30 August 2017

Ethiopia: How Effective National Research, Innovation to End TB By 2035?

Ethiopia has made a momentous stride in TB research and innovation towards curbing several impediments and emergence of new strains of multi-drug resistant TB (MDR-TB) . However, a large number of fellow citizens have been yet exposed to the high risk of contracting TB.

Moreover, the national effort to end TB by 2035 is at stake due to the increasing number of multi-drug resistant TB (MDR-TB) patients.

As Ethiopia is a member of the Global End TB Strategy Commitment, TB research and innovation is one of the three pillars of the commitment, says Dr. Andargachew, Country Director of Partners in Health.

The WHO global TB report indicates Ethiopia is one of the thirty high burden TB nations. To sustainably avert the scenario, the nation has so far been actively and intensively engaged in research and innovation.

For instance, Ministry of Health (MoH) has been intervening with placement of enormous attention on TB prevention and control, and set up a well-established national TB Research Advisory Committee (TRAC).

Armaer Hansen Research Institute (AHRI) Director Dr. Taye Tolera, who claims that Ethiopia can be taken as a pioneer in TB research and innovation, also associates the success basically with the presence TRAC network. He calls it 'a great opportune' for it brings together a number of investigations that are used as policy inputs.

Standard Researches meeting TRAC criteria by the Ethiopian Public Health Institute, other research centers like AHRI, and universities present their findings on the Annual TRAC conference.

Policy makers, program implementers, and others concerned from MoH, regional and zonal health bureaus meet researchers and make consultation, share experiences, identify research gaps as well as discuss future research areas, according to Dr. Taye.

There have been fundamental changes regarding the pattern, level and diversity of TB research over past 16 years experience of networking through TRAC.

Seconding the director's idea, Dr. Blen Ayele ministry's DRTB Program Manager indicates that her ministry, in addition to carrying out surveys to trace the magnitude of MDR-TB and launches appropriate intervention measures, largely utilizes TRAC findings and recommendations.

Moreover, she proves Ethiopia's triumph over MDR-TB treatment and cure among other countries. "Ethiopia is one of the five countries, including Russia, that have achieved over 70 percent success in curing MDR-TB."

He also measures the height of the success in terms of other parameters. Dr. Taye adds that clinical trials being undertaken on MDR-TB drug is a manifestation of advancement in the subject. "Ethiopia would contribute to the global MDR-TB prevention effort provided that AHRI's clinical trial to replace the 12 month- MDR-TB drug with a six- month drug would be fruitful." If so, WHO would be forced to change its policy. The results of this international level trial would be unveiled after a year.

TB screening lab experiments, on mycobacterium tuberculosis to identify its evolvement, latent, and active ones, though at initial stage, also heighten the emphasis given and the scale of efforts in TB research and innovation, as to Dr. Taye.

Dr. Andargachew entirely supports the notion that researches through TRAC have achieved tremendous progress. He elucidates this with the place and value of Ethiopian researches in the global TB research reports. "A significant number of researchers shared Ethiopia's lessons during international conferences. Besides, the international publishers are presenting Ethiopian researchers findings in their journals."

Ethiopian researchers have also contributed for the global TB research and innovation efforts. WHO, for example, has shared Ethiopia's best practices through TRAC. "This, hence, helped the nation contribute for the global TB research guideline development," Dr. Andargachew notes.

Further, both directors exquisitely rationalize that most of the research and innovation so far have been operational, thereby contributing for the national TB prevention and control endeavors by altering screening and treatment patterns.

Until recently TB patients had to go to hospital to take their daily medicine. This trend was tiresome and boring to them. Research has brought a lasting solution to this. It identified that given the TB treatment service training, health extension workers at health posts were found to deliver equivalent services as that of nurses or health officers in hospitals or health stations. Thus, the finding led to community based TB treatment service implementation nationwide.

The employment of health extension workers for TB case detection by taking samples from persons with TB symptoms was another successful operational TB research that won international award, Dr. Adargachew states. "This investigation undertaken in Sidama Zone has dramatically increased TB case detection rate by 50 per cent. The lesson then has been propagated all over the country."

In the past a number of people in different parts of the country lost lives because they did not go to hospital and got treatment. Staying in the community with the disease intensified the infection rate as well. Tracing the root causes of the problem through research, it is now possible to avert the trend across the areas, according to Dr. Andargachew.

Director of Partners in Health says these and other fruits of Ethiopia's research and innovation efforts that have immensely contributed to the national TB prevention and control efforts levelled Ethiopia as a pathfinder category.

Indeed, WHO in its recent report identifies Ethiopia as 'capable of advancing' the TB research and innovation- a third pillar of the global End TB Strategy.

Both directors agree that the development and translation of a comprehensive national TB research roadmap that won support from both the government and funding partners has had a significant role for the achievement.

Ethiopia has recently reviewed and introduced a new five-year TB research plan which targets at sustaining the gains so far and reaching TB research areas that have not been addressed. Yet, there could be some challenges there are challenges likely to hinder successful implementation, and hence demand government's, funding partners and other stakeholders' increased commitment.

A 90 percent reduction of TB incidence rate by 2035 might be tougher , Dr. Andargachew says: "This is because it requires a proper leading and handling the research and innovation as well as effective implementation of the results with full commitment."

Financial constraint and swift inclusion of findings and recommendations into policy frames and putting them on the ground could be other challenges.

For his part,St. Peter TB Specialized Hospital General Director Yacob Seman underlines that limited research capacity at national level is a central hindrance to the future of innovative TB research. "Apart from insufficient number of quality senior researchers, there are resource and facility constraints."

He illustrates it with the absence of biological laboratories to experiment on bacteria and the absence of, at national level, level three and four labs meeting international standard. "Even if we get these sort of labs, we cannot adequately get professionals that operate them."

The nation's research policy is an extra challenge. It may not allow a high level TB research and innovation because the priority research issue could be that which persistently affect a large portion of the population, Yacob notes.

Further, Dr. Bilen speculates that researchers might loss interest in TB research assuming that there would not be new area to contribute for there have been a bulk of it so far.

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