“Three profoundly destabilizing scientific

ideas ricochet through the twentieth century,

trisecting it into three unequal parts: the

atom, the byte, the gene.”

Siddhartha Mukherjee, The Gene: An Intimate History

3 September 1999 Oct. 25, 2004Aug. 15, 1994

May 27, 2013Jan. 18, 2010Nov. 13, 2006

January 30, 2015

April 2016

Localization

Clinical relevance

8% of hospital admissions are caused by adverse drug reactions.

50% of prescriptions have positive outcomes.

30% adverse drug reactions have genomic associations.

Clinical relevance

Expensive for out of pocket spending.

Inaccurate biomarker and clinical recommendations for some ethnicities.

Physicians lack support and training to follow up.

Localization

Rami lives in a village in rural Papua, where many

of the villagers suffer from leprosy. Like some of his

family members, he also contracts the disease.

When he took the medication, however, his skin

started to develop lesions and scars.

Our first project in Papua, with genetic tests

that cost 30,000 rupiah each to help leprosy

patients in Papua from life-threatening

adverse drug reactions, aimed to show that

life-saving genetics can be for

everyone.

DapsoneRifampicin

Clofazamine

HLA-B*13:01 Positive

HLA-B*13:01 Negative

RifampicinClofazamine

Get better faster, safer

Patient comes into clinic

Patient given trial drug A

Stat

us

Qu

o

Manifestation of adverse drug reactions

Clinical outcome not reached, trial and error continues

x Death, direct and indirect costs

Money and time wasted

Re

acti

ve P

Gx

Turnaround time not suitable for acute conditions

Failure to communicate long-term benefits of testing

Burden to healthcare system due to minimal uptake of personalized prescription recommendation

Clinical impact

NalaTM PGx Panels: PG x test panel for the most clinically actionable biomarkers

• Modular design

• C urated by proprietary software:

• C linically validated C AP-accredited and ISO-certified lab in S ingapore

• Designed on quantitative PC R (golden standard)

HLA-B

TPMT

DPYD

UGT1A1

CYP3A5

CYP2C19

CYP2C9

CYP2D6

SLCO1B1

HLA-B

UGT1A1

F5

IFNL3

G6PD

VKORC1

CYP2B6

NUDT15

CYP4F2

VKORC1

CYP2D6

• C linical annotation system for 60+ drugs, 40+ variants

• 1,000+ publications from Asian countries to support validation of biomarker

• IEC 62304 and ISO13485-guided report generation software that is HIPAA compliant data storage

• Open APIs to integrate into EHR systems

NalaTM Knowledge Base: database to generate reports and clinical decision support

• Web and mobile app platform

• S ecurely stored genotyping test results

• Access to E-counseling (genetic counselors and pharmacists 24/7)

– S ecure chat between patients and physicians

– Adverse reaction reporting system with voice recognition

• Prescription reminders and log information

• S earch drug, gene, and food interactions

NalaTM Patient Platform: actionable insights, anywhere, anytime.

Motivating Factors

C onvenient

Interconnected

Long Lasting

Accessing records anytime, anywhere.

Intuitive, crossing language barriers

More effective time management

Convenience

Nalabot Gina

Queryable records

Permanent storage

Multi-generational medical and genetic records

Long lasting

Wilson’s disease

Interconnected

Facilitating e-consultations

C linical decision support

Easier access to treatments

Genetic Counselling

Important everywhere, but especially in

healthcare.

Privacy

AI in healthcare

S ecurity and breaches

Thank you!

admin@nalagenetics.com

Making the Case for Investing in Adolescent Reproductive Healthdr. Asti S Widihastuti, MHC

HIV prevention officer - UNFPA

Adolescent

Adolescent

UN: youth 15-24 and adolescent 10-19

Indonesia law 40/2009: youth 16-30

Neuroscience

Increased brain plasticity during adolescent: sensitive to both positive and negative environmental influences

Bain plasticity: significant capacity for rapid learning and skills acquisition. On negative side, structural determinants and population level stressors (poverty. Famine, war) and individual experiences (violence, bullying or social isolation) can be associated with pathological neurological outcomes.

Pre-frontal cortex is still under development: adolescent brain becomes hyper sensitive to risk taking and pleasure seeking, impulsiveness is strong, while thoughtful decision making is weak

Adolescent: Time when gender roles were consolidated, challenged, or transformed

Girls Boys

Child marriage Joining gang, armed groups

School drop out Drinking

Forced and unprotected sex

Using drugs

Early pregnancy, GBV

Unprotected sex

Triple Divident

Poverty

Violence

Discrimination

Lancet series: Coordinated investments in adolescent health, well-being and education provide high economic and social returns

investments which enhance adolescent well-being, protection and skills development yield a triple dividend of benefits – today, into adulthood, and for the next generation of children.

A Demographic Dividend

Although proportion of adolescent globally is declining, the absolute number of adolescent is expected to continue to rise

Whether this large population of adolescents has a positive or negative effect on a country’s social and economic development depends on how well and quickly governments respond to their needs and enable them to engage fully and meaningfully in civic and economic affairs.

With supportive macro-economic policies and strategic investments in education and health as well as the promotion of gender- equality, investment in adolescents can contribute towards a demographic dividend.

Why investing in adolescent?

INVESTING IN YOUTH HELPS BREAK THE CYCLE OF POVERTY

Poverty and inadequate health systems compound adolescent vulnerability to sickness and early death

Source: Adolescent at a glance, World Bank

When a young person becomes infected with HIV or resorts to unsafe abortion to terminate an unplanned pregnancy, poverty is often the root cause.

A poor adolescent is more than three times as likely to give birth as a wealthy adolescent.

Poor Health exacerbates poverty, by disrupting and cutting short school opportunities, by weakening or killing young people in the prime of their working lives, or by placing heavy financial and social burdens on families.

Poor youth are particularly vulnerable to sexual violence and exploitation. Girls in many countries report having sex in exchange for money or gifts.

Youth from AIDS-affected homes, including 13 million under age 15 orphaned by the disease, often have to forgo schooling and other opportunities, which diminishes their livelihood prospects, pushes them deeper into poverty, and increases their own chances of contracting HIV.

@UNFPAIndonesia @unfpaindonesiaMyUNFPAIndonesiaUNFPAIndonesiawww. indonesia.unfpa.org

Adolescent Sexual & Reproductive Health: What is the state of art?

28%young people

Adolescent fertility reduced as per IDHS Preliminary report (36) but SUPAS data shows higher level

Provincial differences that shows higher fertility rates for

Jakarta & Yogyakarta.

Half a million births are among 15-19 years

one third of maternal deathsare among adolescents

Adolescent pregnancy –affects their own growth, birthweight of baby, risk of hypertensive disorders during pregnancy, fistula, anemia, high risk of neonatal deaths high

1 in 9 girls married

before the age of 18

Low contraceptive use

(less than 50 %) (better compared to other countries in the region)

New HIV infections predominantly among adolescent girls

Access to services major constraint

Law prohibits accessing services on their own and also access to contraceptives for unmarried

Using the official Indonesian definition, of youth, the profile of Indonesia’s youth in 2017 can be summarised as below:

There were 63.6 million youth in 2017, of which 50.6 percent were male and 49.4 per cent female;

55 per cent and 45 per cent respectively lived in urban and rural areas

One in four youth were in school, while 1 in two were employed

Indonesia youth profile, continue

60 per cent of youth got married for the first time at the age of 19-24; while 52 per cent of young women and 29 per cent of young men were married

16.7 per cent of women aged 15-18 were pregnant

1 in 10 youth are head of households (2017)

7.9% of youth did not possess an Indonesian electronic Identity Card (KTP) in 2015

Why is this issue matter to all of us?

Not only we have a shared responsibility, we also have an interest in addressing the needs of adolescents!

To government:

As citizens, youth should be heard. They also represent a large proportion of the population. Youth are not only the leaders of tomorrow, they are leaders of today

To companies:

Skills and education acquired by adolescence and youth are a major precursor to investment and economic growth.

To communities:

Adolescents are powerful change agents, and often highly active members of civil society. Communities are empowered by a focus on youth.

To technology sector

Youth are not only empowered by innovation, but innovation is also empowered by youth, their ideas and ambition

A price of a cup of coffee

$ 4.60

$ 3.80

Improving the physical, sexual and mental health of adolescents aged 10-19 years, at the cost of about $4.60 per person per year, could bring a tenfold economic benefit by averting more than 12 million adolescent deaths and preventing more than 30 million unwanted pregnancies in adolescents.

Similarly, programmes to reduce child marriage, at about $3.80 per person, can bring an almost sixfold return on investment and cut child marriage by around a third.

Rights based approach to addressing the needs of young people

1. Greater focus on the root causes of poverty: specific rights and obstacles of realising those rights

2. Easier to specify the criteria for measuring outcomes

3. Governments need to involve citizens including the poorest, as far as practicable, in the development and implementation of public policy to give effect to their rights.

4. a rights-based approach also entails an obligation on the part of governments and other actors to realise these rights