Sounds like you’ve been doing really incredible work. Going from incubated to GiveWell funded so quickly is a hell of an accomplishment! A few questions that spring to my mind having read quickly through your docs.
The Drug Itself 1. What is it called? 2. How much does it cost? 3. Roughly how does it work? 4. What’s the side-effect profile like?
Growth 5. How’d you get the government so excited so quickly as total outsiders? (asking for a friend) 6. How much do you reckon you’ll benefit from economies of scale? 7. Are funding and target population size the only real constraints that you see at present?
Outside the box 8. At least in rural areas, where getting there is the majormost cost, why not do other things beyond TB screening / prevention too e.g. delivering under-supplied medicines / vitamins / goods (assuming you / your partners aren’t already doing that)
Great questions! And thank you for the kind words.
I should also say going from incubated to getting GiveWell money is in large part a function of GiveWell being excited in 2024/early 2025 to make grants to earlier stage charities and us picking an idea that they independently looked into and approved a grant to CHAI about!
The Drug Itself
What is it called?
A combination of two drugs: Isoniazid plus Rifapentine. The combination is called 3HP.
How much does it cost?
$10 for the standard version of 3HP—both drugs are combined together into one tablet.
$7 for the brand-new child-friendly version
But note Spiro doesn’t buy the drugs—the government gets them usually with money from the Global Fund
Roughly how does it work?
For people who have been infected with TB, these are antibiotics that fight the TB bacteria before it develops into TB disease. (Roughly Isoniazid blocks the bacteria from building their cell wall, Rifapentine blocks them from replicating)
What’s the side-effect profile like?
Generally extremely well-tolerated especially in kids. Occasional reactions can be rash or vomiting.
Growth
How’d you get the government so excited so quickly as total outsiders? (asking for a friend)
Haha I don’t think it was quick! Each stage has been very incremental. Some amount of being at the right place right time I think. [Can say more by DM]
How much do you reckon you’ll benefit from economies of scale?
Hopefully it should help! But I haven’t done any good modelling of this yet.
Are funding and target population size is the only real constraints that you see at present?
I think my personal capacity is a constraint right now as all Spiro things still go through me so I need to build that out.
Outside the box
At least in rural areas, where getting there is the majormost cost, why not do other things beyond TB screening / prevention too e.g. delivering under-supplied medicines / vitamins / goods (assuming you / your partners aren’t already doing that)
This is an excellent question and I think usually expanding to other verticals when you’ve solve a “last-mile problem” is a really good idea. We haven’t yet explored this seriously for our TB program—one of the awkward things is that we’re only going to houses where someone has TB not going to all doors in the area which would be an odd strategy for something like vitamins / immunisation. We are more hoping to go the other direction—layer our TB program onto other health workers who are already going door to door. That’s our plan for Punjab. But in the meantime we’re focusing on expanding our program in Sindh and showing it works at scale.
Sounds like you’ve been doing really incredible work. Going from incubated to GiveWell funded so quickly is a hell of an accomplishment! A few questions that spring to my mind having read quickly through your docs.
The Drug Itself
1. What is it called?
2. How much does it cost?
3. Roughly how does it work?
4. What’s the side-effect profile like?
Growth
5. How’d you get the government so excited so quickly as total outsiders? (asking for a friend)
6. How much do you reckon you’ll benefit from economies of scale?
7. Are funding and target population size the only real constraints that you see at present?
Outside the box
8. At least in rural areas, where getting there is the majormost cost, why not do other things beyond TB screening / prevention too e.g. delivering under-supplied medicines / vitamins / goods (assuming you / your partners aren’t already doing that)
Great questions! And thank you for the kind words.
I should also say going from incubated to getting GiveWell money is in large part a function of GiveWell being excited in 2024/early 2025 to make grants to earlier stage charities and us picking an idea that they independently looked into and approved a grant to CHAI about!
The Drug Itself
What is it called?
A combination of two drugs: Isoniazid plus Rifapentine. The combination is called 3HP.
How much does it cost?
$10 for the standard version of 3HP—both drugs are combined together into one tablet.
$7 for the brand-new child-friendly version
But note Spiro doesn’t buy the drugs—the government gets them usually with money from the Global Fund
Roughly how does it work?
For people who have been infected with TB, these are antibiotics that fight the TB bacteria before it develops into TB disease. (Roughly Isoniazid blocks the bacteria from building their cell wall, Rifapentine blocks them from replicating)
What’s the side-effect profile like?
Generally extremely well-tolerated especially in kids. Occasional reactions can be rash or vomiting.
Growth
How’d you get the government so excited so quickly as total outsiders? (asking for a friend)
Haha I don’t think it was quick! Each stage has been very incremental. Some amount of being at the right place right time I think. [Can say more by DM]
How much do you reckon you’ll benefit from economies of scale?
Hopefully it should help! But I haven’t done any good modelling of this yet.
Are funding and target population size is the only real constraints that you see at present?
I think my personal capacity is a constraint right now as all Spiro things still go through me so I need to build that out.
Outside the box
At least in rural areas, where getting there is the majormost cost, why not do other things beyond TB screening / prevention too e.g. delivering under-supplied medicines / vitamins / goods (assuming you / your partners aren’t already doing that)
This is an excellent question and I think usually expanding to other verticals when you’ve solve a “last-mile problem” is a really good idea. We haven’t yet explored this seriously for our TB program—one of the awkward things is that we’re only going to houses where someone has TB not going to all doors in the area which would be an odd strategy for something like vitamins / immunisation. We are more hoping to go the other direction—layer our TB program onto other health workers who are already going door to door. That’s our plan for Punjab. But in the meantime we’re focusing on expanding our program in Sindh and showing it works at scale.