The year 2012 marked a significant milestone for the Global Health Committee (GHC) in Ethiopia as 607 patients have been initiated on lifesaving therapy for Multi-drug Resistant TB (MDR-TB) since the program began in 2009. GHC initiated the countrywide program for MDR-TB in Addis Ababa at St Peter’s Hospital in 2009, and in Gondar at the Gondar University Hospital in 2010 in partnership with the Ethiopian Ministry of Health, using approaches developed in Cambodia in this remarkable program which has extremely high adherence rates and low mortality in the very sick population of patients.
MDR-TB treatment requires the administration of five costly drugs with powerful side affects over a two-year period. This is compared with a six-month regimen of readily- available and easily tolerated drugs for “regular TB” where there is no drug resistance. This is particularly noteworthy in Ethiopia, which today ranks #7 among the 22 world’s highest TB-burdened countries, and #15 among the 27 highest MDR-TB-burdened countries. Strikingly, WHO estimates that there are 6,000 new cases of MDR-TB each year in Ethiopia.
With funding from the Jolie-Pitt Foundation, the Lilly MDR Partnership, and Annenberg Foundation, the first patients to begin MDR therapy in Ethiopia in 2009 were begun by GHC in a converted isolation ward in St. Peter’s Hospital in Addis Ababa. GHC has overcome numerous challenges along the way, including a year long delay in the availability of second line TB drugs necessary to treat MDR coupled with a year-long delay in the completion of the MDR-TB isolation ward at St. Peter’s Hospital. But year-by-year progress has been steady, with 74 patients receiving MDR-TB medicines and care in 2009, 171 patients at the end of 2010 in both Addis Ababa and Gondar, 342 patients at the end of 2011, and eclipsing 600 in the latter part of 2012.
“Failure is just not option when you are treating a lethal but curable infectious disease,” says Dr. Anne Goldfeld, GHC president and co-founder. “We are fortunate to have the opportunity to partner with the Ethiopian Ministry of Health, St. Peter’s Hospital, and the Gondar University Hospital.”
To further the impact of its work, GHC plans to scale its programs in the north of Ethiopia in the Amhara region, following the community-based approach established by GHC/CHC in Cambodia, where more than 32,000 have been treated for TB to date and where CHC/GHC initiated the Cambodian countrywide MDR program in 2006 in partnership with that country’s National TB Program. The unique model of community-based care and treatment that has its roots in the refugee camps of the Thai-Cambodia border in the 1980’s, has been central to the program’s success first in Cambodia and now in Ethiopia, where 80% of patients are receiving outpatient and community-based care after initial hospitalization and treatment. In addition, nearly 100 patients have been initiated on MDR-TB treatment as outpatients, and all are receiving multidisciplinary care in the form of nutritional support and social support.
“A rapid scale-up of MDR care is critical to give those suffering a chance at a normal life and to interrupt transmission of this deadly disease,” Anne says. “We are making many positive strides, creating MDR centers of excellence in Addis Ababa and Gondar, expanding community-based treatment programs, and expanding access to lifesaving treatment.”
2013 looks to be a year of accomplishment as well with the anticipated opening of the Zahara Children's Center in Sebeta, on the outskirts of Addis Ababa. The center will help meet the needs of the thousands of children infected with or affected by TB and HIV, and will be a center to treat MDR-TB in children. The Zahara Center is modeled on the GHC’s Maddox Chivan Children’s Center in Cambodia where over 1,000 HIV infected or affected children have been cared for in a unique multi-sectoral program of medical, nutritional, and educational services.