MDR-TB in Ethiopia: Access to Diagnosis and Care

GlobalGiving Report: Multi-Drug Resistant TB (MDR-TB) In Ethiopia: Access To Diagnosis And Care

Global Health Committee (GHC) has raised $27,387 since December as the result of the generosity of donors who gave through the GlobalGiving website which includes $4,452 in matching funds received by Eli Lilly through the Eli Lilly TB Challenge in addition to $3,000 for taking first place in the challenge. 

With these funds, GHC has initiated 8 additional patients on MDR therapy in the North of Ethiopia in Gondar.  These patients are individuals who, without therapy, would have undoubtedly died.  In addition, through utilization of these funds, GHC is on its way to purchasing a GeneExpert machine for its program in Ethiopia.  Once purchased, GHC will greatly increase its impact in Addis Ababa and Gondar over the coming year.  The accomplishments of the year upon which GHC will build are as follows:

2010-2011 Achievements:

• Since March 2009, 200 patients have been initiated on active therapy for MDR-TB.  All of these patients had been waiting for life-saving therapy for years, and were in a compromised state.  15 patients in Gondar have begun therapy since August 2010.  
• With use of the GeneExpert, rapid diagnosis of TB will allow for identification of hundreds of others who can then be placed on therapy.  Global Health Committee expects to enroll at least 100 more patients for treatment by the end of 2011.

Tools developed:

• The GHC/FMOH (Federal Ministry of Health) model in Ethiopia was evaluated by World Health Organization’s  (WHO) monitoring body for MDR-TB, the Green Light Committee, in May 2010 and was found to be highly effective with excellent interim outcomes in adherence (100%) and patient outcomes, resulting in WHO approval of an additional 245 rounds of therapy for patients in Addis Ababa over the next year.
• GHC has developed intake and follow-up forms that include information about the patients’ demographics, smear and culture, anthropometrics, HIV history and treatment status, prior TB history, risk factors, clinical symptoms, and clinical diagnoses.  This record system will help the health care providers track baseline patient information and clinical evolution, and assist in medical decision-making.  It is also a very useful tool for monitoring & evaluation of the program’s impact. 
• The outstanding GHC program is becoming the regional model for MDR-TB care in the horn of Africa.

Partnerships:

• GHC has forged an alliance with the University of Gondar and provides on-the-job training to medical doctors through work with its MDR program.  GHC has also partnered with other Lilly partners such as the International Council of Nurses (ICN) for the “Training of Trainer” course in October 2010.
• GHC provides ongoing support and training to St. Peter’s hospital physicians, inpatient nurses, community nurses and selected treatment supporters.
• Through the GHC/FMOH partnership model a sustainable network has been established with health centers in Addis Ababa to ensure close monitoring of MDR-TB treatment in the community.  This has resulted in high adherence rates to treatment (~100%).

Benefits of the model:

• The lessons learned and methods developed through this project have resulted in a model that can be applied in other parts of Africa and hold incredible promise for application on a global scale.

Benefits of the planned GeneExpert:

• Specifically, introduction of the GeneExpert will rapidly identify TB cases and, consequently, provide the first step in treatment for patients in Ethiopia.  This rapid identification of cases will mean earlier treatment and a better chance at a more rapid recovery for many with fewer deaths and less long-term consequences of waiting such as destroyed lungs and hearts and will also decrease the ability of the disease to spread. 
• Less time and resources spent on diagnosis means more time and resources spent on treatment tools, research and formation and development of critical partnerships within the community.