Q&A: Essential diagnostics key to tackling noncommunicable diseases

Across the globe, the COVID-19 pandemic has disrupted basic health care services, but also the detection and long-term management of noncommunicable diseases, including heart disease, stroke, cancer, diabetes, and chronic lung disease. In addition to facing decreased access to services in thinly stretched health systems, people living with NCDs are also those most at risk of severe complications from other illnesses, including COVID-19.

The pandemic has further highlighted the importance of diagnostics. Even during a crisis, health systems must have the capacity to accurately diagnose and monitor individuals for a variety of conditions. Diagnostic tools are included in one of the six building blocks of a health system, as defined by the World Health Organization. WHO’s global NCD targets also include achieving an “80% availability of the affordable basic technologies and essential medicines … required to treat major NCDs in both public and private facilities” by 2025.

As health systems look to “build back better” and make up for stalled progress on achieving universal health coverage during the current pandemic, improved access to essential diagnostics and medicines will be key to ensuring the necessary diagnosis, treatment, and care for those living with NCDs — which are responsible for 41 million deaths each year.

Devex spoke to Lena Wahlhed, director of alliance development at HemoCue — a global leader and pioneer in point-of-care testing solutions — about the need for ensuring adequate access to essential diagnostics in low- and middle-income countries to combat and treat NCDs.

This conversation has been edited for length and clarity.

In many countries, resources have been diverted away from basic health services and toward the COVID-19 response. How has this impacted people living with NCDs and their access to diagnostics, medicines, and care?

These are conditions that need regular monitoring to adjust treatment and monitor progress. If tools for such are not available, there may be an increased risk of unnecessary and preventable complications. In addition to this, there may be a number of undiagnosed patients, which are at increased risk of severe illness and even premature deaths due to lack of adequate treatment.

Because of changes in global disease patterns, NCDs now account for 71% of all deaths annually. How is this shift impacting health systems in LMICs, and what can be done to ensure they are better prepared?

Behind those numbers are millions of people being affected, with a name, with a family, with friends. NCDs affect not just the one person but also the society at large. So these long-term conditions may have devastating effects. And as we’ve seen with COVID-19, many of the patients with preexisting NCDs are more vulnerable when a pandemic hits.

So what can we do to be better prepared? Reduce barriers, including addressing stigma and ensuring easy access to care. Primary health care and universal health coverage is No. 1. We need to view and treat each patient from a holistic point of view, because the same patient that has diabetes can also have anemia. The cause of anemia can be the first sign of renal disease due to complications from diabetes or a different reason such as malaria or malnutrition.

It is vital to act on early symptoms and to ensure that care is easily accessible. This includes the tool to detect a condition and monitor its progress, essential diagnostics, as well as the tools to treat [the condition]. It is usually more cost-efficient for a society to prevent than treat the long-term consequences of NCDs.

What’s the role of essential diagnostics in preventing and diagnosing NCDs? Can you give us a sense of the potential and scale?

A diagnosis is the first step to getting effective treatment, and every medical decision is dependent on an accurate diagnosis. Still, it is estimated that about 45% of diabetes cases in adults are being undiagnosed, [with] about 84% of these in LMICs.

A recently published study highlighted that diagnostics and monitoring tools for noncommunicable diseases is a missing component in the global response. These diagnostics are essential to have at the point of care in LMICs as well.

Essential diagnostics support multiple diagnoses. In diabetes, the most important tests are glucose for detecting diabetes [and] HbA1c [glycated hemoglobin] to monitor glucose levels over time and support treatment decisions. What is as important and sometimes underestimated is the importance of detecting anemia also in diabetes patients. A recent study done in Ethiopia showed a prevalence of anemia in close to 26% of ... diabetes patients screened for it.

These are tests that can be easily performed in low-resource settings and are proven to have an impact. It is also proven that point-of-care testing — allowing for direct feedback to the patient — has shown to also improve adherence to treatment.

The importance of essential diagnostics goes beyond age, ethnicity, gender, and diagnosis. They do not change as we go through the course of life. This further adds to their importance and cost-efficiency as tools for enhanced continuity of care.

What role does innovation play in helping to address some of these gaps? And what’s needed to ensure new solutions are sustainable at the local level and in low-income settings?

The best innovation is the one that is suitable for the environment where it needs to be used. It provides the expected results, and it does so for the long term. It doesn’t necessarily have to be a new innovation every time; the innovation that lasts is the best innovation. It needs to work in the location it’s meant for. It needs to serve that health care system, and it needs to add value to the health care provider and patient.

What’s your call to action on the importance of ensuring access to essential diagnostics? And what’s at stake if we don’t succeed?

The need is certainly there. The knowledge and the tools are available, as are the organizations that can support implementation and strong supply chains, yet the funding gap needs to be addressed.

A recently published article in [the journal] Global Health listed “more attention with regards to diagnostics for noncommunicable diseases as a key component of the health system is needed.” Another publication stated that with many people living in rural areas, access needs to be moved from hospitals and into smaller clinics and health posts as part of primary care. The WHO essential diagnostic list provides guidance as to which tests are essential in these settings — and all of them are available, accurate, and accessible with the right funding and programs.

In April, the World Health Organization launched the [Global] Diabetes Compact to help accelerate action on diabetes but also to highlight the need for an international funding mechanism dedicated to NCDs. Diabetes is increasing most rapidly in LMICs, and of the 15 million people who die prematurely from NCDs each year, 85% [of the deaths] occur in low- and middle-income countries.

It is equally important to understand competing priorities, but for short-term care and long-term impact, action is needed now. Essential diagnostics addressing public health challenges are available, yet they also need to be accessible and accurate and allow for sustainable impact.

Today, funding for NCDs can be improved. Primary care and universal health coverage require a collaborative effort with academia, financial institutions, implementing organizations, procurement agencies, and manufacturers. While this will take time, with partnership, collaboration, and dialogue, we’ll be able to kick-start action.

Primary care centers and health care posts need to be equipped with essential diagnostics in order to allow for the tools to subsequently treat a condition. Making these available will be key to reaching the health-related U.N. [United Nations] Sustainable Development Goals. If we are to realize life’s potential, we need to support medical decisions at the point of care for everyone.