Challenge / Problem Overview
In Ethiopia, drug-resistant tuberculosis (DR-TB) remains a significant public health problem, with an estimated annual incidence of 2,000 cases, of which only 46% are diagnosed and treated. There is a large proportion of patients with DR-TB missed each year. Many DR-TB patients face barriers to treatment due to prolonged and toxic regimens, leading to low adherence, loss to follow-up, and catastrophic costs for households. This undermines the effectiveness of DR-TB management and poses a substantial public health risk.
Approach
To address these issues, the LEAP Local program, led by Genesis Analytics and supported by USAID, provided critical technical support to the Ethiopian Ministry of Health. A LEAP Local Technical Advisor (TA) embedded in the National TB, Leprosy, and Other Lung Diseases Program (NTBLLD) played a pivotal role in initiating a data-driven DR-TB case-finding strategy. The TA introduced national mapping, registry, and testing of all DR-TB affected households, registering and testing household contacts of DR-TB patients from 2018 to 2024 using mWRDs (Xpert MTB/Ultra Assay). This community-based approach involved health workers from DR-TB treatment centers conducting outreach and testing.
The TA also led a swift policy change in DR-TB care, resulting in the nationwide rollout of the 6-month BpaLM regimen following new WHO guidelines. The TA updated national TB treatment guidelines, ensuring healthcare workers were trained on the new regimen and advanced diagnostic techniques. The TA coordinated efforts between the Ministry of Health, USAID, WHO, and other international partners, ensuring efficient completion of all preparatory activities for the regimen rollout.
Results
As a result of the enhanced efforts to improve DR-TB case finding through the novel national registry, mapping, and testing of DR-TB affected households, 73% of registered household contacts were screened and tested using Xpert MTB/Ultra Assay irrespective of TB symptoms and signs. This led to the identification of 78 DS-TB patients and the detection of rifampicin-resistant TB (RR-TB) in 40 household contacts contributing to an additional 19% of national DR-TB notification. Ethiopia officially launched the BPaLM regimen in September 2023, well ahead of other high-burden countries. The introduction of the BPaLM regimen significantly improved management of DR-TB cases, reducing the treatment duration and improving patient adherence. “I would like to express my great excitement at being the first DR-TB physician in Ethiopia to use the novel 6-month BPaLM regimen to treat DR-TB patients. This new regimen will have a substantial impact in improving the patient outcomes, bringing significant socio-economic gains to affected families and patients who in the past must undergo a lengthy treatment course with higher toxicities and significant disruption of livelihoods and serious compromise in the quality of life of affected patients’’, Dr Ayantu Bekele, Lead DR-TB physician from Gadaa DR-TB Referral care center under Adama Hospital Medical College. The proactive approach taken by Ethiopia in adopting the BpaLM regimen has not only improved patient outcomes but also set a precedent for other countries battling TB. The success of this initiative underscores the importance of strategic technical support and robust program management in enhancing national health systems.
Conclusion
The LEAP Local initiative, through its targeted technical support, has demonstrated the power of strategic interventions in transforming DR-TB case finding and improving treatment outcomes in Ethiopia. By addressing critical challenges and enhancing local capacities, the initiative is paving the way for more resilient and effective TB programs, ultimately contributing to the global fight against tuberculosis.
