 subjects (without a history of previous heart attack or stroke) over five years. The proposed placebo-controlled study will recruit individuals (men over 55 and women over 60) with a INTERHEART risk score (obtained through a questionnaire based on family history and lifestyle factors) greater than a threshold value with a estimated yearly primary event rate of 0.75 to 1 per cent. The primary outcome will be a composite of CV death, non-fatal MI and non-fatal stroke.
Novel candidate drugs against M. tuberculosis: design, validate and optimise leads targeting NAD(P)(H) utilizing enzymes.
AstraZeneca and AstraZeneca India have been awarded translational funding to identify lead compounds of novel structural classes capable of inhibiting NAD metabolism, as candidate drugs for the treatment of Mycobacterium tuberculosis.
Curative tuberculosis therapy requires killing a 'difficult-to-treat' residual population of non-replicating organisms. Significant evidence now suggests that NAD metabolism is an essential factor in the survival of non-replicating M. tuberculosis bacilli and thus provides a rare opportunity to drive a discovery program directly addressing sterilising capability. The programme aims to inhibit NAD(P)(H)-utilising enzymes, including those involved in the biosynthesis of NAD, by competing with the NAD binding domain, using NAD mimetic libraries.The programme of work is based on a NAD mimetic pilot study that identified a number of lead-like scaffolds with promising activity and selectivity. Building from the molecular starting point library used in the pilot study, a second generation library will be created and tested in a screening cascade which blends the strengths of target-based optimisation with the power of whole cell screens. The design of the primary library involves pharmacophore and substructure overlap together with the mapping of key interactions between NAD and the cognate binding site, based on known co-crystallisation studies. The screening cascade is designed to build on the strengths of (a) target-based approaches (early structural knowledge facilitates compound optimization) and (b) whole cell screening (early proof of whole cell activity ensures drug-like behaviour in all early series). The key challenge in targeting the ubiquitous NAD molecule is to introduce specificity. The literature precedence and AstraZeneca’s initial work suggest that this is achievable.
Curative tuberculosis therapy requires killing a 'difficult-to-treat' residual population of non-replicating organisms. Significant evidence now suggests that NAD metabolism is an essential factor in the survival of non-replicating M. tuberculosis bacilli and thus provides a rare opportunity to drive a discovery program directly addressing sterilising capability. The programme aims to inhibit NAD(P)(H)-utilising enzymes, including those involved in the biosynthesis of NAD, by competing with the NAD binding domain, using NAD mimetic libraries.The programme of work is based on a NAD mimetic pilot study that identified a number of lead-like scaffolds with promising activity and selectivity. Building from the molecular starting point library used in the pilot study, a second generation library will be created and tested in a screening cascade which blends the strengths of target-based optimisation with the power of whole cell screens. The design of the primary library involves pharmacophore and substructure overlap together with the mapping of key interactions between NAD and the cognate binding site, based on known co-crystallisation studies. The screening cascade is designed to build on the strengths of (a) target-based approaches (early structural knowledge facilitates compound optimization) and (b) whole cell screening (early proof of whole cell activity ensures drug-like behaviour in all early series). The key challenge in targeting the ubiquitous NAD molecule is to introduce specificity. The literature precedence and AstraZeneca’s initial work suggest that this is achievable.
