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Purdues Global Impact: Responding to the tragedy of HIVAIDS in Africa


Purdues Global Impact: Responding to the tragedy of HIVAIDS in Africa – PowerPoint PPT presentation

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Title: Purdues Global Impact: Responding to the tragedy of HIVAIDS in Africa

Purdues Global Impact Responding to the tragedy
of HIV/AIDS in Africa
  • J. Paul Robinson
  • SVM Professor of Cytomics,
  • School of Veterinary Medicine, Professor of
    Biomedical Engineering,College of Engineering,
  • Bindley Bioscience Center,
  • Discovery Park,
  • Purdue University

Bindley Bioscience Center
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A mother with AIDS
Magongo is from a small village in Swaziland. She
has HIV/AIDS and has a CD4 count of 39. A normal
CD4 count is 500-1500. Anyone under 200 should be
on therapy. At under 50, her chances of survival
are very slim. She does not have the 30 Rand each
way to get to the nearest clinic for treatment.
The checkup is 3 Rand. For the sake of 9 she
does not have, she may not get treatment.
  • Her 2 year old child may or may not survive.
    She survives on the food she can grow in her
    garden. Why does Magongo have to walk 30 miles
    to a clinic that can not even do her CD4? Why is
    it that no-one in rural Africa has access to a
    technology that is required for survival?
  • This photo of Magongo and her baby was taken
    by a Purdue Public Health Science graduate
    student Annie Elbie in March 2008 when on a
    Purdue program exploring the needs and
    opportunities for service in Africa. (Used with

  • Stephen Lewis addressed the XXIII congress of
    the International Society for Analytical Cytology
    on May 21, 2006.
  • He spoke passionately about the devastation of
    families and villages impacted by the AIDS
    epidemic as he addressed 1,400 of the worlds
    leaders in cell analysis and flow cytometry

Lewis basic message .If you are such smart
scientists, why cant you solve the problem of
cheap CD4 tests?
Cytometry for Life www.cytometryforlife.org
First 136 days of 2008 Africans died of
HIV/AIDS- 1,156,000
  • In some countries over 1/3 of the population is
    HIV positive

The World from 1569
The Problem
Comparative Land Areas
Great Britain
300 million
20 million
60 million
900 million
(Area Sq.Mi)
3.7 million
3 million
11.6 million
Population of Africa
Indiana Area 92,896 km2 Pop. 6.5
million Texas Area 678,000 km2 Pop 22 million
  • Countries by Size (61 countries)
  • Nigeria 140 million 923,000 km²
  • Egypt 70 Million
  • Ethiopia 68 million 1.13 million km2
  • Congo 55 Million
  • South Africa 44 million
  • Tanzania 37 Million
  • Kenya 31 million
  • Morocco 31 Million 447,000 km2
  • Uganda 25 million 235,000 km2
  • Mozambique 20 million 802,000 km2
  • Total Population 900,000,000

Africa covers 6 of the Earth's total surface
area and 20.4 of the total land
Map of world
Peters projection - equal land area
Some facts about Africa
  • Africa is 11.6 million sq. miles
  • USA is 3.5 million sq. miles
  • Africa population is 900 million
  • USA is 300 million
  • USA average lifespan is about 75 years
  • Lesotho average lifespan is 42 years
  • Healthcare spending
  • In the USA we spend around 6700/person/year
  • In Africa, the some countries spends

Comparative land area
Purdues Globalization goals
Meeting Global Challenges
  • Define the role of Purdue in the 21st century
    entrepreneurial culture with a visionary program
    as a national model, focusing on University-wide
    talent, along with intellectual and physical
    resources, to maximize leverage, and providing
    transparent and coordinated access to
    intellectual resources.
  • Link research initiatives to market needs and
    trends through partnerships with business and
    industry in support of the model for
  • Inform public policy and provide informed
    leadership to policy discussions by way of a
    public policy institute that conducts analyses
    and impact assessments, and promotes coordination
    between large-scale research and economic
    development, leading to increased investment
    funds and Indianas impact on national as well as
    the global economy.

From the new draft Strategic Plan presented by
President Cordova
Lewis spoke of CD4 machines-which measure the
number of CD4 immune cells and indicate whether
someone with AIDS should be treated-that are
bulky, difficult to use and, at about 50,000
each, vastly out of reach of most of the
continent. -Apoorva Mandavilli , Nature Medicine
12 (10) , October 2006
Lewis continues to speak against what he sees as
unconscionable neglect and reckless
indifference to AIDS. I think the global
community has responded lamentably, he says,
his voice rising. Were fighting for human
lives, what in Gods name is wrong with these
people? -Apoorva Mandavilli , Nature Medicine
12 (10) , October 2006
Exponential epidemic growth
lt 40 million

Millions of infections
WHO 40 M infected 2000
lt 300k
lt 2k
Another disturbing fact
  • Children born of HIV positive mothers in the USA
    or Europe are only 0.2 likely to be HIV positive
    themselves. They will survive and probably
  • In some places in Africa, 80 of babies born to
    HIV infected mothers contract the disease. These
    babies will probably die before they reach the
    age of 2

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  • CD4-T cells are white blood cells
  • They are destroyed by the HIV virus
  • Without CD4-T cells your immunity is destroyed
  • Normal levels of CD4 are 500-1500/microliter
  • lt200 CD4/uL you must go on therapy
  • A CD4 test will occur every 3-4 months for
    patients on therapy for life

The Bottom line Ready access to CD4 counts is an
absolute necessity in Africa
Mack FulwylerInventor Innovator(1937-2001)
  • A wonderful print of Mack Fulwyler by SVM
    Professor David Williams

Cell Sorter - 500,000
Cell Analyzer - 150,000
The 3 Essentials for HIV/AIDS
  • 1. Determine if the patient is HIV
  • 2. Perform a CD4 test to determine immune status
    (CD4 lt200/µ must have therapeutics)
  • 3. Provide antiretroviral therapy (ART)

Dipstick test is now available solution evident
Major problem in this critical path component
Foundations Governments working towards solution
How do you measure CD4
Complex systems do multiple tests
Flow cytometry is a technique for counting,
analyzing and sorting microscopic particles that
have been suspended in reagent or stream of
fluid. It allows concurrent multiparametric
analysis of chemical and/or physical
characteristics of single cells flowing through
an optical and/or electronic detection apparatus.
Image Source http//openlearn.open.ac.uk/file.ph
Current Model in Africa
  • Create large central labs that can do everything
  • Fill them with expensive instruments
  • Try to train technicians and keep them (cant)
  • Ship all the samples to central labs
  • Send the results back to the remote places
  • If lab is overloaded, buy more automated
    expensive instruments

The Bottom line It sounds very good, but does it
Diagnostic tests in Africa
  • only 384 (40) of 964 patients with recurrent
    smear-positive pulmonary tuberculosis had their
    specimens arrive at the Central Reference

Cathy A. Petti, Christopher R. Polage, Thomas C.
Quinn, Allan R. Ronald, and Merle A.
Sande Laboratory Medicine in Africa Clinical
Infectious Diseases 42377-382, 2006
The Bottom line The current system does not work
well at all
The results of the present system
  • All the patients have to travel to the city or
    large centers
  • The laboratories become overloaded and demand
    more automated instruments (automation is not
    always effective)
  • Majority of people in rural communities do not
    receive needed diagnostics or therapeutics

The Bottom line Who will argue that this system
is successful?
Current Diagnostic Tools
  • Designed for Western health care system
  • Driven by
  • Large market of people who will pay
  • Centralize system of management
  • Multifunctional, extendable, upgradeable tools
  • Large infrastructure, electricity, water, etc
  • Databases and networks, automation

The Bottom line The Western health care system
is NOT good for Africa!!
Impact on Africa
  • Creation of inappropriate instrument base in
  • Many require significant infrastructure which is
    not there
  • Use complex multi-test instruments require
    enormous training
  • Instruments designed to do many tests but only
    one test (CD4) is mostly performed

The Bottom line Why is there no small cheap
device that does ONLY CD4 ?
  • Dont reinvent the wheel,
  • just realign it

Anthony J. D'Angelo
Location Related Issues
gt70 of AIDS patients in Africa are in rural
areas. User need Assessment 2006-7 220 medical
professionals. Useful instruments
  • Have to be small and light
  • Must be easy quick to set up
  • Use finger stick not venipuncture
  • Must be easy to operate (minimal training)
  • Must be easy to clean
  • Must be robust accurate
  • Must operate in high temp/humidity
  • Must be low cost/test (around 1)
  • Must be manufacturable

What is needed in Africa?
The C4L Solution
C4L Cytometry For Life
Who will build these instruments?
  • What incentive is there to design an instrument
    that has uncertain return-on-investment?
  • It is hard enough to survive in the Western
    global market with all the existing incentives
  • What possible advantages could a company have for
    moving to an unpredictable, complex, and
    difficult to manage market?

The Bottom line In reality, for diagnostic
instruments, the African market is not a good ROI
The C4L Solution - point-of-care cytometer
  • No Automation
  • No Computer
  • No complex fluidics
  • No complex optics
  • Very compact
  • Very robust

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  • Housed in a small, solid carrying case.
  • Contains battery, necessary containers, reagents
    and all other needed components.
  • Weight less than 12 pounds.
  • GPS link to network
  • Phone-link for data or USB
  • Lifetime of test data collected can be stored on

Re-use of mass-produced technologies
Avalanche Photo Diode Bulk price
estimates based on 2007 information
The C4L technology
Low Cost
Battery operated (totally portable)
Accurate (as good as any other system)
Single Purpose (easy to train use)
GPS (Location of most need)
Cell Phone (data transfer)
  • Ability to track instrument and CD4 count
    remotely for epidemiological purposes
  • Identify regions of therapeutic need
  • Transfer data by cell phone or blue-tooth
  • Potential for evaluation of drug resistance

Every CD4 count is mapped onto a location map so
we know where the most important areas to treat
are located
This concept uses very traditional chemistry and
assay design because this is mature and well
understood but the implementation is innovative
GPS system
  • Track every instrument location
  • Operational condition of units
  • Transmission of data
  • Epidemiological studies?
  • We can locate area of need
  • We may be able to monitor resistance

Where are we today on this project?
  • We have developed and tested a finger-stick based
    single tube CD4 test using 20 microliters of
  • We have an operating prototype
  • We have several collaborations on the ground in
  • We are in process of designing the electronics
    (GPS, Cellphone, DSP) systems
  • We are identifying new partners to make this a
    successful implementation

The Bottom line Dont assume that someone else
will do it!
How do you measure CD4?
Requires Lab, Electricity, a variety of lab
tools, Computer, software, significant time
How will we measure CD4 in future?
Requires No lab, no electricity, a single lab
tool (auto pipette), no computer, no software,
takes 10 minutes start to finish
Image Source http//openlearn.open.ac.uk/file.ph
  • We have excellent complex instruments for
    diagnostics but they dont satisfy the needs in
    remote areas
  • The more people who go on therapy, the greater
    the demand will be for CD4 testing
  • Our initial CD4 solution is an immediate (next 5
    years) solution to an immediate problem
  • Next-generation tools will hopefully follow
    they are clearly not effective now despite the
    promises hopefully they will be here within 5
  • A simple, manual, single-test only device will be
    very effective in remote regions of Africa
    where the majority of HIV/AIDS patients are
  • We need to meet the challenge!!!

The Cytometry-For-Life team
Lova Rakotomalala
J. Paul Robinson Gary Durack
Hildred Rochon
National Coordinator
C4L Founders
And the many volunteers helping to make this
project a reality in Africa
Funding Parker Hannifin, private donations,
Purdue University
Dont reinvent the wheel, just realign it
You can help this project by donating to SVM
directly or to the Cytometry for Life program.
See page for details www.cytometryforlife.org
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