Integrating Diagnostics for Global Health Equity with Dr. Ben LaBrot

Summary

Podcast Summary: "Integrating Diagnostics for Global Health Equity"

Podcast: A Shot in the Arm
Host: Ben Plumley
Guest: Dr. Ben LaBrot (Roche Diagnostics & Floating Doctors)
Date: November 11, 2024

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Episode Overview

This episode explores the critical role of diagnostics in advancing global health equity, focusing on the integration of diagnostic services, especially for infectious diseases like HIV, hepatitis, and tuberculosis. Host Ben Plumley and returning guest Dr. Ben LaBrot discuss trends from recent international conferences, real-world challenges in low- and middle-income countries, new diagnostic innovations, and the need for both systemic and behavioral changes to improve healthcare access and efficacy.

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Key Discussion Points & Insights

1. The State of Diagnostics in Global Health

• Diagnostics is often considered the "Cinderella of global health"—overlooked but essential for both population-level disease surveillance and personal treatment decisions. (A - 00:00)
• Recent global health conferences emphasized integrating services rather than keeping them isolated in "silos." (B - 01:41)

Notable Quote:

“The need to increase access to diagnostics... was a big emphasis at R4P. All the stakeholders, all the way down to the patient, really need a broad menu of different options for both prevention and diagnosis and treatment.”
– Dr. Ben LaBrot [02:11]

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2. Integration vs. Siloed Approaches

• Vertical, disease-specific programs (e.g., HIV alone) were effective in emergencies but now hinder broader, holistic care. (A - 06:28)
• Integrating testing and treatment makes practical sense, particularly in countries experiencing overlapping epidemics and migratory pressures (e.g., HIV/TB among Venezuelan refugees in Peru). (B - 03:37–07:11)

Notable Quote:

“If we get these people in front of us once... we need to give them the works... The services themselves need to be integrated.”
– Dr. Ben LaBrot [04:42]

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3. Changing Provider and Patient Behavior

• There is a strong need to “incentivize healthcare workers to think in a more holistic way” and not be constrained by specializations or bureaucratic boundaries. (A - 08:07)
• WHO and global guidelines need to evolve to encourage integrated, context-specific solutions rather than one-size-fits-all. (B - 08:16)

Notable Quote:

“Global guidelines really need to take into account the individual needs of all these different countries and even different regions within countries.”
– Dr. Ben LaBrot [09:19]

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4. Progress & Innovation in Diagnostics

• Growing movement toward test "panels" and consolidated laboratory platforms, rather than single-purpose machines. (B - 12:10–13:31)
• Need to balance decentralized, rapid point-of-care testing with high-quality, centralized reference labs, especially in resource-limited settings. (A & B - 13:39–15:08)
• Discussion of Roche's plasma separation card—a technology allowing stable, high-quality blood samples to be easily transported from remote areas without refrigeration. (B - 16:34, 18:44)

Notable Quote:

“The plasma separation card is essentially like a dried blood spot but with a fine filter... so you’re left with a dried plasma spot, and that gives you much cleaner opportunities for molecular PCR.”
– Dr. Ben LaBrot [19:36]

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5. Equity and the "Middle-Income Country Paradox"

• Middle-income countries often fall through the cracks: ineligible for low-income-targeted subsidized diagnostics; lacking the resources of wealthy nations. (B - 20:57)
• These countries have enough resources and infrastructure to make good use of support—greater impact could result from investment.

Notable Quote:

“We middle-income countries... feel like, forgive me if this is exactly the way it was said to me by at least six people, that we’re not shitty enough... not in bad enough shape to warrant any kind of consideration or support.”
– Dr. Ben LaBrot [22:18]

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6. Patient Empowerment & Information Dissemination

• Both providers and patients need to be empowered: training for holistic care, and patient education so individuals can advocate for comprehensive testing. (B - 28:13–29:06)
• WHO’s recent social media campaigns using influencers to spread accurate health information are highlighted as promising.

Notable Quote:

“If you can reach patients where they already are on the social media platforms that they're already using, there's a real opportunity to get this messaging... so that patients know what they need.”
– Dr. Ben LaBrot [31:07]

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7. Leveraging Trusted Messengers & New Media

• The challenge is to outcompete misinformation ("weeds") with trustworthy, targeted “flowers”—messages from influencers or community leaders whom people trust. (A & B - 33:06–36:06)
• Practical example: Panama engaged religious leaders during COVID-19 for grassroots information sharing—a model for efficient, trusted communication.
• Companies should focus on meeting people "where they are," physically and digitally. (B - 36:06)

Notable Quote:

“The weeds are going to grow no matter what we do... if we can plant enough flowers, maybe people will... start seeing the flowers, not just the weeds.”
– Dr. Ben LaBrot [34:06]

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8. HIV/TB Co-infection & Practical Diagnostic Challenges

• Real-world experience: completion rates for TB treatment are dismal in rural Panama.
• Integrating diagnostics is not just optimal; it's essential—HIV or TB cannot be effectively managed in isolation. (B - 39:23–42:16)

Notable Quote:

“It’s almost not worth just managing a patient’s HIV if you ignore their TB and vice versa... whatever you did with one was almost a waste because the other one is going to get them.”
– Dr. Ben LaBrot [41:51]

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9. Building Capacity Among Researchers in the Global South

• Industry and academia need to invest in emerging, motivated local researchers—those on the front lines—rather than only established figures in wealthy countries. (B - 42:57–45:58)
• These practitioners will be future leaders and decision-makers.

Notable Quote:

“From an industry point of view, not targeting those researchers for support is a huge strategic blunder because... they will become your most loyal collaborators... making decisions about what platforms of diagnostics or programs to have.”
– Dr. Ben LaBrot [45:13]

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Notable Quotes & Memorable Moments

• [02:11] Dr. Ben LaBrot: “All the stakeholders, all the way down to the patient, really need a broad menu of different options for both prevention and diagnosis and treatment so that patients can really be empowered.”
• [09:19] Dr. Ben LaBrot: “These global guidelines can’t just be handed down from above… [they] really need to take into account the individual needs of different countries and regions.”
• [22:18] Dr. Ben LaBrot: "We middle-income countries... feel like we're not shitty enough. Like, we're not, you know, we're not in bad enough shape to warrant any kind of consideration or support."
• [34:06] Dr. Ben LaBrot: “If we can plant enough flowers, maybe people will, you know, start seeing the flowers, not just the weeds.”
• [41:51] Dr. Ben LaBrot: "It's almost not worth just managing a patient's HIV if you ignore their TB and vice versa... the other one is going to get them."

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Timestamps for Key Segments

• 00:00–02:41 – Setting the stage: diagnostics as the “Cinderella” in global health
• 03:37–07:11 – The problem with siloed services; refugee context in Peru
• 08:07–10:38 – Rethinking professional education and guidelines for integration
• 12:10–15:08 – Innovations in diagnostics/testing platforms & field realities
• 16:34–20:25 – Plasma separation card innovation & challenges in remote sample collection
• 20:57–26:52 – The “middle-income country paradox” in access and equity
• 28:13–34:06 – Patient/provider empowerment & communication strategy
• 36:06–39:01 – Panama’s use of religious leaders; social media and influencers
• 39:23–42:16 – HIV/TB co-infection: why integrated care is vital
• 42:57–45:58 – Building research capacity in high-burden regions

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Conclusion

The episode is a nuanced call-to-action for breaking down traditional barriers in global health diagnostics. It spotlights innovations, the need for holistic provider and patient engagement, and creative strategies for disseminating accurate information. Most pressingly, it underscores the necessity of integration—across diseases, diagnostics, and policy frameworks—to achieve meaningful progress in global health equity.

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For listeners seeking accessible explanations, innovative ideas, and actionable insights at the intersection of diagnostics and global health policy—this episode delivers.

Transcript

[A]

Welcome to A Shot in the Arm podcast. I'm your host, Ben Plumley, and this is a podcast about innovation and equity in global health. And this is one of our regular updates to explore what is going on in the world of diagnostics. Very often the Cinderella of global health. Yet so essential to understanding both at a population based, what is going on with existing and new infectious diseases, but also very important, primarily from the personal perspective, what does it mean for an individual and how can they get the best treatment and how can they monitor that it is continuing to work for them. Well, and as always on these diagnostic conversations, I'm delighted to be joined by Ben Labrotta from Roche Diagnostics. He is a physician working both in the industry, but also of course, as a nonprofit leader in his own right. Ben, it's great to have you back on A Shot in the Arm. Where are you at the moment?

[B]

Actually, on my last day in Panama, wrapping up a bit of a roadshow through Latin America in Peru and Brazil as well.

[A]

So we've not spoken since just before the AIDS conference in Munich back in July. And I guess in your travels you will have been at the R4P conference, also organized by the International Aid Society in Lima. Research for Prevention.

What have you learned? What have you picked up over the course of these conferences?

[B]

You know, the, the R4P conference mirrored in many ways the messaging from the main AIDS conference and.

Seeing some of the same themes, which are again, the need to increase access to treatment, the need to increase access to diagnostics. One of the things I really noted at this more recent conference was the big emphasis on integration of kind of siloed HIV and STI and hepatitis services with other services.

And also a big emphasis at R4p on the need for options and choices that patients, countries, all the stakeholders, all the way down to the patient, really need a broad menu of different options for both prevention and diagnosis and treatment so that patients can really be empowered to engage with options that fit their own lifestyle and fit their own needs better. And I couldn't agree more.

[A]

Do you know? So one of our co hosts, Yvette Rafael, will be very happy to hear you raise choice. That's something that's very, very close to her heart, particularly as it relates to options for women and girls with HIV prevention. But we're really going to focus in on this integration question in this podcast and.

On one hand it makes a great deal of sense. You know, don't have siloed tests for individual.

Infectious diseases. Go and get a test that can connect with that can provide information about a range of things.

And I guess we're not quite at the point where this is a reality, although we're getting there. What have you learned around integration since Munich and then coming out of Lima?

[B]

You know, prior to Munich, actually, I saw a really interesting paper that was looking at emergency room visits. This was in the US and they went back and looked at several thousand emergency room visits where the patients were attending for broken wrist or a stomach pain or whatever. And the people doing the study looked at these case histories and went, huh, now this person really had indications for HIV screening, but. But of course received none. And they went back and followed a lot of these and found out how many of those patients eventually went on to be diagnosed in other settings. And it was staggering number. Like 7% of these were just totally missed opportunities. But in a world of increasing medical specialization, it can become quite difficult to providers to think outside their lane. And there's this weird disconnect between the way things are being practiced because that's of course, within the U.S. every country I visited on this trip, you know, the complaints are often from the hepatitis research are saying there's a totally different body working on hiv, there's a completely different office working on sti, TB is way out here. And like in Brazil, for example, one of the, excuse me, in Peru, one of the investigators that hopefully we'll be doing a study with soon was really complaining about the difficulty of high rates of CO infection with tuberculosis and HIV in Peru. Peru has absorbed about 2 million Venezuelan refugees essentially, and quite a number of them were HIV positive and also had tb. So now into the, you know, their country has this huge influx. You know, it's this public health problem and trying to, you know, a lot of these patients are impoverished or you have doubtful immigration status. All the same kinds of challenges you see with these populations at any setting. And they're like, look, if we get these people in front of us once in, whether it's in a maternal health clinic or an STI clinic or you know, general health clinic, like we need to, we need to give them the works. Like we need to be doing this kind of testing altogether. And the services, not just the diagnosis, but the services themselves need to be integrated. And this kind of optimization makes so much sense. You know, it's sometimes quite frustrating for especially individual practitioners to be sort of forced institutionally into totally separate areas where to try and do any project or start anything new. You now have to get alignment from 10 different bodies rather than work with one body. And so this is, yeah, concept of integration is really something we need to throw a lot of weight behind to demonstrate how well it works.

[A]

It makes me think, because, you know, it's the scourge of the AIDS response, in a sense, the scourge of the legacy of the AIDS response, the exceptionalism of HIV back in the 2000s and the 2000s and tens. Because we were just trying to get it on the agenda and raise money, which we were very successful in doing in pushing the HIV agenda. The flip side is that we created a very siloed vertical program which seemed to meet the needs, emergency needs at the time, but which practically makes no sense at all. And so we've, I think, in the AIDS movement, had a hard time.

Opening up and letting a thousand flowers bloom. But there's also a medical side to it which is. And I don't know how you feel about this, but this sense that you have disciplines that are very protective and even within infectious disease. You mentioned hepatitis, hepatitis B versus hepatitis C versus hiv. And then, of course, you have this underlying issue of tuberculosis. You raised it as in, you know, relates to Peru. I was not aware of that. But of course it makes total sense. And of course, you see it particularly in southern Africa. HIV has been one of the drivers of the increasing rates of TB over the last few decades. Do you think there is something that needs to be done in the way we train and educate and.

Dare I say, incentivized healthcare workers to think in a more holistic way?

[B]

Yes. The short answer, yes. And I guess, you know, there's a few ways we could really look at this. When we look at guidelines that are released by, like, World Health Organization, they release guidelines for hepatitis. And what I'd really like to see would be a lot more emphasis on guidelines for integrated testing. And, you know, one of the things that I realized during this trip that we're sort of accustomed to is, you know, World Health Organization or UN will kind of set these global guidelines. And one of the things I was hearing a lot, both at the conference and in my conversations during this trip was every. And there was some. There was some specific research at R4P actually looking at this. You know, every. Every country. I teach malaria at USC as well. And only a week or two ago, or two or three weeks ago in class, I was sharing the observations of a malariologist from 200 years ago who was saying, look, problem with malaria is it's a thousand different diseases in a thousand different places. And what is the best thing to do in one place might be the worst thing to do only 40 miles away. Now, we love our single bullet solutions, you know, as humans, like we're always looking for universally applicable things. But it's really important to consider that these global guidelines can't just be handed down from above, that these global guidelines really need to take into account the individual needs of all these different countries and even different regions within countries. And I think like, you know, like getting some global guidance that really starts emphasizing integrate, not just telling people you should integrate, but releasing guidelines that show how to integrate by releasing strategies for integration. And especially, you know, some of the health economics, you know, stuff related to how much more efficient these integrated programs can be, how much, you know, it's a lot easier to have one group that's doing like all this work than 12 different groups doing all this work. So obviously like people are always a little bit protective of their specialties, protective of their territory. But if national governments might get a little more encouragement and support at biting the bullet and pushing some of these programs closer together and integrating these programs officially, I think that would be really helpful.

[A]

And there's a wonderful incentive, I think, facing all of us interested in healthcare and that is.

Cost efficiencies and decreasing budgets. And in many ways, if there isn't a greater incentive to treat people and treat them well and treat more of them, it means we have to join the dots, we have to integrate.

So it's going to be forced upon us. And I guess this sort of brings us onto the diagnostics component of the conversation. I guess diagnostics ought to be the place where the magic happens. You mentioned folks coming into the emergency room with a broken arm.

But for whatever reason, you come into a healthcare provider's facility in whatever context, and you could be offered an HIV test, a test for hepatitis, pregnancy test, who knows? How do we make sure that what we're offering people perhaps is, oh, how much blood are you going to take from me? You know, a platform that covers as much of the likely tests that you're going to need in a particular context, in a particular locality. How close are we to being at that point where we can do this?

[B]

I think, you know, at least speaking from my area of molecular diagnostics, I do feel like I'm just starting to kind of see movement in that direction. The combining of individual tests into panels. For example, one of the things I heard a lot on this trip was, you know, in relation to hepatitis B and hepatitis D. Roche has just released a hepatitis delta RNA molecular test as a research Use only assay. And I had a number of hepatitis B researchers essentially say, can you, can we have one test that does hepatitis B and hepatitis D?

Some of those ideas, just combining all these things into one stop shop. Another complaint I often heard was that within Ministry of Health or something like that, there's one machine that they obtained to test for HIV and, and a different machine that they use for this, a different machine for this. And there was, you know, a lot of interest in can we just have like a machine that has great big portfolio so we can run all these tests on one machine? Which was one of my purposes in coming was try to encourage and facilitate some studies happening with some of Rocha's platforms that are, you know, have a very large test venue, you know, for that very reason.

[A]

And again, it sort of goes to the be careful what you wish for.

Challenge in front of us because we've been trying to push diagnostics closer and closer to the people so that if you need a test, you can get it done quickly, you get a result quickly. And that's also taken us in the HIV front to self testing, which throws all sorts of other questions open, which I want to come back to, particularly given the amount of gray hair I have and the experience of the HIV response over 30 years. But there is a sort of a push and pull here, getting tests closer to people. So point of care, simple rapid versus providing.

A platform that's going to need these reference laboratories. You and I have spoken over the years of how important it is to have the hub and spoke and that the hub, particularly these reference laboratories that are easily accessible by everyone to cover as much of the testing needs as possible or reinforcing and confirming initial testing.

How far are we in sort of reconciling these two?

And you know, we'll come on to what it looks like in country practice in a moment. But how is the research looking in terms of making this sort of balance work?

[B]

So I would say finally starting to make a little bit of progress in that regard. There's really sort of two avenues that people are looking at. One is moving more and more plain of care, so much so that you've got like World Health Organization guidance going. Look, in some settings, you know, to rapid test to using two different rapid tests would be enough to like confirm diagnosis. Right? You know, so on the other end of the spectrum you have access to central laboratory molecular diagnostics, you know, PCR, you know, down to like 12 copies, you know, like. And so I always find myself, you know, both as a Member of industry and as a, you know, NGO leader who spent my entire practice working in the middle of the jungle, far from any electricity or water, any access to cold chain storage or et cetera, lab testing as trying to find ways not to go either or okay, this setting will only be good for some kind of point of care rapid test. This setting will is the only setting where they can have central lab. I keep looking for ways to bridge those gaps and one of Roche's products that is very interesting in that regard is the plasma separation card which Roach developed specifically to try and link communities and populations that previously just have no access to central laboratory testing with the kind of performance and high throughput and sensitivity that you expect from a central lab. So it's like that was a, that.

[A]

Was a collaboration with product Red, wasn't it? And you know, particularly for mother to child transmission, I mean I think it had a huge impact, generated significant.

Interest and helped.

The Cinderella of the HIV response diagnostics get to the ball.

[B]

And so I've been really trying to take this integrated testing model. Roche's claims on the plasma separation card as a sample type at the moment are for HIV 1 viral load and very recently for hepatitis C RNA, which also performs very well at. But I look at a tool like that and I think to myself, you know, what about syphilis, what about tuberculosis, what about gonorrhea, what about hepatitis? And so actually I probably have five or six studies running right now, like in Ghana, in Pakistan.

I'm actually anticipating the submission of several proposals now from this trip from this Latin America. I'm very excited with like sexual health clinic, a maternal health clinic, you know, non traditional settings to actually do this kind of hepatitis and HIV testing in where they're going to be utilizing the plasma separation card to really kind of see what it can do and to kind of demonstrate the utility of something that doesn't require refrigeration and is temperature stable at 42 Celsius for two months in an envelope to be able to link via these underserved patient populations with central laboratory performance. So really exciting.

[A]

So for people who, who don't, who don't live and breathe diagnostics, the plasma separation card, it's like a dry blood spot test, isn't it? You have a card and you send that off and what you're saying with it being stable at 42 degrees for a few months is that it could get caught up in a country's slow.

Reference distribution and submission of samples or.

[B]

I mean it could be in the trunk of a Ministry of Health Land Rover for three weeks or in a backpack of some community health worker on a motorcycle that's working in these very remote settings and only periodically, or a very remote health center that only periodically is able to send any kind of sample and even then not under cold chain storage. So that's the plastic separation carb is really designed to try and overcome that lack of cold chain storage, which is what I'm really trying to demonstrate with it. So yeah, really excited about the possibilities for it especially, I mean we're really casting a wide net, experimenting off label with biochemistry with other types of serology. And yeah, after this period of discovery, I'm very interested to see what kind of evidence collection I'll have to demonstrate, I hope a much wider potential for the use of this card for testing, hopefully a wide variety of biomarkers. The dried blood spot is really great. A lot of people have been using that for a long time, but it's dried whole blood. And from molecular testing, the problem with whole blood is that all that pesky human DNA in the red blood cells and white blood cells gets in the way of your PCR testing. So the plasma separation card is essentially it's like a dried blood spot but with a very fine filter over the spot. So the filter path or the absorbent pad sucks the blood through this filter and all the whole blood products get filtered out. So you're left with a dried plasma spot and that gives you much cleaner opportunities for molecular pcr.

[A]

I love that innovation, particularly because.

It doesn't involve complex technology, cartridges, Bluetooth and wireless access that may be difficult in many settings. And I guess this gets to the other point. You've been looking at access to diagnostics across the world. What have you been seeing in terms of low and middle income countries? Just how many people do get access to diagnostics routinely?

[B]

You know, I'm glad you asked and I'm glad that you mentioned middle income countries because I would say that my biggest insight from this trip was every person I talked to, their ministry of health doctor, their research didn't matter, who affiliate members, whoever I talked to, if they were from a middle income country, they said the same thing, which was we are very frustrated because we understand that most, you know, money from international sources, money from World Health Organization, external support is really, you know, global access. Pricing from industry is really focused heavily on low income countries, the countries with the greatest need. And they were essentially like, look, we get that right, we understand prioritizing resources for where the need is greatest. They said, but we really feel left out. We middle income countries essentially feel like, and forgive me if this is exactly the way it was said to me by at least six people that we're not shitty enough. Like, we're not, you know, we're not in bad enough shape to warrant any kind of consideration or support. They're like, oh, you guys are middle income country, you're fine. And they were like, look, you have a very low income, high need setting, you put in this much resource and you get maybe this much benefit. But we middle income countries, maybe you give us this much support, we could get this much benefit because we have some infrastructure and some programs and motivated people and knowledge resources, but we're just not in bad enough shape to warrant much attention. And so the middle income countries, I learned, have this real sense of feeling left out. You know, it's real like middle child syndrome actually, like where they're like, oh, they're fine, they're not so young that we need to pay attention to them and they're not so old that they don't need any attention. They just. But they really get ignored. And so I'm really, the message I'm really carrying back to, you know, at least our industry is we really need to look more closely at the way we evaluate opportunities for supporting middle income country activities because these are the countries that are best positioned, you know, to actually make real gains. I actually was sitting a few months ago at some other event next to a person in Los Angeles who was on the, like the homeless council, you know, like the county board, trying to combat unhoused, you know, kind of situations in Los Angeles, which as many people know, is very severe. And he expressed the exact same thing to me. He said, you know, right now the vast majority of resources are prioritized for the unhoused who have the greatest need. He said, and you get that, that makes sense, like ethically. He said, but like I routinely, you see like a recently homeless family where both parents are working, but they've just become homeless. They're all living out of their car, the kids are actually still in school. No one yet has a big substance abuse problem. And he said, those, if, if I could give them this much support, they'd be back, you know, housed again. You know, they stop that downward spiral. But I rarely have that support for them. Most of the support is for people the greatest need. He said, but those are folks that have mental health problems and criminal records and no job skills and substance abuse problems and histories of abuse. And he said, you can pour resources at those candidates. But your gains are quite modest compared to what you could get if you supported the middle income country version of the unhoused, which would be like a recently homeless family.

[A]

I'm nodding my head vigorously at everything that you're saying because this is a really timely conversation. You've got a large pharmaceutical company that had some extremely interesting data at the Lima AIDS conference about the performance of a long acting injectable for prevention. And it's announced an access strategy globally which is terrific in advance of the product actually being fully approved for prevention. But it's getting criticism that that access program is not available to middle income countries. And you know, this is a problem. You know, who pays. I remember a South African activist saying to me a good few years ago that South Africa should not be treated in the same way that you would treat Zimbabwe when South Africa had just put an order in for I think four or five new submarines. So it's about national prioritization around health. But again, it's a little bit like, you know, the chicken and the egg. And you get around that by saying if you build it, they will come. And if health policymakers know that it may not be at the same level of affordability or accessibility as you would in the poorest settings, but if they know that it is going to be doable, there's absolutely a coming together. I think that can happen. And I think you are spot on about the folks who are just getting themselves into housing, what up in Northern California they call the marginally housed. And I think that's absolutely right. They've got to be services, particularly around diagnostics, because you need to know what you're dealing with. You as an individual need to know what you're dealing with. And if you have limited access to your doctor or nurse, you want to make best use of that time. And the best use of that time is, is to say, well, let's as well as checking your viral load. If you're HIV positive, is your treatment working? Let's see how you're doing with these other potential diseases.

Hepatitis is a, is a grand ex, or the hepatitis, the viral hepatitis is a grand example of that. So I'm really glad we've, you know, you've raised that.

With us.

So going forward, looking at what you're doing with the company Roche, but also with your own nonprofit work, where do you go from here in building an integrated.

Approach to promoting diagnostics, to promoting integrated access to diagnostics?

[B]

Oh, I mean, what, oh, and as an aside, without naming Any names? Let's just say a lot of people had a lot to say, you know, during this, you know, Latin America trip of mine about the, you know, kind of new, you know, permission to manufacture generically of this particular medication and a lot of grumbling from middle income countries about. And it was a real, there was a certain cynicism too, kind of a. And once again, we're being totally left out of that, even though we're in the best position to make good the best use of this. Yeah, like it was a real. There was definitely some strong feelings about this. So, yeah, I like noted.

What we can do. I mean, I guess with my floating doctors hat. In my own organization.

We really do two things right. We're providing health services, but one of the ways we support those health services is by inviting foreign physicians and health workers and students to come and train with us. And the funding from that training program really supports the medical program itself. And we're constantly emphasizing to them, don't forget to ask the patient how they're sleeping, how are things at home? How are they coping? What are they eating? They came for their broken wrist. You're going to ask all these other things. Ask them the questions that will let you know, should I offer them an HIV test? Do they fall into a category where they're supposed to ask them if they've ever been screened for hepatitis B? Have they been vaccinated for hepatitis B? If not, offer them the test. And so, I mean, certainly the messaging to providers.

Really needs to encourage like, hey, don't forget to ask about this, ask about this. And the other is, and this I think has not been done as effectively yet. It's to really aim that messaging at patients. Patients. And I kind of look at how healthcare has progressed in the US and especially over the last 10 or 15 years. I feel like the likelihood that patients are going to really get what they need when they go to their provider is becoming increasingly dependent on the patient to know what it is that they really need so that they can ask for what they need. Every story I hear is I went, and then the doctor did this And I asked them, well, should I also have this? And Dr. Went, you know, that's a good idea. And they ordered it. And I like the idea of not just trying to empower and support physicians to do this kind of more paternalistic model. I really like the idea of making sure that patients understand what their options are, what their health needs are. I saw, actually only recently, I had no idea about this, that the world Health organization has, and I have no idea how new this is, has embarked on a really big social media campaign. I guess they had like 800 content creators, as the website said, they reached like 150 million people. So I just found out about this and I had no idea, like, what outlets and platforms they're using. But I, I plan to reach out and kind of see what industry can do, like, if they're working with content creators, like, here's our industry is forever creating content to educate patients, to educate providers, to educate policymakers. And of course, the traditional ways we get that information out doesn't always reach people. You put it up on a website somewhere, hidden on your industry's pages. Not every.

Patient in the street is going to access those. But if you can reach patients where they already are on the social media platforms that they're already using.

There'S a real opportunity to get this messaging, to get the right and accurate messaging out there so that patients know what they need.

[A]

And I really, that was the whole reason for setting up a shot in the arm podcast. I spent God, 20 years convening and then drafting reports.

You know, expert reports, action reports, calls to action. They look great as public published materials and they went onto people's shelves. Nothing ever happened with them. And, and I think, you know, a, a, a really big interest for us, of course, is, you know, LinkedIn, YouTube, Spotify, particularly to reach an audience that perhaps wouldn't necessarily think about, say, diagnostics as part of a health policy work. Were very niche, of course, in speaking to health policy folks, speaking to ourselves, one might say. But there are different ways of communicating and reaching people. And you know, our assistant producer who does a number of podcasts herself, Waisha Rafael, looks particularly at who influences young people, who do they listen to and who do they trust? And influences are absolutely essential in that and presenting information in ways that make sense, ways that, you know, we, at the other end of the spectrum, us perennial teenagers, might not think is entirely relevant. So I'm with you entirely. And I think.

You know, a next wave of integration of healthcare, of wellness is going to have to include.

Influencers, people, trusted sources of information or information sources that are trusted by people.

As entry points. Of course, the thousand flowers blooming model also involves perhaps 1500 weeds emerging at the same time. So that whole information misinformation and disinformation. But nonetheless, I think you're absolutely, absolutely right. But what do you think.

Companies working in the health sphere can do to.

Capitalize on that, support that without being drawn down into, you know.

For those of us who still watch terrestrial or terrestrial cable TV during the advert break, seeing the, the long list of pharmaceutical adverts.

[B]

You know, the Thousand Weeds was actually a really good example because the weeds were already growing. Right? The weeds are going to grow no matter what we do. And so I have heard people got to, you know, kind of go, well what's the point of like messaging out there? Because there's all these we all these weeds. And I of course take the opposite view and say that's why it's so important to plant these flowers. Yeah, we can plant enough flowers, maybe people will, you know, start seeing the flowers, not just the weeds. And you know, people will be able to make up their own minds. I think, you know, your point about using trusted stakeholders is the key. You know, a lot of people for all over the world, for all kinds of reasons, don't necessarily trust messaging that comes from their government or comes from industry or comes from. And, but they might, but everyone has some kind of stakeholder that they really listen to. Panama, outside of social media did something interesting during the pandemic. They were trying to roll out their vaccine program and you know, not necessarily wanting to spend tens of millions of dollars to establish a new government agency to disseminate information. Panama, one of the things they did was they called like the head bishop of Panama and rabbi and imam, all the major religious leaders and said, hey, you guys have an existing network of trusted community leaders that extends from like the capital city all the way down into all these tiny little remote villages. Can we give you guys the information about the vaccine that we want to get out and can you disseminate it through stakeholder all your stakeholders who are already trusted community members and by giving them the right information, it also prevented them, by giving them flowers, it also prevented them from handing out weeds based on misinformation. And I thought that that was such a typical lower middle income country. Solution, efficiency solution, you know, of course, you know, I asked some of my, a couple of friends who are priests in the U.S. he's like, did anyone in the U.S. come to you guys about that? And they're like, no, of course not. Nobody's talk to us about that. And I was thinking what a, what a missed opportunity that would have been, you know, to get messaging out. Because plenty of people in the US heard messaging from CDC or government or health agencies and were automatically skeptical just because, you know, people in the US are often like that. So yeah, really finding out who these trusted stakeholders are this is conversations that we've been having in Roche, you know, over the last year, you know, like where are people getting it? I saw not at these this year, but last year there was, was an interesting presentation where and I pretty sure it was with Grindr, you know, that app, you know, which has ads on it. You know, they started including ads that were about prep and access to prep. And through the ad you could actually select a link that would link you to receiving like self testing materials through the mail. And I thought this is talk about, we always talk about reaching people where they are, where they live, but we've so far really focused on that physically and we've sort of neglected digitally. Like where can we reach people digitally? That's why I like coming on a shot in the arm. Typically industry might put on some kind of event at a conference where if 60 physicians come, that's a huge success and it's very expensive and who knows, like the 60, what will actually come of that. And the first time that we did a podcast and I took the analytics back about three or four weeks later and we were able to go like, oh, and by the way, 50,000 people have listened to this already in like 15 countries. You know, a lot of people within our company were like, wait, what? And it really spurred a lot of interest in Roche, even starting to make their own podcasts and looking for these other sources and ways to reach providers, policymakers and patients where they're already hanging out and really like identifying the key individual agencies or individual stakeholder influencers and partnering with them to deliver the messaging, I think is really the next stage in the evolution of trying to meet these information challenges.

[A]

And we have to learn that people are consuming content in very, very different ways.

Not going to get into politics, but. But you'll notice that in the United States, both candidates have been spending a lot of time on podcasts.

And podcasts that are not, you know, organized by the New York Times or Politico, but really sort of getting out there. And I think, you know, that is the future. That's absolutely the future. There was one other area, Ben, turning track that I wanted to come back to. You mentioned the co infection of HIV and TB that you were seeing in Lima.

In part I guess caused by the flow of refugees coming from Venezuela. But I wonder if you could reflect a bit more on that co infection and again, where integrated diagnostics could help drive effective care for folks.

[B]

Sure. I mean, so here you've got these two diseases, one of which for, let's say for practical Purposes can't be cured. Yes, I know we just had another patient, the oldest patient yet. So awesome. But for practical purposes, a disease, hiv, that's going to require lifelong treatment and lifelong laundry. And then the other side, you've got tuberculosis, this condition that very easily develops resistance that requires taking multiple medications for six months, nine months longer if it's resistant. And the consequences, of course, of interrupting that treatment are catastrophic from an individual and public health standpoint. Yeah, I would say of the patients I encounter in Panama, who had in. In rural settings where I work in Panama, patients who had ever commenced treatment on. For tuberculosis, I would estimate that one. And this is again, just back of the envelope, you know, like, what's my anecdotal experience? I would say one out of every 100 to 200 completed their therapy, you know, that the other 99 to 199 interrupted somewhere in that region. Sometimes, you know, they might miss an appointment because they had to travel two days to get there. And then they were worried about going back. They're worried they get in trouble or they stop because they felt better, which most people, when they start their TB treatment, feel a lot better really soon. And then just like, you know, patients taking amoxicillin for, you know, chest detection, the States, you know, take this for 10 days. After five days, they're like, I feel better. And they stop taking it. And then they. And yeah, resistance. So, you know, these are. Both of these conditions are ones that require pretty high investment of clinical time, like with the patients. And you can either do that twice in two separate settings, or you could do this once in one setting where you're monitoring and treating their TB at the same time that you're monitoring and treating their hiv. And this is where.

In diagnostics, having one machine that can do both, potentially having sample types or tests where one can do both, things like that, these would all be big advantages in being able to provide patients these care. Because it's almost not worth just managing a patient's HIV if you ignore their TB and vice versa. Because if you ignore one and not the other, whatever you did with one was almost a waste because the other one is going to get them. Yeah. And so these are not just like, well, it's more optimal. This is where if you want your HIV treatment to be worthwhile, you can't afford to ignore their TB or vice versa.

[A]

And this is where.

Funding mechanisms like the Global Fund, which covers aids, TB and malaria, but the AIDS and TB particularly can really play a role in incentivizing that Approach to an integrated.

Comprehensive approach to diagnosis and care. Well, look, Ben, we're getting up to the top of the hour. Is there anything that we've missed, any nugget of wisdom from your travels these last few months that you think our listeners and viewers might benefit from?

[B]

Yes. I have one more observation that I think might have real value both for industry and for all of the people trying to actually combat these. Traditionally, you know, as an industry person trying to develop new evidence, you know, you're partnering with researchers to do studies that use your test, you know, in a particular way or check its performance against other things like that. Most of the time, traditionally we really try to target like the most famous investigators, right? Who is the who's like the main kol in this space, things like that. And when I came into aro, you know, a lot of our studies for HIV and hepatitis were at that time really heavily located in Europe, like with really, you know, a lot of awesome investigators, you know, that I've had, I've learned a lot from working with. But I really wanted to try and move a lot of our research into the countries and regions where the burden is the highest, where you've got a combination of like young and hungry practitioners and people who really want to get into research but don't necessarily command big academic departments, an army of graduate students for their data analysis, publication support and all that stuff. And also really experienced physicians who haven't maybe published that much yet, but, oh, have spent 30 years in the front lines combating these conditions where they are, and have this wealth of knowledge and experience. And I've found ways to really engage the ARO resources to support these earlier career stage investigators or later career stage investigators who haven't been able to leverage their experience on the world stage yet, to really start getting published and getting research at some of these big conferences and being able to establish a presence. And of course, from their point of view, this is really useful in helping them develop professionally and helping them develop the evidence that they know is needed to convince local policymakers what needs to be done. From an industry point of view, not targeting those researchers for support is a huge strategic blunder because these are the researchers who will become your most loyal collaborators and the ones who 5 years from now, 10 years from now, will be making the guidelines for the Ministry of Health in their countries, making decisions about what platforms of diagnostics or programs to have. And so that is definitely my advice to industry is to don't neglect the young and hungry or very experienced, but not well published researchers who have faced real barriers to being able to do research because they have a lot to offer. And really these are the folks who are going to be leading the charge, especially in low and middle income countries.

[A]

And it's sort of a physician's or receipt researchers perspective of nothing for us without us. So. Yeah. Amen to that. Our Ben. Well, look, with that, I'll let you get back to packing for your flight home.

We actually live in the same state, although the opposite ends. And I. We should really sort of try and do one of these in person. So whenever you're up in Sacramento or there's an invitation for you to come up to Sacramento and record in person, it would be great.

[B]

That would be fun. Count me in. And Croy is going to be in San Francisco in the spring, so that might.

[A]

That is right. Yeah. Yeah, we'll do it. We'll do a lot of stuff from Croy. Oh, yeah. Oh yeah.

[B]

You'll be, you'll be at Cry this year.

[A]

Oh, hell yes. Yeah.

[B]

Awesome.

[A]

Yeah.

[B]

What a great conference. All the really juicy research gets saved up for Croy. I feel like.

[A]

Yeah, yeah. And I mean what they will think of me saying, will you be a Croy? Hell yes. There we are. Okay, Ben, well, fair winds, as you say, travel safe and we'll see you soon.

[B]

Thank you so much, Ben. Always a pleasure.

[A]

Well, that's it for this episode. Thank you to Ben Labrot for all of his insights. Thanks to. To Erica Spara, our director and producer from newsdoc Media. A big thanks to Waisha Raphael, our assistant producer. And finally, a big thanks to you. Don't forget to subscribe and give us five stars. Hope you enjoyed this episode. Have a great week and a safe week, everyone.