Armauer Hansen Research
Institute
Annual Report
Table of Contents
Foreward
The year 2014 has been an exciting year at AHRI. Several large research projects were successfully conducted. The meningococcal carriage study in Arbaminch completed its field work and samples are being analyzed at both AHRI and Oslo collaborating laboratories. STREAM trial has been enrolling patients with multidrug resistant tuberculosis at both AHRI and St Peter's Specialized TB Hospital. Gondar University joined in as a third site to accelerate patient recruitment. The trial will move into Stage 2 in 2015 with more stringent procedures put in place to ensure high standards that can meet registration requirements. The Regional Bioequivalence Clinical Center at AHRI successfully completed two protocols and is preparing to apply for WHO prequalification. It is hoped that site visits will be conducted in 2015 to initiate the process.
A total of 74 projects were running at the Institute in 2014. The number of publications topped 53, the largest in a year in the history of the Institute! This was a result of extensive collaboration of AHRI researchers with University and Health Facility colleagues in various parts of the country, often centered around postgraduate student training at AHRI and elsewhere. Most of the publications arose from work conducted at AHRI laboratories. The progressive increase in the number of AHRI publications is one sign of the expanding role and increasing maturity of AHRI postdocs and senior research assistants. It shows that AHRI has managed to generate competent research leaders who can realize the further expansion of the Institute and its extended hub function.
Postgraduate training was further strengthened with three programs in 2014. These were the Emory-Ethiopia TB Research Training (EETBRT) Program funded by the National Institutes of Health Fogarty program, the Biomedical Sciences Postgraduate Training Program (BSPP) funded by Sida and the Brighton-Sussex Global Health Centre funded by the Welcome Trust where AHRI hosts students for co-supervision and research support in collaboration with Addis Ababa University and the other partners. The BSPP will enable 10 PhD candidates to acquire advanced skills in molecular techniques in Sweden. It is expected that the graduates will help catalyze biomedical research at regional universities in Ethiopia. To accommodate the increasing number of PhD students, AHRI has taken steps to acquire more laboratory equipment, more lab space and better access to reagents and supplies. Two new large autoclaves were received in 2014 and are being installed, both donated by Heal TB/USAID to support AHRI research. Field mobility will improve with the acquisition of several new vehicles purchased through Norad support.
In the last 10 years, 73 MSc and 21 PhD students graduated from AHRI. One of the strategic aims of AHRI is to stay linked with as many of them as possible to strengthen collaboration and promote research in the universities and health facilities where many of them are currently employed. A survey is in progress to map where the alumni are. AHRI aspires to strengthen its hub function through continued collaboration with its international partners in advanced laboratories and its link with national institutions engaged in research and training. An example of a practical output in 2014 is the establishment of an immunology laboratory at the Amhara Regional Laboratory in Bahir Dar. Butajira Hospital received laboratory equipment to strengthen its research capacity in HIV, malaria and TB from EDCTP as a satellite sister institution of AHRI. AHRI received financial support from the MoH to strengthen clinical research. It plans to use this to enable peripheral hospital and university laboratories such as at Arba minch and Harar to conduct collaborative research (linked to postgraduate training whenever possible) on arboviral diseases, antimicrobial sensitivity and hepatitis, all significant problems at the sites selected.
AHRI researchers have contributed to national and international scientific conferences and participated in several committee tasks at various levels. AHRI contributed to the WHO Meningitis Epidemic Guideline development in 2014. The AHRI Neglected Diseases Team is a member of the National Taskforce for NTD Control and has contributed to the national Master Plan and mapping of the national NTD distribution. The Leprosy team is similarly involved in the National Leprosy Program. The TB team promotes close links with regional programs and supports government initiatives.
In 2014, the Capacity Building for Operational Research in TB (CORE-TB) program hosted at AHRI with financial support from TBCARE/USAID successfully achieved a milestone: all six first cohort research teams presented their findings at the 2014 International TB Conference in Barcelona and published articles in the peer review online journal Public Health Action! The second cohort of six other regions has completed its data collection and entered the analysis phase. The evidence generated by each team is likely to be of immediate benefit in solving the local problems because the research was led by program managers and responded to research questions posed by them.
With increasing number of graduates from the universities and a rising demand for research space, AHRI is obliged to seek means to stay relevant and useful. One persistent challenge has been its administrative inefficiency and lethargic handling of logistic constraints. The Institute's management was strengthened this year through the establishment of a Procurement and a Finance Unit under the Scientific Director's Office. A Procurement and Finance Coordinator supervises the performance of the two units. Particular attention has been paid to ensure strict adherence of the units to good practice standards. It is expected that progress will be faster as team members build experience in handling assignments and improve efficiency.
The Ethiopian government's strategy for Science, Technology and Innovation is to lay the ground work for a knowledge based economy of the future today. This requires institution building. AHRI had submitted an application to the Ministry of Health to be formally established as a Government Research Institute focused on biomedical, clinical and translational research serving as a sister Institute to the Ethiopian Public Health Institute. A draft legislation was developed by the legal unit of the Ministry of Health in consultation with AHRI and was subjected to stakeholder review. The appropriate Government organ is expected to deliberate on the document and take decision soon.
The achievements of AHRI were only possible because of the continued support of the Federal Ministry of Health, Ethiopia, and its core funders Norad and Sida. AHRI is proud of its national and international research partners without whose contributions AHRI would not have reached this stage. Particular thanks go to the postgraduate students whose achievements we celebrate here. The AHRI/ALERT Ethics Review Committee and the AHRI Scientific Advisory Board are two very significant contributors to the quality of work at AHRI that have managed to keep it on track and to foster its national and international reputation. This year, the Ethiopian government provided AHRI with research funds to address clinical challenges. This move, building on the support of all the partners mentioned above, is very likely to lead to a new era for AHRI in the next years.
Tuberculosis (TB) Team
The TB team; which was formally established in July, 2006, is the biggest team in terms of the number of projects, MSc and PhD students as well as research staff. In 2014, there are 6 projects on diagnostics, 13 on epidemiology, 4 on biomarker and 11 on basic biomedical research; which gives a total of 34 projects. Some of these projects are just in the initial phase, most are half way while the remaining are on their final phase. (Please see the full list of projects and status.)
Diagnostics Research
University has been submitted as a patent application to the South African Patent Office.
Smear based diagnosis depends on meticulous
depends on accurate and timely diagnosis and proper management of cases. Several
microscopic reading of multiple fields. In the case
key areas needed in TB diagnostics
of smears with scant mycobacteria, rare positive
T include, 1) Improved sensitivity and cells can easily be missed because of suboptimal
specificity of TB exposure tests (for latent
assay conditions and worker fatigue. Imaging technology offers the potential to rapidly screen
multiple slides and fields to simplify identification of
immunocompromised patients such as in HIV disease, 2) rapid field friendly point of care tests
rare positive acid fast mycobacteria and improve
for TB diagnosis, 3) Improved efficiency of existing
the sensitivity of smear positive TB detection.
smear TB tests, 4) cheaper and faster TB culture
Engineer Zebano Worku, an MSc student
methods. Accordingly, the TB team is trying to
candidate, is investigating automatic imaging technology to improve efficiency and accuracy of
embrace innovation research and as part of this
smear reading. The project, entitled "Optical
initiative, 5 projects on diagnostics have been initiated. The first project is entitled ‘Improving the
adjustment and stage automation of a microscope
& automatic detection of mycobacterium species
Immunological Approach'. Dr Markos Abebe and
from sputum smear slides using image analysis techniques" is underway with financial support
Dr Abraham Aseffa in collaboration with Dr Carol
from AHRI core budget.
Holm-Hansen at NIPH, Norway have been investigating on modifications of the standard QFT gold TB assay in order to improve detection of Mtb
A related problem in TB control, particularly in
immune reactivity in HIV positive patients known to
resource limited settings is the high prevalence of
have depressed cellular immune responses, and
smear negative TB cases, typically diagnosed by
this work has resulted in a patent application to the
clinical and radiological criteria often several days
European Patient Office in London. Further
or weeks after initial presentation. Hence, rapid
and accurate diagnosis of smear negative TB
Norwegian volunteers will be conducted at Cr.
cases is crucial for TB control. Recent research
Carol Holm-Hansen's lab in Norway and will
contribute to further definition of the specificity of
mycobacteria accumulate lipid bodies and lose
the assay among TB and HIV co-infected
theoretically its potential for detection by the latter methodology. However, such bacilli can be
Dr. Adane Mihret initially observed as a part of his
detected by counter staining methods for lipid
PhD thesis "Gene Expression and Cytokine
bodies, raising the possibility that sensitivity for smear positive TB, and potentially smear negative
Pattern of Pulmonary Tuberculosis Patients and
TB might be improved through counter staining of
their Contacts in Addis Ababa, Ethiopia "that plasma IP-10 levels successfully discriminated
lipid bodies. In a project entitled "Lipid Bodies; can
healthy contacts and TB patients. IP-10 and other
they be Biomarkers for improved Diagnosis of Disease and Better Patient Management?", we
plasma cytokines have been further evaluated in
have commenced a study of 50 smear positive and
collaboration with Stellenbosch University within
50 smear negative TB cases to evaluate the
promising biomarkers able to distinguish TB
potential of lipid body staining in comparison to
disease from other pulmonary diseases with
standard Ziehl-Neelson and Auramine-O staining
similar clinical presentations. The collaborative
approaches to identify mycobacteria in sputum and
work with Dr. Adane Mihret and Stellenbosch
culture specimens from these subjects. The project is supported by AHRI core budget and currently the proposal is submitted to AAERC.
Development of a simple, cheaper and rapid
Epidemiology research
method of TB culture is also a focus of the TB team. To this end, Befekadu Debebe, an MSc student, has evaluated the performance of 7%
urrently, a number of epidemiological
sheep blood agar (SBA) for the primary isolation of
research projects are on-going. The goals
Mycobacterium tuberculosis from pulmonary TB
of these projects are to understand the
suspected individuals under routine diagnosis
dynamics, geographical clustering, drug
condition, in a study entitled "Evaluation of culture
Cr esistance pattern and molecular typing of
of Mycobacterium tuberculosis on blood agar in
TB in order to better understand the basis
resource limited setting in Addis Ababa, Ethiopia".
for transmission and virulence of the
This media is routinely used in microbiology
laboratories for the diagnosis of different bacterial species, and prior reports have suggested it's
Studies on the molecular epidemiology of TB
utility in growth of MTB from sputum. Sputum
in multiple regions within Ethiopia.
samples from 212 tuberculosis suspect individuals from selected health facilities were analysed by conventional smear microscopy, and cultured in
Globally there are seven human-associated
either conventional Lowenstein Jensen (LJ) media
Mycobacterium tuberculosis lineages that are
or 7% SBA agar. The sensitivity, specificity,
differentially distributed with certain lineages
positive and negative predictive value of blood
predominating in certain geographical regions and
agar media compared with LJ was 96.43%,
human populations. Indio-oceanic (IO) - Lineage 1,
98.08%, 94.74% and 98.71%, respectively.
West African Lineage I - Lineage 5, West African
Importantly, the number of days of culture required
Lineage II - Lineage 6 represent the ancient
for detection of colonies was significantly less in
branch of MTBC, East-Asian (EA) -Lineage 2,
7% SBA, median 14 (range 9-28) compared with
East-African-Indian (EAI) - Lineage 3 and Euro-
conventional LJH media, median 20 days (range
American (EA) -Lineage 4 belong to the modern
12-39). The cost per culture in terms of
branch of MTBC. The new lineage-Lineage 7 (L7)
consumables and labour is comparable between
was discovered at AHRI (from samples collected in
the two methods. Thus, SBA may be a good
Woldiya region of Ethiopia). Woldiya is the North-
alternative of LJ medium for more rapid detection
Eastern part of Ethiopian highlands. Lineage 7 is
of MTB from sputum in resource limited settings.
of considerable evolutionary interest because it represents a phylogenetic branch intermediate between the ancient and modern lineages of M.
A final approach to potentially improve diagnosis of
tuberculosis. L7 is confirmed to be associated with
smear negative TB will be to evaluate mask
the Horn of Africa. Searches in international
sampling. Patients apply a surgical mask over their
databases including more than 90,000 strains
mouths for a short time period and are encourage
identified L7 only among immigrant patients from
Ethiopia and Somali. In a previous study MTB
microdroplets of mycobacteria on a filter within the
strains of L7 were isolated in the Central and
mask surface. Following droplet elution, DNA is
Northern part of Ethiopia with high degree in
PCR amplified by Gene Xpert, the current gold
Woldiya region. Genetic variability in MTBC clinical
standard for PCR based TB diagnosis from
isolates and clinical phenotypes can be better
sputum samples. Initial pilot reports of this
understood, and thus the reason of dominance of
approach have been encouraging, and Dr. Baye
certain MTBC lineages in certain geographical
Gelaw from the University of Gondor is
areas requires further investigation.
collaborating with AHRI to evaluate this approach and sample collection has begun. The project, "Mask sampling as a method to detect tubercle
In the Mycobacterium tuberculosis complex
bacilli from smear negative pulmonary TB patients"
(MTBC), a possible role for strain diversity in
is funded by AHRI core.
human tuberculosis (TB) is increasingly being suggested from work in various infection models. Significant differences among MTBC lineages have been reported in terms of their propensity to cause secondary cases in different human population, their progression to active disease in recently exposed household contacts, and their recognition by the human immune system. Most other related studies have reported associations between
phenotypes. Additionally, the emergence of resistance to anti TB drugs, and particularly
multidrug-resistant tuberculosis (MDR-TB) has
National ethics review committees. Project specific
been identified as one of the major obstacles to
training has been given to the study team. The
global TB control and pointing to the importance of
project is funded by NIPH. Study specific
pathogen genetic factors for the modulation of
workshops have been conducted in South Sudan,
infection outcome and epidemiology. Some of M.
Sudan and Ethiopia (Addis Ababa and Bahir Dar).
tuberculosis strains are reported to be strongly associated with MDR TB.
Another epidemiological research in the Southern Region of Ethiopia is a PhD project by Yared
However, the overall picture of the correlation
‘Molecular Epidemiology and Drug
between mycobacterial genotype and clinical
Resistance of Tuberculosis in Southern Region of
disease characteristics is not well understood.
Ethiopia'. The objective of the study is to describe
The majority of studies focused only on a particular
the molecular epidemiology and drug resistance
strain types such as the Beijing genotype. There is
a need to classify the whole variety of strains
circulating in some particular area and to describe
development and spread of drug resistance in
phylogenetic lineages and associations with
different settings of SNNPR and Shashemene
clinical characteristics.
area. A cross-sectional study design and survey will be employed at different study settings: health
Elena Hailu, a PhD candidate from AHRI has
institutions in Jinka of South Omo zone of SNNPR,
started a new project entitled "Molecular
at health institutions in Shashemene areas and
epidemiology, drug resistance patterns of Mtb and
Hawassa prison. A variety of individual and
clinical outcome evaluation in Woldiya region,
household characteristics in relation to TB
Ethiopia." The main objectives wil be to further
transmission will be assessed. All isolates of M.
define lineage 7 and related lineages or
tuberculosis strains will be screened for drug
sublineages in smear positive and smear negative
resistance and the drug resistance strains will
culture positive patients in Woldiya, to find
further undergo molecular characterization. In
correlations between MTB genotypes and disease
addition, all isolates of mycobacterium species will
phenotypes and to determine anti-TB drug
be typed to differentiate between individual strains
resistance patterns of mycobacterial isolates. The
within the main lineages and identify putative
project is yet to be submitted to AAERC.
transmission clusters. Sputum samples will be collected according to the National TB programme of the country and processed using standard
In addition to the focus on Woldiya, several
protocol. Funding: AHRI and Addis Ababa
projects at AHRI are probing other geographically
distinct regions in Ethiopia, including two in the southern regions, one in Benishangul Gumuz and one in Ambo region.
Remote areas remain in Ethiopia for which little information
epidemiology. An area in Ethiopia which has
Dr Solomon Yimer, from the Norwegian Institute of
received little attention is Benishangul Gumuz
Public Health (NIPH), in collaboration with
which boarders Sudan. An MSc project by Takele
investigators from AHRI, South Sudan and Sudan, has initiated a study entitled‘Evolution of Novel
Argicho, "Epidemiology and drug resistance pattern
Mycobacterium
tuberculosis
Mycobacterium tuberculosis genotypes in East Africa and Clinical virulence trait assessment'. A
Northwest Ethiopia: Resource Limited Setting", assessed the mycobacterial genotypic diversity
recent spoligotyping study of M. tuberculosis
and drug resistance pattern of M. tuberculosis
isolates among pulmonary tuberculosis patients in
complex, and the knowledge, attitude and practice
the Amhara Region of Ethiopia showed the
(KAP) of TB suspects towards tuberculosis. He
presence of high level of diversity of strains among
conducted a Health care institution-based cross-
237 M. tuberculosis isolates, in particular a high
sectional study in Benishangul Gumuz and Awi
proportion of SIT 910 and SIT 1729 which are only
zone of Amhara region. 112 Smear positive
samples were collected from study participants
database and whose relationship to the previously
from Benishangul Gumuz and the adjacent Awi
identified Ethiopian lineage 7 remains to be
zone of the Amhara region.DST results from 87
determined. The main objective of the Dr. Solomon's project is to decipher if distinct M
samples revealed resistance to one or more drugs in 16.5% of the isolates, and monoresistance to
tuberculosis lineages (SIT 910 and SIT 1729) are
isoniazid in 6.9%. Multidrug resistance was
associated with typical or unique clinical features
observed in two cases, one of which was a
and transmission pattern compared to other
lineages. The project has obtained ethical
tuberculosis isolates spoligotyping revealed 32
clearance both from the AHRI/ALERT and the
previously unrecognized patterns suggesting the
distribution of TB strains in this part of the country
Disease incidence in clusters may be associated
may differ significantly from elsewhere in Ethiopia.
educational level, poor housing quality, crowded
predominantly to SIT289, SIT53, SIT149, SIT37
living conditions, patient factors and alcohol abuse.
and SIT134 strains. Out of 383 participants
A mathematic modelling study found that targeting
involved for the KAP study, about 5% had never
control interventions to high incidence clusters
heard about tuberculosis, two thirds knew that TB
may have similar impact on the wider tuberculosis
was transmitted by aerosols, about a third of
respondents had no knowledge of means to
throughout the remaining community. A thorough
prevent TB. Half of respondents indicated that
understanding of the temporal changes in the
delay in health seeking behaviour was due to lack
pattern of tuberculosis is thus important for tailored
of knowledge, whereas 19% indicated that delay
control measures. Dr Brita Askeland Winje from
was due to reduced accessibility and affordability
NIPH, Norway has established a collaborative
of health care. In sum, these studies indicate that
epidemiological study, ‘Spatial Analysis of
although the current level of drug resistance is
Tuberculosis Clustering in Dale District, Sidama
apparently low in this remote region of Ethiopia,
Zone, Southern Ethiopia' together with AHRI (Dr
many respondents had a poor understanding of
Markos Abebe) and University of Hawasa (Dr
TB; hence, continued education and maintenance
Daniel Datiko) to further probe pockets within the
of high quality DOTs in the area is recommended
country where TB prevalence rate are high, and
so that treatment remains efficacious.
case detection suboptimal. Similar studies are among the TB team strategic plan so as to
Melaku Tilahun, MSc student, is studying the
generate National TB cluster map. Such map will
‘Molecular Epidemiology and Drug Sensitivity
help the National TB control program for targeted
Patterns of Mycobacterium tuberculosis Isolated
intervention and revise the existing policy on case
from Tuberculosis Patients in and around Ambo
detection strategies. The protocol is finalized;
Town, Central Ethiopia'. While increasing
funding is secured and ready for submission to
information is becoming available on the strains of
ethics review. Funding for this project is provided
M. tuberculosis (MTB) circulating in Ethiopia in
by the Norwegian Institute of Public Health and the
general, no information is available on those in and
Norwegian Health Association, Norway.
around Ambo Town in particular. In this study repeated cross-sectional study designs will be
Bovine TB: control strategies, prevention,
used to recruit 152 human TB cases visiting health
possible transmission to and from humans
institutions from within and around Ambo Town for TB treatment. To date, equal numbers of smear positive pulmonary TB and TB lymphadenitis
AHRI has for many years been engaged in
subjects were recruited. From smear positive TB,
research of bovine TB (BTB), which has significant
50 isolates have been obtained and shown to be
impact on the dairy farming Industry and also may
Mtb by PCR based RD9 deletional typing. 22 fine-
contribute to human disease. Research projects
needle aspirates from TB lymphadenitis lesions
include 1) improvement in Bovine TB control
exhibited growth, and of these 12 were confirmed
strategies, 2) Development of a cattle vaccine
to be Mtb by deletional typing. Spoligotyping and
model against bovine TB, 3) Epidemiological
drug sensitivity testing to further define the strain
studies to probe possible transmission between
diversity of these isolates is underway.
Mtb and M. bovis between human and cattle.
Cluster detection as an epidemiological
A team from AHRI, Addis Ababa University, Ministry of Agriculture, Cambridge University and
research tool to improve TB control in
Animal and Plant Health Agency from UK under a
consortium project ‘Ethiopia Control of Bovine Tuberculosis Control Strategies (ETHICOBOTS)'
Cluster detection techniques for surveillance of
working to provide a strong scientific
tuberculosis incidence may support disease
understanding for the development of sustainable
control activities and reveal temporal changes in
control strategies for BTB in Ethiopia that could
the pattern of tuberculosis. One spatial clustering
significantly reduce the high rate of BTB and its
study from Dabat Region in northern Ethiopia
zoonotic transfer in the expanding dairy sector,
found smear positive tuberculosis to be clustered
especially to more disadvantaged population
geographically and concluded that this kind of
sectors; minimise trading of BTB-infected dairy
clustering may be common in the country. This has
cattle to protect the national zebu herd and the
implications, not only for investigating underlying
livelihood of poor farmers and reduce the risk of
etiology, but also for real-time intervention.
zoonosis in high risk populations. The projected has now obtained ethical clearance from the
National Research Ethics Review Committee and
the most common aetiology of TB in humans, and
soon will start sample collection.
M. bovis the most common for bovine TB, yet each mycobacteria can cause TB in both humans and in
Bovine tuberculosis is highly prevalent in intensive
cattle, and little is known about the transmission
dairy farms of the urban ‘milk-sheds' in Ethiopia.
mechanisms involved and risks involved in groups
Nonetheless, it is not a notifiable disease. As
such as farmers exposed to cattle and vice versa.
Ethiopia, like other emerging economies, cannot
Importantly, a recent study at AHRI demonstrated
afford to implement a test and slaughter control
that poor dairy farm workers in peri-urban Addis
strategy for both economic and social reasons,
Ababa had a greater than 2-fold higher prevalence
vaccination could be an acceptable alternative
of TB than controls, raising the possibility that
strategy. To approach this, Dr. Gobena Ameni
cattle to human transmission may have occurred.
leads a project entitled, ‘Establishment of a natural
Dr. Araya Mengistu, a PhD student, is investigating
‘The Epidemiological Role of Cattle in the
Mycobacterium bovis Bacillus Calmette-Guerin
Occurrence of Human Pulmonary Tuberculosis in
model to enable assessment of tuberculosis
the Rural Community of Northwest and Northeast
vaccine to prevent its transmission'. In this study,
Parts of Amhara Region, Ethiopia'. The purpose of
the performance of BCG in protecting bovine TB
this study is to investigate the transmission of the
was evaluated in 49 (23 vaccinated and 26 control)
etiological agent of tuberculosis from cattle to
Holstein-Friesian calves inserted into a herd with
human and vice versa in North Wollo zone of the
high bovine TB prevalence. Additionally, the
Amhara region, Ethiopia. This study evaluated
intranodal challenge model for the evaluation of
vaccine efficacy was ascertained. The calves were
Questionnaires administered to cattle owners
vaccinated with the equivalent of 5 human doses
of BCG Danish or with placebo via the
transmission of TB. Nearly half of interviewed
subcutaneous route when 2 weeks old and then
cattle owners drank raw milk from cattle, and
exposed 6 weeks later to the infected herd where
approximately 60% ate raw beef. More than 75%
they were kept in contact with infected donor
did not know the benefit of boiling milk in
animals for about one year. Gamma interferon and
preventing TB. About 80% of respondents did not
comparative intradermal tuberculin tests, gross
remove or isolate their sick cattle, and a
and microscopic pathological examinations as well
substantial percentage of household cohabited the
as bacteriological culturing including colony
same dwelling with their cattle.
counting and molecular typing were used to evaluate the performance of BCG. The result
In the first cohort, cattle owners with suspected TB
showed a 63% reduction of gross pathology in the
were recruited and evaluated for TB, and their
vaccinated calves of as compared the non-
cattle skin tested for TB. Only 4 of 134 cattle
vaccinated calves (p<0.05). Regionally, gross
owners tested positive for TB, whereas 10 cattle of
pathology in the lung lobes, pulmonary, head and
381 tested positive by tuberculin skin testing. 9
alimentary tract lymph nodes was reduced by 59,
owners of positive cattle were identified and
46, 87, and 88 %, respectively. The percentage of
interviewed, and of these none had TB, even
animals presenting without gross pathology
though 6 of 9 routinely drank raw milk from cattle.
increased by 24 % in the BCG vaccinated group.
In the second study, 35 cattle owning households
In conclusion, BCG vaccination of cattle in Ethiopia
with a known human case of TB were recruited
could constitute a potent tool to reduce pathology
along with 105 cattle owning households without
and thereby animal to animal transmission. This
known TB. Cattle owned by each household were
project has two parts, evaluation of the protective
assessed for TB by skin testing. The results
efficacy of BCG, and validation of the intranodal
showed that whereas about 15% of households
challenge model for vaccine efficacy testing in
without human TB owned cattle with bovine TB,
bovine. The latter objective is planned to be
nearly 48% of households with TB owned cattle
performed during the coming 6 months. The
with bovine TB, a threefold increase. Studies are
project is funded by Bill and Melinda Gates
planned to determine whether the aetiology of
Foundation and is performed in collaboration with
bovine TB in these cattle is M. bovis or
Aklilu Lemma Institute of Pathobiology, Addis
alternatively MTB. In the third cohort, cattle owners
with recently diagnosed TB were identified and
Diagnostic and Investigation Centre, Sebeta,
their disease causing mycobacteria isolated and
Ethiopia; the School of Veterinary Medicine,
characterized. 50 isolates were identified after
University of Surrey, U.K., and Animal Health and
culture, and all found to be MTB. Further molecular
Veterinary Laboratories Agency, Surrey U.K.
characterization by spoligotyping revealed that most isolates belonged to either East-Africa-Indian
TB may potentially spread between humans and
(57.4%), or Euro-American (34.0%) lineages, with
animals and between animal species MTB is by far
Ethiopian (lineage-7) (4.3%) and undetermined
(4.3%) accounting for the remaining strains.
miRNA and inflammation biomarkers in Ethiopian
International Types (SIT) 21, 25, 26, 35, 53, 109,
Mycobacterium tuberculosis and HIV during anti-
149 and 289 were found as clusters, and a total of
tuberculosis and antiretroviral treatment" with the
8 clusters were identified suggesting current
aim of identifying markers that can be used for
ongoing TB transmission.
detection of different groups of patients. Sample collection is completed. Preliminary tests on qPCR
Collectively, this study identified a number of high
for miRNA is done. A student has been recruited
risk activities commonly practiced by cattle owners
from AAU to take part in the project and will be
which theoretically would be permissive for cattle
travelling to Sweden for a 2 months attachment.
to human transmission or vice versa. Consistent
Peripheral blood collected in PAXgen tube will be
with this, cattle-owning households with TB were
sent to Sweden for microarray analysis and the
nearly three times more likely to have cattle with
results will help to select candidate miRNA to be
TB than cattle-owning household without TB.
analysed by real time PCR.
Nonetheless, the causative agent for TB among cattle owners was invariably MTB and not M.
A critical component of vaccination is to generate
bovis. Thus if transmission occurs between
antigen-specific
humans and cattle in Ethiopia, it is most likely due
lymphocytes of sufficient quantity and quality to
to Mtb and potentially moves from humans to
provide long term protection against re-infection. In
cattle (and potentially subsequently back to
spite of considerable advances regarding immune
human). Alternatively, the observed associations
response to Mtb, it is still challenging to interpret
between cattle and human TB may be due to other
results of vaccine trials. This is partly due to lack of
definitive markers of protection, which could be
transmission. Further work needs to establish
used to assess vaccine efficacy. The T-cell
whether and how common Mtb can be identified in
Specific Adapter Protein (TSAd) is considered to
TB disease bearing cattle in these Ethiopia, and
be a key regulator of T-cell polarity and a possible
molecular similarities between putative Mtb strains
marker for T-cell memory. Meseret Habtamu (PhD
identified in cattle and those in human.
candidate) in a project entitled, "Molecular markers and mechanisms of T cell memory" will be looking
Biomarker Research
at the role of TSAd in maintaining T cell memory responses by comparing TB patients and healthy individuals. The project is funded by AHRI core budget and Norwegian Quota program.
iomarkers are biological properties or molecules that can be detected and measured in blood or other tissues.
Biomarkers may be associated with either
evaluation of the relative frequency of different T
normal or diseased processes in the body.
cell phenotypes (central, effector, terminally
B AHRI has been involved in studies to find differentiated memory and naive T cells) in blood
associations between clinical states of TB
from TB patients at base line and following
and biomarkers such as cytokines,
treatment (Dr. Markos A). This project is at its final
apoptotic markers and more recently
stage of data analysis. Evaluation of serum
inflammatory proteins such as C-reactive protein, neopterin, procalcitonin and metalloproteinases as biomarkers distinguishing different clinical stages
MicroRNAs are small, non-coding RNA fragments
of TB disease is being undertaken by Dr Adane M.
that can repress protein expression by targeting mRNA. It was recently shown that many microRNAs are involved in the regulation of
Basic Biomedical Research
immune responses, including expression of proinflammatory cytokines to different pathogens.
number of basic biomedical research on
Among others, Toll-like receptor (TLR) signalling
TB are undergoing at AHRI. Most are
pathways have been shown to be tightly regulated
oriented towards better understanding
by microRNAs Mtb infection may trigger several
the host immune response in different
TLRs, particularly TLR-2, TLR-4 and TLR-9.
groups of individuals. A study by Dr Liya
However, the role and the expression profile of
Wassie, "Characterization of innate and
different microRNAs during Mtb infection of
memory phenotypes to TB and hormone
myeloid target cells are not yet known. Dr
modulations in apparently healthy children and
Marianne Jonson from Lund University, Sweden,
adolescents across age"is aimed at defining the
in collaboration with Dr Markos Abebe and Dr
influence of hormone modulation during puberty on
Abraham Aseffa are looking at the "Expression of
the host immune response to TB.The study will
compare cohorts of school aged children and
In the second project, Dr. Fekadu Desta is
adolescents before and after puberty. To date,
evaluatingbovine lymphnode lesional cells, in a
optimization of lab procedures and sensitization of
project entitled "Immunophenotype and Functional
participants have been performed. Different innate
Characterization of T Cell Subset and Monocyte-
and adoptive immune markers will be measured
Macrophage Lineage cells within Lymph Node
using flow cytometry, RT-PCR and ELISPOT
Granulomas and peripheral blood of calves
approaches. The project is funded by EDCTP (TB-
Exposed to Natural Mycobacterium bovis Infection"
TEA grant) and AHRI core budget, and done in
Previous work by Dr. Gobena and collegues (see
collaboration with Staten Serum Institute (SSI).
above) has established a natural infection model whereby young calves are transplanted to a herd
PhD candidate Martha Zewdie is addressing the
with high TB prevalence, and disease progression
role of regulatory T cells in Tuberculosis (TB)
can be monitored with or without prior vaccination.
disease, latent TB infection (LTBI), and vaccinated
This study will characterize lesional cells in
individuals in a project entitled "Analysis of
comparison with PBMC to gain insights into
regulation of immune responses in Tuberculosis"
mechanisms of BCG- induced protection of TB
The immune response in TB patients and LTBI has
disease. Paired PBMC-lymph node samples from
been assessed by measuring IFN-γ production by
either BCG vaccinated or unvaccinate calves with
ELISPOT and regulatory T cell subsets analyzed
high risk exposure to TB have been isolated and
in these study groups by flowcytometry. Results to
cryopreserved. Flow cytometric phenotypic and
date revealed an increase in a specific population
functional characaterization of lymphocyte and
of regulatory T cells, actively proliferating memory
monocyte/macrophage
samples is underway. In parallel, complementary
CD4+CD25+FOXP3+CD45RO+Ki67+, in TB patients
studies will evaluate in situ cell surface phenotype
when compared to LTBI.A manuscript reporting
and cytokine expression from parafin embedded
this novel finding is underway. Future work will
tissue from these animals. In collaboration with
further define this and other regulatory subsets
IPB, AVLRA, and AHRI, AHRi core funded.
through analysis of gene expression profiles and additional Treg markers. The project is funded by
Ethiopia has a rich history of traditional medicine
EDCTP, and done in collaboration with SSI.
from local plant extracts. To evaluate whether any of these extracts have anti-mycobacteriocidal
Most studies of TB pathogenesis, particularly
activity, a PhD student, Wubayehu Kahalw, in a
those in human and cattle, have relied on use of
project entitled, "Activity Test, Isolation and
peripheral blood mononuclear cells (PBMC). Two
Chemical Structure Elucidation of Anti-tuberculosis
studies are addressing pathogenic mechanisms
Constituents from Plants Used in traditional
using extracted cells from tuberculosis lesions. In
Medicine in Ethiopia", has prepared chloroform
the first, we investigated apoptoic markers.
and/or methanol and/or acetone extractions from a
Previous work at AHRI by Dr Markos Abebe,
number of local plants including (Otostegia
thatCD14+ monocytes are less susceptible to
Americana,Vernonia Amygdalina). These extracts
apoptosis by over expressing FasL and down
will be evaluated for their activity against Mtb in an
regulating Fas and TNFs. To gain further insight
in vitro model with Mtb infected THP-1 human
into how this mechanism might contribute to TB
macrophage cells.
pathogenesis, we sought to evaluate these and other apoptosis markers using cells collected
aternal and child health are among the
within TB lymphadenitis lesions.Nejat Juhar (MSc
top priority areas of both the MDG and
candidate) did her project on comparing apoptosis
the Federal Ministry of Health. AHRI
related molecules on macrophages and T-cells in
has continued to conduct research in
peripheral blood and lymph node of TB
this area. One project, by Silesh
Abdessa, aimed to define more
understanding how the bacilli interacts with the
precisely using PCR methodology the
immune cells at the site of infection. The study,
prevalence of female genital tuberculosis. The
"Comparison of apoptotic markers on macrophage
results indicated that female genital TB accounts
and T cells in peripheral blood and Lymph node
for up to 5% of all TB in this country. A second
from TB patients and controls"showed a difference
project, entitled "Mycobacterium tuberculosis
in the expression of apoptosis related molecules at
specific immune response among HIV infected
the site of infection and peripheral blood as well as
pregnant women" by MSc student Malet Birku, has
on macrophage and T-cells. The study also
addressed impact of the combination of pregnancy
showed a decrease in macrophage apoptosis in
and HIV infection on TB specific responses.
the lymph node, which may help the bacilli to
LTBI, as assessed by QFN and TST tests was
replicate and evade the host immune response.
significantly less in HIV+ pregnant women (19%)
responses were very weak throughout. These
compared with HIV- pregnant women (29%). Using
studies reveal the impact of both pregnancy and
sensitive Mtb-specific single cell ELISPOT assays,
HIV infection in reduction of Th-1 IFN-g responses
HIV+ pregnant women exhibited significantly lower
in LTBI, as well as the influence of pregnancy in
IFN-g responses, but higher IL-10 responses than
augmenting immunosuppressive IL-10 responses.
Grant Applications
1. Biomarkers for tuberculosis diagnosis and
2. Effect of maternal factors on neonatal
treatment response in Ethiopia (Grant
BCG vaccination (Grant submitted to
application for NIH/NIAID together with
experts at Emory University, status-
rejected) (Dr Liya W)
Attendee
Conference/workshop/training title
University of Oslo, Norway
To run experiments at Prof Spurkland's lab.
University of Oslo, Norway
Course work and laboratory training
Dr. Markos Abebe Khartoum
To train EvoTB-2 project staff on sample collection
To participate in the annual THY-B04 project meeting
To participate in TB HIV research dissemination workshop
World TB day at AHRI
by students from different Schools (137),
commemorated at AHRI by organizing
invited guests from different Associations
open day event to students, visitors and
(28) and staff from ALERT and AHRI (35)
invited guests to AHRI. The program
(Few pictures taken during the laboratory
laboratory visit. The event was attended
List of TB Researches at AHRI
Project type/PI
Diagnostics research
Improving the sensitivity of QFT TB Gold assay
AHRI project (Markos A)
Patent application submitted to the
AHRI core budget
using T cell Blast (ISQA)
European Patent Office (EPO)
Methods of Diagnosing tuberculosis.
Consortium projects
Patent application submitted to the
South African Patent Office
Optical adjustment and stage automation of a
AHRI core budget
microscope & automatic detection of
Procurement of equipments
mycobacterium species from sputum smear slides using image analysis techniques
Evaluation of culture of Mycobacterium
Thesis defended, manuscript in
tuberculosis on blood agar in resource limited
setting in Addis Ababa, Ethiopia
Validation of Tuberculosis Diagnostic Algorithm
Thesis defended,
AHRI core budget
and Newly Emerging Tests for the Diagnosis of
2 manuscripts in preparation
Childhood Tuberculosis in Ethiopia
Mask sampling as a method to detect tubercle
Consortium project
Sample collection undergoing
AHRI core budget
bacilli from smear negative pulmonary TB
Lipid Bodies; can they be Biomarkers for
Protocol development
improved Diagnosis of Disease and Better Patient Management?
Epidemiology research
Molecular Epidemiology and Drug Resistance of
Ongoing: Sample collection
AHRI core budget
Tuberculosis in Southern Region of Ethiopia
Spatial analysis and clustering of tuberculosis in
SNNPR in Ethiopia: A Population Based
Funding secured, protocol
Prospective Cohort Study
submitted for ethics review
Drug resistance pattern in lineage seven and
AHRI core budget
other lineages of mycobacterium tuberculosis on
archived isolates
Molecular Epidemiology and Drug Sensitivity
Ongoing: sample collection, TB
AHRI core budget
Patterns of Mycobacterium tuberculosis Isolated
from Tuberculosis Patients in and around Ambo Town, Central Ethiopia
Determinants of MDR-TB in Eastern part of
AHRI core budget
Ethiopia Dire Dawa
Data collection completed and analysis started
Molecular Epidemiology and Drug Resistance of
AHRI core budget
Mycobacterium tuberculosis Among New Smear
Positive Pulmonary Tuberculosis Cases in eastern Ethiopia
A community based study on the prevalence of
Tuberculosis cervical lymphadenitis in Yilmana
Densa district, Amhara region, Ethiopia
Prevalence of Endometrial Tuberculosis and
Thesis defended, Manuscript in
AHRI core budget
Characterization of Isolates among patients
undergoing endometrial biopsy at Tikur Anbesa specialized Hospital, Addis Ababa, Ethiopia
Molecular Epidemiology, drug resistance pattern
of M. tuberculosis and clinical outcome evaluation
in Woldiya region, Ethiopia
Phenotypic and genotypic assessment of drug
AHRI core budget
resistance tuberculosis in Dessie and surrounding
The role of Cattle in transmitting the causative
Data analysis and thesis writ up
AHRI core budget
agent of tuberculosis in two Zones of the Amhara
Epidemiology and Drug resistance pattern of
AHRI core budget
Mycobacterium tuberculosis in North West
Ethiopia: Resource limited region.
Ethiopia Control of Bovine Tuberculosis Strategies
Consortium project
Submitted for National Ethical
ZELS program, UK
Establishment of a natural transmission model in
Experiment and data analysis
cattle to validate the BCG challenge model and to
completed, manuscript write up
enable assessment of TB vaccine to prevent TB transmission
Biomarker research
Expression of miRNA and inflammation
Postdoc (Marianne J)
Ongoing: Sample collection
AHRI core budget
biomarkers in Ethiopian individuals singly or dually
completed, QFT test done. RNA
and Lund University
infected with Mycobacterium tuberculosis and HIV
during anti-tuberculosis and antiretroviral
Evolution of immune response during treatment
Ongoing: Data analysis
Serum Inflammatory proteins as biomarkers for
Samples collected and reagent
discriminating different tuberculosis infection
bought, ELISA test underway
Molecular markers and mechanisms of T cell
AHRI core budget
Basic biomedical research
Evolution of Novel Mycobacterium tuberculosis
Postdoc (Solomon Y)
Ongoing: ethical clearance, training
genotypes in East Africa and Clinical virulence
given to study team
trait assessment
Immunophenotype and Functional
Ongoing; Optimization
AHRI core budget
Characterization of T Cell Subset and Monocyte-
Macrophage Lineage cells within Lymph Node Granulomas and peripheral blood of calves Exposed to Natural Mycobacterium bovis Infection
Activity Test, Isolation and Chemical
Structure Elucidation of Anti-tuberculosis
Plant extract ready for in vitro
Constituents from Plants Used in traditional
Medicine in Ethiopia
Characterization of innate and memory
phenotypes to TB and hormone
sample collection
modulations in apparently healthy children
and adolescents across age (TBTEA)
Analysis of regulation of immune responses
Data analysis, thesis
submission April 2015
Mycobacterium tuberculosis specific
AHRI core budget
immune response among HIV infected
Thesis submitted
Comparison of apoptotic markers on
Ongoing: Thesis write-up
AHRI core budget
macrophage and T cells in peripheral blood
and Lymph node from TB patients and controls.
Dysfunctional immunity in TB
Manuscript in preparation
Institute, AHRI core
Effect Of Diabetes Mellitus on T-Cell
Sample collection undergoing
AHRI core budget
Immune Response among Pulmonary
Tuberculosis Patients In Addis Ababa, Ethiopia
Bacteriology Team
AHRI Bacteriology team was established in 2006 to conduct epidemiological and molecular studies on common bacterial diseases. The aim of establishing the bacteriology team is to lead, plan and coordinate research activities related to meningitis, pneumonia, typhoid fever and other infections caused by pathogenic bacteria. Moreover, the team plays a significant role in capacity building activities of AHRI. As a result of this, MSc and PhD students research projects are provided all the necessary support such as supervision, funding and laboratory space at the bacteriology laboratory to conduct their research. The overall goal of the team is to characterize and identify etiologic agents of diseases in different geographical areas of the country so as to provide research based information to policy makers.
entitled "Bacterial Meningitis actual disease burden report and disease severity in non-epidemic season in Ethiopia by use of real time
Wude Mihret [Senior Researcher]
Dr. Demissew Beyene [Post-doctoral
sequence typing and cytokine detection assay"
is integrated with the main study and the student
Tsehaynesh Lemma [Medical Microbiologist]
is coordinating this consortium study both at field
Dr Mekonnen Teferi [Research Assistant]
Elena Hailu [Research Assistant]
A total of 163 Study participants clinically
Biruk Yeshitela [Research Assistant]
diagnosed to have bacterial meningitis were
recruited from Hawassa, Gondar and Tikur
Anbessa University Hospitals. Bacteriological
Mahlet Tadesse [Laboratory Technologist]
and molecular diagnosis were run to detect
Neisseria meningitides, Haemophilus influenzae
Melaku Yiedenekachew [Biologist]
and Streptococcus pneumoniae among 139
Wondewosen Tsegaye [PhD student]
study participants whose samples and case
Nigus Zegeye [MSc student]
record forms (CRFs) collection were completed.
Among the 139 patients suspected with bacterial
Project Lists
meningitis admitted at the three hospitals in Ethiopia during 2012-13, 46 harbored either serogroup
Disease burden and severity of bacterial
pneumococci, reinforcing the need for intensified
meningitis in Ethiopia in non-epidemic
affordable meningitis vaccines for the African
meningitis belt. Remaining work includes serum cytokine analysis for all study participants to
[PI: Professor Dominique Caugant and Dr
determine associations with bacterial etiologies,
meningococcal serogroups defined at AHRI and for molecular identification of non-typable
Ethiopia is one of the meningitis belt countries
an area with repeated occurrence of meningitis
Manuscript preparation for the completed portion
epidemics in Sub-Saharan Africa. This study is
of the work is in progress.
designed to investigate the actual burden of bacterial meningitis during non-epidemic periods since only limited data is available in this regard. An MSc student capacity building research
Funding Source: The Norwegian Research
suspected patients from all age groups in St
Norwegian Institute of Public Health (NIPH).
Paul's hospital, Addis Ababa. 185 blood culture samples were analyzed from eligible patients. About 23% of the samples were positive for
Typhoid Fever Surveillance in Africa
bacteria, and more than 10 species of bacteria
were identified. The bacterial type and DST results were sent to the clinic to assist in clinical
[PI: Dr Florian Marks, Dr Abraham Aseffa;
management of the patient. The relevant data were double entered in to the database, and
Status: Completed]
final analysis remains.
In collaboration with International Vaccine
The impact of Ten-valent pneumococcal
Institute (IVI), TSAP began recruitment in Butajira from March 2012 with the objective to
estimate the incidence of typhoid fever in Africa
Streptococcus
pneumoniae
using a standardized surveillance method
currently utilized across 10 different African countries. TSAP recruited about 900 febrile
phenotypic and genetic diversity of
patients from four health facilities serving 10
isolates from Addis Ababa, Ethiopia
surveillance site. Blood samples these cases were cultured using the Bactec system, and
[PI: Dr Wondewosen Tsegaye; Status: On-
further subculture and species identification was
performed. Strain sequencing will be performed by IVI to define circulating S. typhi strains in
The objectives of this project are to determine
Ethiopia which will assist in matching needs with
the impact of the PCV 10 vaccine on
current vaccine candidates. In parallel, TSAP
aimed to determine the health care seeking
pneumonia by evaluating pre- and post-vaccine
behaviour of the catchment population through
samples, and to analyze the phenotypic and
administration of a health care utilization survey
genetic diversity of pneumoccal isolates. Pre-
vaccination specimens from newborns were
administered to 592 selected households, data
collected from 7 health centers in Addis Ababa.
entry and cleaning and analysis is underway.
From 789 study participants we identified a total
The final results will be reported by IVI.
of 512 bacterial isolates, the most common of which
staphylococcus (171), Moraxella catarrhalis
(104), and Hemophilus influenza (31). Post-vaccination evaluation is underway, and thus far we have obtained samples from about 20% of
Characterization
those initially vaccinated, resulting to date in the
Susceptibility Patterns (CASP) of blood
culture isolates from septicemic patients
Moraxella catarrhalis, and 9 Haemophilus
at St Paul's hospital, Addis Ababa,
molecular analysis of genes responsible for resistance to erythromycin and penicillin are underway.
[PI: Adugna Nigussei; Status: On-going]
Funding Source:
CASP was initiated in December 2012 with the
AHRI core budget.
aim to define the prevalence of bacterial species and their antimicrobial sensitivity pattern from
Throat carriage rate and antibiotic susceptibility
streptococcus in children with rheumatic fever
Specialized Hospital, Addis Ababa,
Bacteriology Team
A Comparative Study of Blood Culture
[PI: Nigus Zegeye; Status: This project iscompleted]
and Widal test in the Diagnosis of Typhoid Fever in Febrile Patients in
Isolation of group A streptococci from children
selected Health Centers, Addis Ababa,
having rheumatic heart disease is a MSc project aimed to determine the effectiveness of
secondary antibiotic prophylaxis, and to further characterize
[PI: Biruk Yeshitela; Status: On-going]
isolated. Throat sample, blood specimen and risk factors associated with streptococcal throat
The primary objective of this study is to compare
infection have been collected from children at
the diagnostic performance of Widal test and
Tikur Anbessa hospital. Throat culture and
blood culture in the diagnosis of typhoid fever in
biochemical tests have been done to isolate
febrile patients in Addis Ababa, Ethiopia.
betahemolytic streptococci and stored for further
Typhoid/paratyphoid (enteric) fever is a systemic
tests. Out of 234 participants, throat carriage
prolonged febrile illness which is an important
rate of β-hemolytic streptococci was 23.9 %
health problem in many developing countries
(56/234). Children who received antibiotic
and is caused by certain Salmonella serotypes
including S. typhi, S. paratyphi A, S. paratyphi B
significantly lower β-hemolytic streptococcal
and S. paratyphi C. S. typhi is a highly virulent,
throat carriage than those sampled 4 weeks
host-restricted invasive pathogen that affects
after injection (p=0. 004). Of the β-hemolytic
only humans. Most of the health burden occurs
streptococci identified, 4 were S. pyogenes, and
among people of low-income regions. The Widal
Streptococcus dysgalactaie subsp. equisimilis
test has been in use for more than a century as
possessing Lancefield group A, C and G were
an aid in the diagnosis of typhoid fever.
also isolated. Six different emm gene types with
However, the predictive value of this test has
one newly discovered subtype (stGrobn.1) were
been debated. The goal of this study is therefore
to evaluate the Widal test for sensitivity and
transferase in strain emm 68.2 (multidrug
sensitivity in a case control study.343 individuals
resistant strain) had N-linked glycosylation
were recruited, laboratory analysis is ongoing
carrying a unique HexNAc-deoxyhexose, a
and demographic and risk factors data collected
post-translational
from study participants is currently being entered
by the data management and statistics unit.
streptococci were susceptible to penicillin except
S. agalactaie. Erythromycin and tetracycline
resistant S. pyogenes were identified.
Funding Source: AHRI core budget.
Impact of meningococcal conjugate
NIPH in Oslo, Norway. Data entry and cleaning
vaccines on serogroup A transmission in
for both the cross sectional and longitudinal
Ethiopia – mechanism and dynamics of
studies are completed and shortly data analysis
clearance of asymptomatic carriage -
will be started.
The Ethiopian carriage study
Funding Source: The Norwegian Research
Counsel Collaborating Institution (s): The
[PI: Professor Dominique Caugant and Dr.
Norwegian Institute of Public Health (NIPH),
Demissew Beyene; Status: This project is
Nationalities and Peoples Regional Health Bureau, Arba Minch University and Arba Minch
To eliminate meningitis epidemics caused by
General Hospital.
Neisseria meningitis, a new serogroup A meningococcal conjugate vaccine, MenAfriVac,
was developed by the Meningitis Vaccine Project (MVP). The vaccine was introduced in
Surveillance of Bacterial Meningitis in
mass vaccination campaigns in Burkina Faso
and parts of Mali and Niger in December 2010. Roll-out of MenAfriVac is planned to encompass all 25 countries of the African meningitis belt by
[PI: Professor Dominique Caugant and Dr.
Abraham Aseffa; Status: On-going]
The aim of the project is to demonstrate the
The aims and objectives of this study is to
ability of MenAfriVac and other conjugate
characterize the etiology of bacterial meningitis
vaccines, to reduce pharyngeal carriage, and
in 8 selected hospitals in Ethiopia during the
thus, transmission of the pathogen. The study
period 2014-2016 and to study antigenic
will investigate the dynamics of carriage
variation, molecular variation and antibiotic
clearance in correlation with vaccine-induced
susceptibility patterns among the patients'
antibody responses in serum and saliva. By
isolates. To date, 41 patients have been
studying the dynamics of carriage clearance and
recruited from Hawassa referral hospital, and 3
correlating carriage to antibody concentrations in
patients recruited from Arbaminch hospital.
saliva and in serum, the study may provide
Laboratory analysis is ongoing.
further knowledge on the mechanism of action of conjugate vaccines and determine an antibody
Funding Source: The Norwegian Research
threshold necessary to prevent carriage.
Norwegian Institute of Public Health (NIPH).
Both the sample collection and laboratory activities of the project are completed. A total of
Capacity building
7723 pharyngeal swabs have been collected from multiple sites around Arba Minch. All these samples
The team provided training for two PhD
biochemically tested with Oxidase, GGT/ONPG
students and two MSc students.
and agglutination tests to identify pharyngeal
RT PCR training is given for 7 EPHI
carriage and to serogroup them. A total of 74
bacteriology staff, 1 Hawassa university
carriers with different serogroups were identified.
staff and 5 AHRI staff.
Out of the 74 carriers identified, 65 carriers were
grouped into the vaccine and control groups and all of them were followed. Appropriate clinical specimens (blood, saliva and blood spot) were
National: Addis Ababa University, Gondar
collected for immunogenicity testing. The
immunogenicity tests will be performed at the
University, Saint Peter's Hospital, Arba Minch
University, Arba Minch General Hospital, SNNR
Vaccine Institute (IVI),University of Bergen,
health bureau, Amhara Regional Health bureau,
Norway, KIT, Biomedical Research Institute,
The Federal Ministry of Health of Ethiopia,
ALERT hospital, EHNRI.
Diseases Research Institute (IDRI), USA, The Norwegian
International: London School of Hygiene &
Tropical
(LSHTM),International
Neglected Tropical DiseaseTeam
In 2013 the NTD-Malaria team was involved both in research and professional services to the Federal Ministry of Health (FMoH). As a member of the national Neglected Tropical Disease Control task force, the team was involved in the development of NTDs five year master plan and launching workshop. In addition, the team participated in the preparation of the Map of NTDs in Ethiopia, in the revision and editing of the guideline for Diagnosis, Treatment and Prevention of Leishmaniasis in Ethiopia 2nd edition June, 2013. Research activities comprised three leishmaniasis related projects and three Malaria related projects, and 4 articles in peer reviewed Journals were published. Moreover, the team has contributed in human capacity building; 5 PhD students were linked with the research activities and in collaboration with Addis Ababa University and 1 MSc student thesis was successfully defended.
Highlights: 2014
Compared to the preceding year, our team in
The team identified the need to established
2014 had unique experiences.
Leishmania culture capacity, and trained staffs at the Bahir Dar, Amhara Regional laboratory (Figure 2).
In response to lack of cytocentrifuge our PhD student proposed designing a bucket with accessories which could be interchanged into the ordinary centrifuge rotor to produce hybrid cytocentrifuge; this was funded by the Ethiopian Science and Technology Ministry. Partnering with a private engineering service provider, the team constructed and tested the functionality of a prototype Cytocentrifuge (figure 1).
Figure 2. Team members training the regional staff
Continuing its collaboration with the FMoH as member of the NTD control task force, the team is participating in the onchocerciasis delineation work. This year the team published 10 articles in peer reviewed journals. In addition there are 2 manuscripts
publication in Plos One and the other under review
Figure 1. Above the new hybrid Cytocentrifuge bucket; accessories below when it is fitted in the
Geoinformatics and 3 under preparation. The
normal centrifuge rotor.
details of Projects ongoing and completed in 2014, other activities and achievements of the team are detailed as in below.
Research and Capacity Building
Significant contributions of our research findings include: (for more information refer to the publications listed below):
In Ethiopia, over 83.6% the population lives in rural areas with subsistence mixed farming practice. Infectious diseases and malnutrition
With basic biomedical and epidemiological
are important concerns in the society. Despite
the political commitment and effort to control infectious disease, malaria and leishmaniasis
1. It is more than a decade since chloroquine
still are among the top public health threats
(CQ0 was withdrawn yet 100% of the
especially for the poorest of the poor; the rural
parasites from both symptomatic and
community. Malaria is the 3rd among Ethiopia's
asymptomatic cases from south-central
disease burden list and 75% of the area of the
Oromia still carry the pfcrtK76T mutation
country-- representing 68% of the population--is
2. No K-3 propeller mutations implicated in
malarious. Leishmaniasis is a re-emerging
Artemisinin resistance previously reported
public health problem with increasing number of
in Southeast Asia was found in P.
reported cases and appearing in new areas
falciparum from twelve sub-Saharan Africa
previously not known to be endemic. The
countries showed
population at risk of leishmaniasis is estimated to be over 3 and 29 million for visceral and
Comparing smear microscopy with molecular
cutaneous leishmaniasis, respectively. The
techniques showed a high rate of species
annual incidence is approximately 2500 to 4000
mismatch: a higher proportion of P. vivax cases
cases for visceral leishmaniasis and 20000 to
were misdiagnosed as P. falciparum-positive by
30000 for cutaneous leishmaniasis. Treatment
smear microscopy.
and diagnostic tools are inadequate for Malaria and Leishmaniasis control and/or elimination.
A Knowledge, Attitude, Practice (KAP) study as
Moreover, as vector born diseases, their
part of 3 years of follow up showed that, proper
knowledge about visceral leishmaniasis (VL) in a
environmental changes. Thus, definition of the
rural community can be improved substantially
environmental determinants, risk areas and the
by community interventions. And VL patients
population at risk, forms the basis for efficient
and relatives can act as successful health
use of scarce resources, and monitoring of
agents if properly informed Using (GIS/RS
control programs. Availability of tools for proper
diagnosis, monitoring of drug efficacy and understanding mechanism of drug resistance
We have made the risk map of cutaneous
form the cornerstones for early and rapid
leishmaniasis and identified risk areas and
diagnosis and treatment not only to reduce their
population at risk for use by the control program
burden but also to contribute to their eventual control and/or elimination. The themes of completed and/or on-going projects of our team
have been: genetic diversity, drug efficacy and
determinants of visceral leishmaniasis in Kafta
resistance in Plasmodium spp., host genetics
Humera, one of the most affected areas in
and drug resistance in Plasmodium spp.,
Ethiopia to aid planning of more focused control
ecology of Plasmodium spp. infection, innate immunity in leishmaniasis, assessment of
Fund raising/grant proposal
disease/infection risk factors, assessment of the type and magnitude of malnutrition in school
The team made five applications for funding and
aged children, and evaluation of geographical
two were granted (Table 2 for details of these
information system (GIS) and remote sensing (RS)in the control of disease of public health
proposals and their status).
importance in Ethiopia.
Professional services
Working as the technical working group for the national Onchocerciasis elimination
Member of the national Neglected Tropical Disease task force
Lists of ongoing projects
Innate Immunity in leishmaniasis,
identify innate immune
Two PhD students:
Visceral and cutaneous
mechanisms targeted by
Geremew Tasew and
Leishmaniasis, German African
Leishmania for evasion
Menberework Chanyalew
collaborative project
obtain new insights into the role of
cellular mechanisms that link innate and adaptive immune responses
Clinical and molecular assessment
determine possible CQ treatment
of P. vivax chloroquine (CQ)
failure during the standard 28 days
Sisay Getachew
resistance and population genetic
of in vivo follow-up test
diversity in South Nations,
genotype the pre- and post-
Nationalities and Peoples Regional
treatment samples to discriminate
true drug failures from re-infection and relapses
characterize P. vivax population
genetic diversity and structure
Ecology of Plasmodial infections in
explore the presence and
selected regions of Oromia, Ethiopia:
prevalence of K13 mutations
Clonal diversity, prevalence of
conferring Artemisinin resistance
antimalarial drug resistance-conferring mutations & host genetic characterization
Therapeutic Efficacy of Artemether-
Determine the efficacy of
One PhD student,
lumefantrine for the treatment of
Artemether-lumefantrine in
uncomplicated Plasmodium
uncomplicated P. falciparum
falciparum Malaria in South Ethiopia
Understanding the dynamics and
systematically investigate the
extent and dynamics of the
asymptomatic malaria carriage in low
"hidden" human reservoir,
and moderate endemic settings in
asymptomatic submicroscopic
Ethiopia – are they challenges for
carriers of malaria infection, in
malaria elimination?
school children in Ethiopia and ultimately infer their infectiousness
New projects submitted for funding
Rapid assessment of Visceral
33, 440.00 birr is transferred
leishmaniasis in Dangur district,
Benishangul Gumuz
Health Extension Workers in
The project sites should be
Ethiopia - Key to improve active
chosen where prevalence is
leprosy case detection and
it should involve already
available system in MoH and regional health bureaus
sustainability, local
resources, partnership should be defined
Identifying Socio-Economic,
good background
Cultural and Environmental
Factors determining the risk to
collaboration with other
leprosy in Oromia-Ethiopia
stakeholders such as regional health bureau and MoH are in need
Asymptomatic visceral
leishmaniasis, and visceral
leishmaniasis control in Ethiopia
Lipid Bodies; can they be
69, 769 birr from AHRI-Core
Biomarkers for improved
Diagnosis of Disease and Better Patient Management?
The impact of frequent mass
Partners identified and
Proposal on development
neglected tropical disease on the control of the vector; mosquitoes.
Conferences, workshops and Training
Attendee
Conference/workshop/training title
Lemu Golassa
Wellcome Trust Sanger Institute
Genomic Epidemiology of Malaria (GEM-2014)
Cambridge, Hinxton UK
Sisay Getachew
Darwin, Australia
Molecular Laboratory Techniques in malaria parasites
Seleshi Kebede
New Orleans, USA
Teshome Tsegaw
Bahir Dar, Ethiopia
DNDI, Visceral leishmaniasis in east Africa
Ahmed Seid
Lensa Aberra
Computer Modeling Training
Adugna Abera
Adama , Ethiopia
Neglected Tropical Disease Managers Training
Lensa Aberra
Adugna Abera
Molecular Biology of Leishmania
Leprosy Team
The Armauer Hansen Research Institute (AHRI) has established the leprosy research team in 2006to lead, plan and coordinate research activities on leprosy. In Ethiopia, it became possible to treat leprosy with a multidrug therapy (MDT) starting from 1982. Although appropriate treatment during the early stages of the disease reduces its progression and spread, poor diagnostics and lack of access to regular health care often mean that many who develop leprosy are treated late in the disease, after disfigurement. As a result of this the incidence of leprosy remains steady as studies conducted in disease endemic countries reported.
In spite of the therapeutic success achieved with MDT to cure leprosy patients, still more work is needed to significantly decrease the current new case detection rate. For this reason, AHRI is currently working on the development of new and improved diagnostic tests, investigating the transmission aspect of leprosy to develop new and improved intervention strategies to curb the transmission of leprosy within the community, the immunopathology of leprosy, genetic susceptibility in leprosy and has also launched working on mapping hot spot leprosy areas in Ethiopia alongside with other priority research areas to generate evidence based findings which can be transformed into practice to improve the existing leprosy control strategies.
Team Members
Dr. Demissew Beyene
Daniel Taye, PhD candidate
Mrs Kidist Bobosha, PhD candidate
Yonas Bekele, PhD candidate
Dr. Markos Abebe, Postdoctoral Scientist and TB
Tadeye Abeje, Researcher
team coordinator
Etsehywet Gedlu, MPH student, completed
Mrs. Martha Zewdie, PhD candidate
Saba M. Lambert (MD, PhD)
Edessa Negera, PhD candidate
Nigussie Seboka, MSc student, completed
(27%), clinical nurses with diploma (66%) and
Research projects:
health assistants (2.8%). The median age of the respondents
comprised 45% of the participants. Overall,
Assessment of the Performance of general
knowledge of leprosy and practice standard of the
health workers in leprosy control activities
respondents was found to be poor while attitude towards leprosy was positive for the majority of the
at public health facilities, in Amhara and
respondents. The results showed that 519 (86.3%)
Oromiya regions, Ethiopia
had poor knowledge. Overall 241 (40%) of the respondents had positive attitude towards leprosy while 205 (34.1%) had intermediate (mixed) attitude
PI: Tadeye Abeje and Dr. Eshetu Kebede
and 155 (25.8%) had negative attitude to the disease. Among 83 respondents assessed for
Project Summary: The aim of this project was to
diagnosis of leprosy only 15 (18%) diagnosed
assess the overall performance of general health
leprosy correctly. Variation in knowledge and
care workers at public health facilities concerning
attitude indicated a significant difference (p<0.05)
activities related to the prevention and control of
among different health institutions, professions,
leprosy. Data was collected by self-administered
gender, in-service training and years of experience.
questions using structured questionnaires and
The current findings underlscore that although
observation of health workers' performance using a
leprosy control activities are integrated to the
checklist. This was supplemented by review of the
general health services in the country, knowledge
medical records and activity reports. A total of 601
and skill of leprosy diagnosis, treatment and
general health workers responsible for leprosy
control activities at public health facilities were
unsatisfactory. Hence, attention should be given to
included in a knowledge and attitude assessment
develop training strategies that can improve health
and 83 of them were subjected to practical
worker knowledge and promote better leprosy
evaluation, with on-site observation of how they
management at public health facilities. This could
handled leprosy patients. These included doctors
be achieved through pre-service and in-service
(MD) (4%), health officers and nurses with BSc
training giving adequate emphasis to leprosy related practical work and continuous follow up.
The manuscript reporting these findings is in
Immuno-pathology
Funding: AHRI core budget. Collaborating
Nodusoma Leprosoma
Institute: ALERT training center.
PI: Edessa Negera
Haptogloblin gene polymorphism amongst patients with leprosy in Ethiopia
Project summary: This project is the PhD
research project of Edessa Negera who has
PI: NigussieSeboka
registered at the London School of Hygiene and Tropical Medicine and is supervised by Professor Diana Lockwood. In leprosy there are two types of
Project summary: This project is the MSc thesis
reactions; type I or reversal reactions and type II or
research of Nigussie Seboka from the Department
Erythema Nodosum Leprosum (ENL). Type II
of Biology, Addis Ababa University. The aim of this
reactions are inflammatory episodes that occur in
study was to assess the haptoglobin (Hp) gene
20-30% of leprosy patients anytime in the disease
allele frequency relationships with leprosy disease
process, before, during or after treatment, and
among patients rom ALERT referral hospital here in
management of these complications is challenging.
Addis Ababa, Ethiopia.
A better understanding of the immunopathogensis of ENL may lead to improved clinical management
Previous studies have suggested that some
of these complications. In particular, this project is
haptoglobin alleles are overexpressed in leprosy.
focused on T regulatory cells--which normally down
The mechanism for this remains to be clarified but
regulate immune responses-- and whether aberrant
may relate to the fact that habtoglobin-hemoglobin
expression of these cells may contribute to
complexes bind to surface CD163 on monocytes
immunopathology. A total of 70 patients have been
and macrophages, and may induce such cells into
enrolled (42 with ENL and 28 with lepromatous
an anti-inflammatory state. This may promote
leprosy (LL) without reaction), and 64 and 56 of
hemoglobin-haptoglobin
these patients, respectively returned for additional
ultimately provided greater heme iron needed for
follow-ups. Blood and punch biopsies were taken
M.leprae survival, while simultaneous suppressing
from each individual at each time point. Flow
an appropriate inflammatory responses needed to
cytometry data analysis has been done for all
eradicate M.leprae. Further studies have revealed
recruited patients to characterize regulatory T cells
important anti-oxidant functions of Hb as well. The
and other lymphocyte subsets. In addition, to
severity of multiple disease states, including HIV,
evaluate antigen specific cytokine responses, 54
TB and leprosy infections have been associated
PBMC samples have been stimulated with
with haptoglobin genotypes, in particular genotype
irradiated M. leprae and the supernatants have
2-2. In the present investigation we sought to
been collected and to be assayed for cytokine
confirm genetic associations between leprosy and
content by ELISA. To measure the functionality of
haptogloin as a first step towards probing this
regulatory T cells, 54 samples have been sorted
mechanism further. We observed that phenotype 1-
using antibody coated magnetic beads into CD25+
2 was under-expressed in leprosy (76%) compared
(Treg enriched) and CD25- (Treg depleted)
with control (92%), while phenotype 2-2 was
overexpressed in leprosy (17.5%) compared with
unfractionated PBMC stimulated in vitro. Data is
control (3.1%) in a cohort of 109 leprosy patients
currently under analysis. Funding: London School
and 108 controls. In contrast to these findings, no
of Hygiene and Tropical medicine. Collaborating
associations were found between leprosy and ABO
Institute: London School of Hygiene and Tropical
blood types. These findings, in particular the
overexpression of phenotype 2-2, is compatible with previous findings observed in other countries
Detection of new leprosy cases and
(India) and further justified additional research into role of haptoglobin in susceptibility to leprosy. The
household contacts at risk of developing
project is completed and the student defended his
leprosy by active case detection in Kokosa
Woreda, West Arsi zone, Oromia region
Funding: AHRI core budget. Collaborating
Institute: Addis Ababa University
PI: TsehayneshLema
Project Summary: This project is the PhD
research project of Tsehaynesh Lema who is
pursuing her PhD training at Addis Ababa
University, Faculty of Medicine, Department of
Assessment of prevalence of leprosy
Microbiology. A remarkable decrease on the
prevalence of leprosy has been observed after 1983 with the introduction of multidrug therapy
associated factors
(MDT) to treat leprosy patients in Ethiopia. In spite of this drop in prevalence, the yearly notification
PI: Etsegenet Gedlu
rate and new cases in children remain remarkably stable, suggesting that there is no reduction in the incidence or transmission of leprosy in Ethiopia.
Project Summary: This is the MSc thesis
Several regions in the country have been identified
research project of Etsegenet Gedlu, an ALERT
with higher incidence rates of leprosy. The goal of
staff and a student at Addis continental institute of
this study is to identify new cases in these regions
public health in a joint program with Mekelle
and trace household contacts at risk of developing
University. The objective of the study was to
leprosy by active case detection and mapping the
retrospectively assess the prevalence of leprosy
distribution of leprosy and assess health care
reaction in leprosy patients and associated factors
facilities delivery status and outcome of leprosy
in ALERT Centre from September 2010 to August
treatment in Kokosa Woreda, West Arsi zone,
2013. A total of 900 patient cards were selected
Oromia region, Ethiopia. The project proposal has
using systematic random sampling and reviewed.
already obtained ethical approval from AAERC and
Among the 900 cases, 22.4% had pauci-bacillary
and 77.6% had multi-bacillary leprosy. More than
(NRERC) and the project
half, 54.1%, had grade 1 disability at diagnosis of
will soon start. Funding: GLRA and AHRI core
leprosy whereas 18.4% had grade 2 disability at
budget. Collaborating Institutes: ALERT, GLRA
time of leprosy diagnosis.
and Oromia regional health bureau
The magnitude of "ever having reaction in leprosy"
was52.9% (476), whereas 44.5% (400) of them had the reaction at the time of diagnosis. Among those
Discriminatory Discourses and the
in reaction, 68.5% (326) had reversal reaction (RR)
ingrained Social Constructs
and 31.5% (150) had erythema nodosum leprosum (ENL). Higher numbers of reversal reaction (38.3%)
PI: Daniel Taye, College of Humanities, Languages
and ENL (44%) were seen in those between 18-30 years of age. Both types of reactions were high
among multi-bacillary leprosy cases with reversal
Department of Foreign Language and Literature,
reaction (71.8%) and ENL (98.6%). Interestingly
Addis Ababa, University.
69.5% of the patients with RR had a bacillary index of 0 whereas 63.8% with ENL had bacillary index of
Project Summary:
Discrimination related to
disability among RR was 57.3%
whereas that among ENL was 51%.; 19.6% of RR
disease and disabilities are common in Ethiopia.
patients had grade 2 disability, while 13.6% of ENL
People use various types of discourse to identify
patients had such a disabiliy.72% of patients with
victims of diseases. The purpose of this study is to
RR, and 68% of ENL developed reaction before
critically examine discriminatory discourses and
starting MDT.55.5% (181) of the patients with
their underpinning (ingrained) social attitudes by
reversal reaction and 49.3% (74) with ENL had co-
healthy people against those affected by leprosy
infections during the month preceding diagnosis
and vice-versa. Two sites, Addis Ababa and
with reaction. Co- infections examined included
Kuyara have been selected to undertake the
those of the urinary tract, gastrointestinal track.
research. More than 40 participants from health
upper respiratory tract, and oral cavity. The study is
caregivers (6), religious persons (6), leprosy
completed and the student has defended her
sufferers and their families (19) as well as people
thesis. Funding: AHRI core budget. Collaborating
living in the adjacent areas who have experience
Institute: Addis continental institute of public
about discourse and text of leprosy discrimination
(9) have been contacted as informants. A qualitative case study research design involving in depth interview was employed to draw data from
two groups of people, the leprosy affected group and the healthy counterpart. Social and linguistics
FMOH, Ethiopia,
theories such as Critical Discourse Analysis (CDA),
Systemic Functional Linguistics (SFL) and social
constructionist theories are the main paradigms
GLRA, Ethiopia
used to conduct the case study.
ALERT hospital and Training centre
Jimma University
ENAPAL on December 18, 2014 to
Wello University
inaugurate a book entitled "the pleasing
Prof. Diana lockwood, London School of
unspoken voice" and had a discussion
Hygiene and Tropical medicine, London,
among partners in how to involve leprosy
affected people and families in poverty
Dr. Christa Kassang: GLRA, Germany
reduction in Ethiopia.
Dr. Linda Adams: HRSA, USA
Fund Raising
Prof. Gisela Bretzel, Germany
Risk Factors for Contracting Buruli Ulcer
Dr. Annemiek Geluk: LUMC
Approach. It is a project initiated in collaboration with two German Universities
Meetings
and research institutes in Ghana and Togo. The project proposal is submitted for
The DFG project (Risk Factors for
funding to DFG. It is also in the process of
Contracting Buruli Ulcer and Leprosy Two
ethical review locally. Jimma University and
Diseases – One Approach) preparation
GLRA, Ethiopia are also partners in this
meeting was held in Munich, Germany from
16-18 July, 2014. Kidist (AHRI) and Dr.
International collaboration for translation of
Tesfaye (Jimma University) participated in
Mycobacterium leprae molecular viability
assay (MVA) to the clinical setting and
The Expert Meeting on "Developing
application of MVA to a chemoprophylaxis-
strategies to block the transmission of
of-contacts model. This is a project
leprosy" was held in Texas Medical Center,
submitted to LRI by Dr. Linda Adams from
Baylor Medical College, and Houston from
National Hansen's Disease Programs, LA,
28 May – 2 June. Dr. Abraham Aseffa from
USA in collaboration with AHRI and MRL
AHRI has participated in the meeting.
(Nepal). The project proposal is approved
Annual country learning events on leprosy
for funding. This project has a training part
activities from Nov 3 to Nov 6, 2014
where one team member will get training
organized by TLMiE. Tsehaynesh Lema (a
on M. leprae viability assay and the
staff and PhD student) participated in the
technique will be established at AHRI.
A team member (Daniel Taye, PhD
student) attended a meeting organized by
Leprosy Research Team on duty
The HIV team and other viral infections are embraced. The team was re-established again early this year with aim of engaging researchers working in the area of HIV research and other viral and sexually transmitted and diseases (STD). Since ALERT Hospital is one of the centers that provide clinical care and services for infectious diseases such as HIV and STD, the Team has envisaged its research activities by engaging physicians working in the Hospital. Currently, the team is active in supervising MSc and PhD students, who are actively working on HIV, STD and other viral diseases of public health importance. Students receive direct scientific and technical supervision from the team. In addition to its scientific structure, the team also organized itself in such a way that other technical expertise are structured for administrative feasibility by the Institute.
Team Members
percentages, 1.9%, 28.1%, 36%, and 0.83%, respectively, were observed in the Shebe town. Some factors such as religion, marital status,
Although the team informally accommodates any
previous history of genital ulcer and other sexually
volunteer as a member who works at AHRI/ALERT,
transmitted infections were found to be associated
the Team currently consists of 1 senior scientist
with HIV infection, whereas factors such as age,
(Dr. Rawleigh Howe), 2 post-doctoral scientists (Dr.
gender, job types, employment status, and amount
Adane Mihret and Dr. Liya Wassie,), and other
of income were associated with HSV-2 and HBV
researchers and technicians (Yonas Bekele,
infections. The data suggest that hot spot road side
Tadeye Abeje, and Kassu Alemayehu) as active
towns in rural Ethiopia continue to exhibit high
members. In addition, PhD and MSc students who
transmission of viral STDs, implying a need to
work on HIV and other viral diseases are also
strengthen disease control strategies through
included as members of the Team.
provision of better education, job opportunities especially for women, and expansion of childhood
Completed Projects
vaccination, particularly for HBV.
Sero-epidemiologic survey for HIV and
proliferative and cytolytic CD8 T-cells response in elite controllers and long term
(PI: Tadeye Abeje)
non-progressors in Addis Ababa, Ethiopia
Road side towns in rural Ethiopia are a potential
(PI: Melat Tsegaye; AHRI mentor: Dr.
sources of spread of HIV in rural communities. In a previous study 10 years ago, we compared HIV
Rawleigh Howe)
and other STD prevalence rates in Shebe, a town outside large city of Jimma with Gundo Meskle, a
Current vaccine strategies for protection against
town in the isolated Derra region. The latter had a
HIV infection are focused on comparisons of
much higher prevalence of these STD, and
cohorts with or without disease progression. A
highlighted that road side towns in remote areas
small percentage of individuals (1%), so called
should be areas of focus for improved prevention of
"Elite Control ers (ECs)", are able to contain the
STD. In the present study, we conducted a
virus without progressing to AIDS. One of the
community survey to reassess the prevalence of
immune system features exhibited by elite
these STD in these areas. The study design was
controllers in comparison with those with more
cross-sectional. Blood was collected from a total of
rapid disease progression is the presence of high
974 participants (492 from Gundo Meskel and 482
frequencies HIV specific polyfunctional CD8+ T-
from Shebe town), aged between 15 and 49 years.
cells. These cells display properties of both
All blood samples were screened for antibodies to
conventional CD8 CTL as well as CD4 helper T
HIV-1, Herpes Simplex Virus-2 (HSV-2), and
cells, as assessed by multiparameter flow
Hepatitis B Virus core antigen (HBc), and for
cytometry. The current study was under taken to
confirm and extend previous findings by evaluating
prevalence of HIV, HSV-2, anti-HBc (history of
HIV gag peptide specific IFN-γ, IL-2 and TNF-α and
HBV infection),and HBsAg (chronic hepatitis B virus
de novo synthesized CD107a and perforin,
infection)in Gundo Meskel town were 13.8%, 47%,
products associated with granules of cytolytic CD8
56% and 5.3%, respectively, whereas much lower
T cells. In addition, the proliferative state of HIV
specific and non-specific CD8+ T-cells by the
Karolinska
Institute
marker Ki-67 was assessed. We confirmed that
mentor: Prof Francesca Chiodi)
polyfunctional T cells, as defined by the aforementioned cytokines and granule associated proteins, were indeed associated (p < 0.05) with
HBV infection among HIV-1 seropositive patients is
elite controllers but the association was modest,
an underappreciated problem, particularly in the
suggesting other mechanisms in addition to
anti-retroviral therapy (ART) era; the public health
polyfunctionality
burden of complications of HBV are predicted to
ultimately surpass the morbidity and mortality of
frequencies of cytokine and granule producing CD8
tuberculosis. Although there are immediate effects
T cells was independent of their proliferative status
of chronic HBV infection in HIV-1 seropositive
ex vivo, regardless of the HIV cohort, implying that
patients contributing to toxicity of ART, the long
most of the ongoing proliferation of CD8 T cells in
term complications are severe and include
HIV patients was unrelated to HIV specific
secondary to liver cirrhosis, and hepatocellular carcinoma. The high prevalence of HBV infection in Ethiopia and other sub-Saharan African countries
Ongoing PhD and MSc projects
underscores the importance of the HBV vaccine. However, this and other vaccines are known to
Role of HLA polymorphism in driving HIV
elicit suboptimal immune responses in HIV patients, clearing indicating that either improved vaccination
scheduling or more efficacious vaccines are
progression in HIV infected individuals in
four hospitals in Addis Ababa, Ethiopia
documenting HBV vaccine responses among HIV patients have been in adults; few have been
(PI: Melaku Adal; AHRI mentor: Dr.
performed in children. The overall aim of this study is to evaluate serological responses to HBV
Rawleigh Howe, AHRI and technical
vaccine in HIV positive and negative children, aged
assistants: Kassu Alemayehu)
between 4 and 8 years who have no prior exposure to HBV vaccine or infection and further assess the
This PhD project is a 4 year collaborative study
functional and phenotypic properties of memory B
between Oxford University, London and AHRI. The
cells to HBV vaccine. The study is a collaborative
overall aim of this study is to assess the impact of
study between Karolinska Institute (KI), Sweden,
host HLA polymorphisms during progression of HIV
AHRI, and the pediatric department of ALERT
disease. Gag, nef and pol genes of HIV isolated
hospital and other selected health centers in Addis
from HIV positive individuals prior to therapy will be
Ababa. Funded by the Karolinska Institutet and
sequenced and compared with high resolution HLA
Swedish Medical Research Council, and AHRI core
typing to identify putative HIV escape gene
mutations associated with distinct HLA allelic polymorphisms within the peptide binding pocket. In
parallel, peptides corresponding to candidate gene regions of interest will be assessed for CD8 T cell
vaccine in HIV-1 infected infants in Addis
stimulatory properties in vitro. Thus far, about 600
blood specimens have been collected from several local hospitals from Addis Ababa. DNA is currently being extracted from these samples, sequencing of
(PI: Temesgen (MSc student); AHRI
proviral DNA will be performed shortly at Oxford
mentors: Yonas Bekele, Dr. Rawleigh Howe
University, followed by HLA typing in collaboration
and Dr. Abraham Aseffa; Karolinska
with the University of Oklahoma, U.S. Funded by
Institute mentor: Prof Francesca Chiodi)
AHRI and the University of Oxford.
Diarrheal diseases are a major cause of
Immunological Response to HBV Vaccine
morbidity and mortality worldwide especially in HIV-
in Children: The Impact of HIV infection in
1 infected children in Africa. Rotavirus is
the vaccine response in Addis Ababa,
recognized as a common cause of severe diarrheal
disease in infants and young children, though the disease burden can be significantly reduced by vaccination. However, impaired responses to
(PI: Desalegn, MSc student; AHRI mentors:
childhood vaccinations have been reported in HIV-
Yonas Bekele, Dr. Rawleigh Howe and Dr.
1-infected children despite successful antiretroviral therapy. The aim of the current study is to assess
the antibody response at 1, 6 and 12 months after
Assessment of peripheral T cells:
rotavirus vaccination in HIV positive and negative
phenotypic and functional heterogeneity in
infants, to compare the rotavirus vaccine efficacy with that of other childhood vaccines (measles,
singly and dually infected HIV-TB patients
HBV) previously studied in HIV positive infants, and
in Addis Ababa, Ethiopia
to assess the cell surface expression of molecules involved in B cell survival and apoptosis in HIV positive and HIV negative infants both pre and post
(PI: Mikias Negash (MSc); AHRI mentors:
rotavirus vaccination. The stud cross-sectional
Dr. Rawleigh Howe and Dr. Liya Wassie)
study will recruit HIV+ and HIV- infants who were vaccinated within the preceding year from the
γδ T cell populations comprises minor subsets
pediatric department of ALERT hospital and
(<5%) of the circulating CD3+ T- lymphocytes,
selected health centers in Addis Ababa, and Patient
However, an increase in relative and absolute
number of γδ T cells have been described in
collaborative study between Karolinska Institute
peripheral blood of HIV-1 seropositive individuals
(KI), Sweden and AHRI; funded by KI and Swedish
as well as in HIV patients co-infected with
Medical Research Council, and AHRI core funds.
Different studies
indicated the increase in γδ T cells in HIV patients
Analysis of co-receptors and innate
is mainly attributed by Vδ1 expressing cel s which
immune markers in HESNs
are not thought to be expanded in response to HIV antigens; rather they may be redistributed from mucosal
(PI: Markos Negash (MSc student), AHRI
expressing cells in healthy individuals are found to
mentor: Dr. Liya Wassie)
be quantitatively and qualitatively defective in HIV-1 infected patients, though there are discrepancies in
Serodiscordance of HIV is a phenomenon that
the literature concerning this subset among
occurs in a minority of HIV exposed individuals,
HIV/Mtb co-infected patients. This study is aimed to analyze the profile of γδ T cells and expression of
wherein one ART naïve partner is HIV positive and
activation (CD38), proliferation (Ki67), adhesion (αE
unprotected sex. Although a number of genetic and
-CAM), exhaustion and apoptotic
immunological factors have been assessed to
markers (PD1, CD95) and cytokine production in
explore the mechanism of resistance, few studies
HIV positive patients with and without Mtb disease
have probed the potential role of innate immunity of
in a cross sectional design TB patients without HIV,
the HIV negative partner. In this study, we
and age and sex matched healthy individuals will
hypothesize that expression and function of innate
be used as control groups. This proposed study
immune cell markers, in particular TLR7, known to
has been delayed due to procurement issues. Like
be an innate receptor for HIV, protective alleles of
the above studies, this project is also funded by
KIR gene products on the surface of NK cells, as
AHRI core budget.
well as NK lytic function, are significant factors contributing
Seroprevalence of cytomegaloViruse and
seronegative individuals, after controlling for viral
Hepatitis E Virus among Pregnant Women
load among HIV positive partners. The study design
in Ghandi Memorial and Yekatit 12
serodiscordant couples and apparently healthy
hospitals, Addis Ababa, Ethiopia
individuals and aimed to compare the expression immune markers using RT-PCR and ELISPOT techniques. Thus far, sample collection from
(PI: Meseret Abebe, AHRI mentors: Dr.
participants has been completed, and shortly
Adane Mihret, Dr. Abraham Aseffa and Dr.
further laboratory analyses are planned. The study
Rawleigh Howe)
is funded by AHRI core budget.
CMV and Hepatitis E infection during pregnancy are major infectious causes of morbidity and mortalitiy for women or their newborn infants. To date, there have been few studies to define the scope of this problem within Ethiopia. The present MSc thesis project is a collaborative study between AHRI and ALERT, to define to determine the seroprevalence of CMV and HEV among pregnant mothers. The study has already obtained ethical
approval and currently blood samples have been
the burden and viral etiology of chronic hepatitis,
collected from 395 pregnant women and serum
stored at -20°C until further assayed for IgG and
hospitalized patients, as well as the seroprevalence
IgM antibodies to these pathogens by ELISA. The
of Hepatitis E and its contribution to pregnancy-
project is funded by AHRI core budget.
related hepatitis. This project is planned for 3 years, and will involve multiple sites throughout Ethiopia.
Other ongoing studies conducted
This project is funded by the Federal Ministry of Health.
by the team
Hepatitis B surface antigen (HBsAg) and
pandemic influenza: prospects for cellular
women at Bishoftu and Tirunesh Beijing hospitals, Ethiopia
Project summary: This study is a collaborative
project between the Norwegian Institute of Public
Health (NIPH) in Norway and AHRI to investigate
(PI: Zelalem Desalegn from Addis Ababa
the prevalence of past pneumococcal and influenza
Science and Technology University, Mentors
infections in children and further determine if
from AHRI: Dr. Liya Wassie and Dr. Adane
immunity to influenza decreases the likelihood of
contracting secondary bacterial pneumonia. The team further plans to test the hypothesis that influenza is a major risk factor for childhood
Project summary: This study has been proposed
pneumonia. The study involves apparently health
by one of the faculty members from the Addis
children residing in different sections of Addis
Ababa Science and Technology University, who
Ababa whoe will be followed up over a period of
has received funding from his University as part of
one year. To date, 107 children have been
thematic research to conduct the study. The study
recruited and optimization of experimental analyses
will be conducted at Bishoftu and Tirunesh Beijing
(IFN-ELISPOT,
hospitals, located in the vicinity of the University
Immunoassy to measure influenza-specific immune responses) is currently underway. This study is
with the objective to assess the prevalence of
proposed for 3 years (2013-2016) and funded by
hepatitis B surface antigens (HBsAg) and identify
attending the two hospitals between June and
Other networking activities,
transported to AHRI lab and further tested for
collaborations and travels
HBsAg. Currently, recruitment of study participants is completed and experimental analyses are
Few members from the team act as local contact
points in the East Africa Consortium for Clinical Research (EACCR), particularly for HIV node
Hepatitits and chronic liver disease
activities of the Ethiopian sister institutions (Butajira Hospital and Bole Health Centre). The consortium
research project
is a multi-country project involving countries of the east Africa including Tanzania, Sudan, Uganda,
Hepatitis and chronic liver disease research
Kenya and Ethiopia. The consortium assists sister
project (Project leaders: Dr. Rawleigh Howe
institutions in terms of building capacity (short-term
and Dr. Adane Mihret together with FMoH,
training and upgrading infrastructure facilities) for
Ethiopia)
future possible clinical trial facilities. This year, the
team provided technical assistance and donated
Project summary: This project has been initiated
with the Federal Ministry of Health, Ethiopia
laboratory facilities to the sister institutions
(FMoH) and AHRI to assess the overall burden of hepatitis in Ethiopia. This includes serological and clinical efficacy of hepatitis B vaccination in the
In addition, in the context of proposed and ongoing
country, the seroprevalence of hepatitis C and D,
PhD projects, the team established links with
several overseas universities and institutions,
Purpose: To setup establishment of a national
including Oxford University (UK), Norwegian
referral lab for Hepatitis in Ethiopia along with other
Institute of Public Health (NIPH, Norwary) and
partners in the Country including EPHI and ALIPB
Karolinska Institute (Sweden).
Purpose: As part of his PhD training program, he
Like the previous year, this year some of the team
has been attached to the KI in Sweden
members also participated in national and international meetings and training activities that
Markos Abebe (September 15-18, 2014, Bahir Dar,
both helped upgrade skills and allow to network
with experts in specific fields of expertise:
Purpose: Research dissemination workshop on HIV
Kassu Alemayehu and Meseret Abebe (Sept 1-4
Yonas Bekele (September – December, 2014; KI, Sweden)
Clinical Trial Team
With the mission to generate clinical evidence for new drugs, vaccines, and treatment regimens against major infectious diseases, AHRI has been increasing capacity building activities in the area of interventional clinical trials since 2001. Currently, three clinical trials involving drugs and vaccines are in progress. In parallel, the team has continued building capacity by establishing a clinical study ward for the conduct of bioequivalence studies and a standard clinical laboratory facility.
Research highlights: Bioequivalence Clinical Centre at AHRI
Bioequivalence Clinical Centre at AHRI (PI:
excellence in the Eastern African region and
Mekonnen Teferi)
beyond for the conduct of BE studies in compliance with international standards.
A generic drug is a drug product which is comparable to a reference (brand) drug product in
The clinical centre at AHRI in collaboration with the
dosage form, strength, route of administration,
regional Bioequivalence Centre (RBEC), has
quality, performance characteristics, and intended
conducted the first ever bioequivalence (BE) clinical
use. However, it can differ in color, shape, taste,
inactive ingredients, preservatives and packaging.
ciprofloxacin in comparison to an innovator
Bioequivalence (BE) studies hence can verify the
production. This initial study conducted to verify
quality of generic products before being widely
whether or not the established system in AHRI and
marketed and it becomes a requirement by
RBEC is able to conduct studies according to
regulatory bodies for licensure. Currently, generic
international requirements and guidelines. In
drugs have a stake of more than 65% in the world's
addition, it aimed to accumulate data for planned
pharmaceutical market. The use of generic drugs is
WHO inspection for possible certification of the
expected to grow over the next few years as a
clinical site and analytical laboratory at RBEC by
number of popular drugs come off patent as well as
characterising the bioavailability of the test product
for cost reason primarily in developing countries. In
(Strox of Universal Cooperation) in comparison to
parallel, pharmaceutical industries that produce
generic drugs are flourishing in East African region
HealthCare Pharmaceuticals Inc.).
including in Ethiopia. These companies are primarily targeting essential drugs such as
A single dose, randomised, open-label, two-
antibiotics, anti-retroviral, and antimalarials among
treatment, two-period, two-sequence crossover
others. Ensuring the quality and safety of such
study was conducted on 12 healthy volunteers
products is thus very essential. However, BE
under fasting conditions at one study site. The
relative bioavailability of ciprofloxacin for the test
particularly in East Africa and in general to sub-
product was calculated as 91.22% (Geom. mean)
in comparison to the reference product at 90% CI
establishment of a locally accessible and affordable
and the finding was within the predetermined
international standard BE testing centre would have
acceptance range (i.e. 80% - 125%), for the extent
paramount importance for ensuring safe, effective
and rate of absorption. The single doses of the test
and quality medicine to the public as well as for
and reference products were well tolerated.
promotion of investment in the pharmaceutical
Therefore, this study serves as a milestone for
industry in Ethiopia and Eastern African region.
future studies and the data can be available for the planned WHO inspection and certification that
The RBEC was recently established in Addis
enables the centre to become competitive
Ababa in the compound of School of Pharmacy,
internationally. Funding Source: AHRI and RBEC.
Addis Ababa University. The center has a scope of testing BE of generic drugs against innovator
products in compliance with the standards set by WHO and plan to provide service to companies in East African region. AHRI was one of the key players that support the idea of establishing a bioequivalence centre in Ethiopia and in line with this it has established a phase one clinical centre for the conduct of BE studies. Therefore, the BE centre in Ethiopia aspires to become centre of
Clinical Trial Laboratory becomes fully
We conducted a double-blind randomized placebo
controlled bridging trial to assess the safety and immunogenicity of the Shanchol oral cholera vaccine among 108 healthy adults (aged 18 years
It is in this year that the clinical trial laboratory
and above) and 108 children (aged 1 – 17
(CTL) starts its full function for clinical trial study
years).Evaluation of anti-vibriocidal antibodies to
subjects. Currently, the laboratory is fully engaged
the O1 inaba serotype indicated that baseline titers
in the screening of study subjects to assess
were detectable in a significant fraction of recipients
eligibility and safety before, during and after the
and these baseline titers increased with increasing
clinical studies. It is unquestionable that this will
age. After vaccination, titers improved dramatically;
improve the scientific standards of clinical trial
this was most apparent in recipients above age 5,
activities in AHRI. In Addition, this will minimize
with resultant sero-conversion rates from 81-89%
laboratory associated trial costs significantly. The
and a 15-32 fold increase in geometric mean titers;
laboratory is equipped with fully automated clinical
those recipients below age 5 exhibited only 53%
chemistry, hematology and electrolyte analyzers to
sero-conversion, and a 4 fold increase in titers. In
provide screening and other services for the clinical
contrast to results with O1 inaba, seroconversion
trial unit of the institute. The laboratory will also
rates specific to O1 agawa were nearly constant
continue striving to maintain the standard of service
across all age groups ranging from 70-90%. Finally,
by establishing a GCLP-compliant
responses to the more severe strain of cholera
internationally accredited facility. Therefore, we
O139 were less pronounced but significantly higher
would like to use this opportunity to announce our
than baseline, and this was true independent of age
readiness to work with partners in capacity building
group. The vaccine was well tolerated and no
and in the conduct of clinical trials using our lab
adverse or serious events were reported within 3
days of dosing in any vaccine recipient. In sum, these results show that the responses to the
Completed Research Activities
vaccine components in the Shanchol vaccine were strongin this clinical trial; younger children aged < 5
The First Bridging Trial in Africa
did not respond as well to the O1 inaba as opposed to the O1 agawa component; and in general,
Cholera remains a serious global challenge with
responses to the O139 component were significant,
disease burden estimated at over three million
but less pronounced. Collectively, these results
cases and more than 100,000 deaths throughout
demonstrate the usefulness of Shanchol in this
much of the developing world. In recent years, the
setting. The manuscript of this study has been
World Health Assembly has called for the
submitted for publication to the Journal of American
incorporation of oral cholera vaccines as part of an
Society of Tropical Medicine and Hygiene. Funding
integrated, comprehensive strategy of cholera
Source: International Vaccine Institute, South
prevention and control. Currently, two killed oral
cholera vaccines (OCV) are prequalified by the World Health Organization (WHO). Both Dukoral™,
Exploratory, phase II double blinded,
randomized placebo controlled trial of
recombinant cholera toxin B subunit (WC-rBS), and
Shiunko ointment local application twice a
Shanchol™, a bivalent whole cel vaccine without
day for 4 weeks in Ethiopian patients with
localized cutaneous leishmaniasis
immunogenicity and efficacy in preventing cholera in endemic settings. The components of Shanchol
PI: Dr Oumer Ahmed
include attenuated strains to the O1 serotypes (including serotypes O1 Inaba and O1 Ogawa), as
Cutaneous leishmaniasis (CL) is a major tropical
well as strain O139, a strain inducing a more
skin disease which represents a worldwide public
severe form of the disease, most common in South-
health and social problem in several developing
countries including Ethiopia. To deal with this, an
exploratory phase II, comparative, double-blind,
Previous studies have demonstrated that Vitamin D
randomized, placebo-controlled, single-centre study
has been carried out in Ethiopia. Clinical efficacy
mucosal immune responses to infections whilst
and safety of Shiunko ointment compared with
placebo, when applied on the lesion twice a day for 4 weeks in a total of 40 patients (25 males and 15
inflammatory responses. The focus of the current
females, aged 18-62 years) with localized solid CL
study is 1) to evaluate the antiretroviral and
immunomodulatory
treatment naïve HIV infected patients, and 2 to
A marked reduction in lesion size was observed on
determine if anti-microbial treatment with vitD3/PBA
week 16 of treatment in the group treated with
can significantly shorten the duration of standard
Shiunko compared with placebo (69 and 22%
anti-TB therapy. The study is a randomized,
reduction, respectively). The overall rate of lesion
double-blinded, placebo-controlled, phase-II clinical
reduction during the four weeks treatment period
trial. TB patients < 5 days into standard
was significantly faster in the Shiunko compared with placebo. Furthermore, Shiunko treatment
chemotherapy and treatment naïve HIV patients
provided significant therapeutic effects on wound
are referred to the study team from health centres
closure in patients with ulcerated lesions. The
and hospitals in Addis Ababa. The goal is to recruit
clinical efficacy and tolerability of Shiunko was
350 TB-infected and 200 HIV-infected patients.
shown to be comparable to placebo with regard to
Daily oral doses of vitD3/cholecalciferol (5000
its clinico-parasitological response (cure rate and
IU/day) and PBA (1 gram/day) will be administered
parasitological clearance).Further studies should be carried out to confirm its clinical efficacy in a larger
during a treatment period of 4 months. Patients will
number of patients with well-defined clinical signs
receive supportive care and follow-up consultations
and symptoms of CL, with longer treatment period
4, 8, 16 and 24 weeks after the baseline
and follow-up, and with modification of the method
assessment. A composite clinical TB score in TB
of treatment application to improve drug penetration
patients and HIV viral load, CD4/CD8 T cell counts,
to the target site of action. Funding source: AHRI
intestinal inflammation and barrier function in HIV
core and the University of Nagasaki
patients are used as primary outcome measures. Antimicrobial
Immune reconstitution in tuberculosis and
immunological correlates of clinical recovery in both
HIV disease using antimicrobial treatment
arms of the study. To date, both the TB and HIV
with vitamin D and phenylbutyrate
arm recruitment has been completed, and follow up is ongoing, with the last follow-up expected to be
PI: Nebiat G. Gebreselassie in collaboration with
completed by June, 2015. The project is a
Endale Kassa, and Wondwossen Amogne, Black
collaboration with AHRI, Black Lion Hospital, Addis
Lion Hospital, Addis Ababa, and Susanna Brighenti
Ababa, School of Public Health, Addis Ababa, and
from the Karolinska Institute
Karolinska Institute. Funding source: the Karolinska Institute
Marking the first BE study at AHRI
Lab Technician taking blood sample from the fist
GCP Training for Shuinko Trial Conducted at Ankober
participant for Oral Cholera Vaccine Trial
Field Travel to Haromya Menenjites Vaccine Trial site
Initiatives
Zoonosis/One-Health Group
Operational Research
Generate a comprehensive baseline data base
on the epidemiological dynamics and impacts of
Projects: Two projects have been funded in 2014
human and animal disease problems in Ethiopian Somali Regional State (ESRS)
ETHICOBOTS (Ethiopia Control of Bovine
Prioritize major human and animal health
Tuberculosis Strategies)
problems according to their projected magnitude and impacts in the region
Identify and prioritize major constraints and
5 year consortium project, UK Government
short coming of existing regional human and
funded (around 3 million GBP)
animal health services
Design and test health service methods and
University (UK), AHRI, AAU, NAHDIC and EARI
tools tailored to the realities and needs of ESRS
(Ethiopia), Swiss TPH (CH)
Evaluate the role of key cross cutting issues on
Start Date: 01/09/2015
existing and proposed integrated health systems
Aim: assess BTB prevalence in dairy farms as
under the pastoral setting. These would include
well as risk factors for disease transmission in
participation, gender and youth representation,
intervention and control strategies (socially and
globalization and free trade, climate change,
economically feasible).
Potential impact: reduce the high BTB burden in
the dairy industry, reduce the zoonotic threat,
Capacity building
provide infrastructure for the control of other zoonosis.
Rea Tschopp will coordinate WP6 (evaluation of
Training of 10 MSc and 3-4 PhDs
relevant control strategies) and advise on WP2
Trainings of regional health professionals.
Provide executive capacity building trainings to
management of illness and health amongst poor
relevant JJU and ESRS stakeholders on
subjects related to development projects
Training of community representatives to create
JOHI (Jijiga Pastoral One-Health Initiative)
awareness on health systems, methods and tools
Establish and run well equipped integrated
12 year project, Swiss Government funded
health database, diagnostic facilities and training
(around 5 million USD)
Main partners: Jijiga University, Swiss TPH and
Deliver adequate diagnostic, therapeutic and
AHRI (tri-partite MoU)
prophylactic inputs for research and outreach
Start: inception phase 01/01/2015; full project
service tasks included in the program
Rea Tschopp will be co-coordinating the project
Service delivery
with Jijiga University
Aim: The program will work on: Operational
research, Capacity building and Extension
Design, test and implement community centred
service targets aimed at enhancing health
methods and tools for sustainable integrated
services in the region thereby promoting food
health surveillance and reporting system
security and economic wellbeing of communities
Design and evaluate pilot packages for
integrated preventive and curative health service (including trained integrated health teams,
detailed program of operations, adequate
tissue samples did not yield any Mycobacteria
technical and logistic facilities, adequate supply
of appropriate strain vaccines and other supplies, appropriate record keeping and
reporting mechanism)
Design, evaluate and implement family planning,
maternal and child health services tailored to the
presentation on livestock productivity in Sellale
realities of regional circumstances
Quarterly science group meeting SDC at the
communication and dissemination of research
Jijiga workshop: 2-4 Sept 2014. Brainstorming
and extension service outputs and lessons from
workshop on JOHI
one health program operations
Promote dissemination of information to raise
workshop Sabetta (2-3 Dec 2014)
public awareness on relevant human and animal
Advisor to Megdelawit Ayele on her DVM thesis
"community perception on the role of dogs in the
decline of the wolf population in the Bale
BTB in non-human primates
Mountains National Park".
15 Reviews for 11 journals (AJMR, VetIt, BMC,
On-going project since 2012, funded by Born
PloSOne, IJLP, BMRJ, JVMAH, JMLD, AJAR,
Free Foundation (UK)
JAERD, SciTechnol, JPHE); abstract review for
4 autopsies were carried out on non- human
the IGAD Conference Dec 2014.
primates belonging to the study. They were found dead. All showed extreme emaciation and multiple granulomas in the liver. Culture of
Capacity Strengthening for
was included. Existing capacity was enhanced
Operational Research (OR) in
through a competitive grant scheme providing TB researchers with financial and technical support.
The Ethiopian Tuberculosis Research Advisory Committee was also supported in its functions.
Regional ethics review bodies were strengthened
instrumental for the enhancement of tuberculosis
or established where they did not exist. Fifty-two
(TB) control. In 2012, the Ethiopian Federal Ministry
people were trained and conducted 13 OR projects,
of Health launched an initiative for capacity building
of which six have been published to date. In
in operational research (OR) with the aim to
addition, eight protocols were supported through
develop capacity for OR in a multiyear initiative.
grants. Ethics review bodies were strengthened in
The initiative was developed in collaboration with
all regions. The initiative trained participants from
regional, national and international experts. Teams
all regions and succeeded in the completion of all
representing regions in Ethiopia conducted OR
stages of the OR process. The success of the
addressing national and regional priorities. To
program can be attributed to the team approach,
make use of local expertise and increase
‘learning while doing', integrated mentorship
sustainability, a domestic mentor training program
program and strong national ownership.
supported by development of selected research
AHRI-AAU Biomedical Science
leaders in universities to form a critical mass of
Postgraduate Training
scientists. AHRI has a strong track record of
Partnership Program (BSPP)
sciences for Addis Ababa University (AAU) by exposing them to its own and partner laboratories
The dramatic expansion of postgraduate intake at
at international Centers of Excellence and
Addis Ababa University may compromise quality in
supporting high quality research.
biomedical research and training unless it is
Thus the aim of the program is to strengthen
biomedical science postgraduate training at Addis
collaborating Swedish laboratories. AHRI will
Ababa University through intensive training of
provide laboratory access and thesis supervision as
talented young scientists at the PhD level for
well as project management. A committee of 6
leadership in research and higher education in
members from AAH and AHRI was formed, and
science at regional universities. Research support
from 27 PhD applications, 10 candidates have been
and training awards will be given to the best PhD
students in medical microbiology, genetics and biotechnology registered at AAU. A bridging course
The expectation is that this program will contribute
in research leadership and laboratory training at
to the development of a high quality post graduate
AHRI and collaborative partner institutions in
faculty for biomedical science training and research
Sweden will be supported. Each PhD candidate will
in the Universities, forge stronger links between
conduct research over 4 years and concomitantly
research and educational programs at AAU, AHRI,
participate in training of Masters and undergraduate
and Swedish universities.
students. Upon graduation, the young scientist will be provided with a small grant to start his/her own
As part of capacity building initiative the following
research at the Department. The project will
trainings have been provided to BSPP candidates
additionally support sabbaticals for AAU professors
[Research Ethics: 11-13 Nov, 2014 and GCP: 16-
and short time training of postdoctoral scientists of
Ethiopia-Emory TB Research
Training Program (EETB-RTP)
The
The main educational mechanism is high quality,
Program (EETB-RTP) represents a partnership
semester long, distance learning courses delivered
between Emory University in Atlanta (USA) and
by faculty at Emory University (Atlanta, USA) via
three Ethiopian institutions in Addis Ababa
real-time web-based videoconferencing as well as
including AHRI, AAU, and the Ethiopian Public
through intensive short courses carried out in
Health Institute (EPHI), a national public health
Ethiopia. A comprehensive mentoring program for
institution that is part of the Ethiopian Federal
trainees, which includes both Ethiopian and
Ministry of Health. The EETB-RTP is focused on
internationally based mentors, is also an important
providing didactic and mentored TB research
program component. From 21 applications, 8
training for promising Ethiopian investigators; the
candidates (5 PhD, 2 postdoctoral researchers and
goal is to provide either short or long term training
1MSC) were selected as a Fogarty fellow for this
for MSc, PhD, and post-doctoral trainees and their
program. Currently, the fellows have identified their
institutions with the skills and capacity to carry out
research topics, and are reviewing their research
internationally relevant TB-related research (e.g.,
ideas and protocols in collaboration with mentors
clinical and/or translational research, epidemiologic
assigned both from Emory and Ethiopia. For the
research, implementation science (operational
coming period they are all expected to finalize their
research), behavioural/social sciences research,
research protocol and submit it to the Institutional
and laboratory based research). The EETB-RTP is
funded by a Global Infectious Diseases grant from the U.S. National Institutes of Health (NIH) Fogarty International Centre
Current Fellows of the Ethiopia-Emory TB Research Training Program (EETB-RTP)
Institution
Position
Muluwork Getahun
Assistant Researcher
Head, National TB reference Laboratory
Addis Ababa University
Lecturer, College of Medicine and Health Sciences , Hawassa University
Addis Ababa University
Assistant Professor, Microbiology, AAU
Yohannes Gezahegn
Addis Ababa University
Lecturer, Social Anthropology, AAU
Mulugeta Tsegaye
Internist, HIV/AIDS, TB, STI Training Specialist
Endalamaw Gadissa
Postdoctoral Scientist
Graduate Training
Training of students (Masters, PhD and summer interns) is one of the key missions of AHRI. Students
registered at different Ethiopian Universities are accepted annually to do their thesis work with the supervision
of AHRI scientists. The tables below shows list of students that are working at AHRI towards their master's
and PhD degree in 2013/2014.
MSC students 2013
Current Status (June, 2014)
Desaglegn Yibeltal
The Effect of Antiretroviral Drugs o
Ongoing (Sample collection)
Immune Response to Hepatitis B Vaccine: The impact of HIV on Hepatitis B Vaccine Response in Children in Addis Ababa Ethiopia
Feregenet Tesfaye
Circulating Breast Cancer-associated
MicroRNA Expression in Serum as Biomarker for Breast Cancer Detection
The New Micro-culture Method(MCM) for
Jimma University
Ongoing (Thesis defense at
the Diagnosis of Cutaneous
Jimma university and
Leishmaniasis in Ethiopia
Publication in process)
Mycobacterium tuberculosis specific
Finished part of my thesis and
functional immune response in pregnant
ready for defense
women with HIV and Latent Tuberculosis co-infection in Addis Ababa Ethiopia
Analysis of CCRS and CXCR4 Receptor
Gonder University
Expression and Innate Immune Markers among Highly HIV Exposed Seronegative Individuals Living in North West Ethiopia
Seroprevalence of cytomegalovirus and
Sample collection and waiting for
hepatitis e virus among pregnant women
the purchase of the
in Gandhi memorial and Yekatit 12
reagents(ELISA kits)
hospitals, Addis Ababa, Ethiopia
The role of γδ T cells heterogeneity in
Ongoing (already have more than
HIV-TB mono or dual infected patients in
90% of reagents needed)
Addis Ababa, Ethiopia
Comparison of apoptotic markers on
Jimma University
Finished all the lab work and writing
macrophage and T cells in peripheral
blood and Lymph node from TB patients and controls.
Comparison of drug resistance between
lineage seven and other lineages of Mycobacterium tuberculosis in Ethiopia
Temesgen Ewunetu
Immuniological response to rote Virus
Gonder University
vaccine among HIV 1 exposed infants in Addis Ababa, Ethiopia
Epidemiology and Drug resistance pattern
Thesis defended and working on
of Mycobacterium
remaining laboratory work
tuberculosis in North West Ethiopia: Resource limited region.
Optical Adjustment and Stage Automation
of a Microscope and Automatic Detection of Mycobacterium Species from Sputum Smear Slides using Image Analysis Techniques
Effect of Diabetes Mellitus on T-cell
Jimma University
Finalized 40% of samples
immune response of Pulmonary
Tuberculosis patients, Addis Ababa - Ethiopia
PhD students 2014
Institute
Current Status
The role of Cattle in transmitting the
Completing research work, writing
causative agent of tuberculosis in two
manuscripts and thesis, three
Zones of Amhara region
manuscripts are ready.
Molecular Epidemiology and Drug
Drug susceptibility testing results
Resistance of Mycobacterium
tuberculosis Among New Smear Positive Pulmonary Tuberculosis Cases in eastern Ethiopia
Critical Analysis of Leprosy
Data collection finalized
Discriminatory Discourse and the Underpinning Social Constructs
Determinants of MDR-TB in Eastern part
Data collection is finalized and data
of Ethiopia Dire Dawa
entry is started
The immunopathology of erythema
Patient recruitment and sample
nodosum leprosum
Molecular epidemiology, drug resistance
Secured grant and develop a
pattern of M. tuberculosis and clinical
research and training collaboration
outcome evaluation in Woldiya region, Ethiopia
Fekadu Desta Tona
Immunophenotype and Functional
Characterization of T Cell Subset and Monocyte-Macrophage Lineage cells within Lymph Node Granulomas and peripheral blood of calves Exposed to Natural Mycobacterium bovis Infection
Innate Immunity in visceral leishmaniasis
Data was analyzed and result was
submitted to German's PI and collaborators
Evaluation of M. leprae unique antigens
Finalized the thesis compilation and
for early detection of leprosy and cytokine
submit for comments to the advisors
profile of reactional patients.
Ecology of Plasmodial infections in
Data has been generated.
selected regions of Oromia, Ethiopia: Clonal diversity, prevalence of antimalarial drug resistance-conferring mutations & host genetic characterization
Analysis of immune response regulation
Works underway include
laboratory experiments, data analysis, and manuscript writing
Role of HLA polymorphism in evolution of
Secure funding of our project and
HIV viral diversity in Ethiopia
activities are on progress
Innate Immunity in cutaneous
80% of Sample collection
completed, 60% of lab work completed and 30% of data analysis done
Molecular markers and mechanisms of T
Efficacy of Artemether-lumefantrine and
Two papers published, Manuscript in
Chloroquine for the treatment of
preparation stage and Remaining
uncomplicated Malaria in Jimma Zone
activity underway
mainly the surroundings of Gilgel Gibe Hydroelectric power dam , southwest Ethiopia
Assessing the prevalence of Plasmodium
A 28 days In vivo efficacy study was
vivaxchloroquine resistance by using in
completed and the results of the
vivo drug sensitivity test and molecular
work were shared to Federal
characterization of parasite isolates in
Ministry of Health and World Wide
South Nations and Nationalities Peoples
Antimalarial Resistance networks,
Regional State (SNNPR), Ethiopia
and publications are underway. The remaining work is on progress.
Discovering Podoconiosis Susceptability
Sample data collected from Gojjam
Genes: from molecular to disease control
for a neglected tropical disease (NTD)
Detection of new leprosy cases and
Project proposal approved by AHRI-
tracing of household contacts at risk of
ALERT Ethical Review Board
developing leprosy by active case
(AAERC) and purchase of materials
detection and assessment outcome of
treatment in Kokosa Woreda, West Arsi zone, Oromia region: Clinical, molecular and immunological approach
Tsighemariam Teklu
Epidemiology of visceral leishmaniasis
Waiting for test kits
and VL/HIV coinfection in North Ethiopia
Monocyte function in TB, HIV, TB/HIV co-
Proposal approved by National
infected patients
Ethical Review Board (NERC)
Wondossen Tsegaye
Epidemiology of Streptococus
Finalized the first phase sample
pneumoniae nasopharyngeal carriage:
Serotyping, molecular characterization and Antibiotic sensitivity pattern in Ethiopia
Wubayehu Kahaliw
Activity test, isolation and chemical
Pharmaceuticals fund and supply
structure elucidation of antituberculosis
agency (pfsa) was communicated
consitituents from plants used in
and purchase of solvents was
traditional medicine in Ethiopia
permitted and the root of Carisa edulis and root bark of Vernonia Amygdalina was collected from Gondar town around Angereb River
Bacterial Meningitis in Ethiopia: study of
Finalized Ethical Clearance
etiologies by use of real time PCR,
Processes and PhD Research
MLST and cytokine detection
Project Sample collection
Epidemiology of TB in South Ethiopia
Reviewing the researching project proposal based on the comments from both AHRI and AAU Institutional Review Boards (IRBs)
Immunological Response to HBV Vaccine
The manuscript is under
in Children: The Impact of HIV infection in
the vaccine response in Addis Ababa, Ethiopia
Postgraduate students completed their study in 2014
Date completed
Completed and in the process of writing Manuscript
Nigussie Solomon MSc
Defended but in the process of working on laboratory work
Defended his Thesis
Research Support
Data Management and
(Oromiya, Amhara, SNNP) region of the
Biostatistics Unit
country in Health Centres and Hospitals.
• Surveillance of Bacterial Meningitis in
Ethiopia: Double data entry done for
AHRI Data Management unit has been supported
Hawassa patients (33 ) , Gondar Patient ()
by a team of dedicated data management staff who
and Black-lion patient()data and filed
have worked tirelessly to establish good and
• Assessment of prevalence of leprosy
implemented procedures for questionnaire or CRF
and database design, double data entry with good
associated factors: a retrospective study in
verification and validation, data analysis, good
All African Leprosy, Tuberculosis and
back-up, filing and archiving system all of which
Rehabilitation Training Center (ALERT
Center) Addis Ababa, Ethiopia (Esegenet
confidentiality of the unit's and col aborator's data.
Gedlu, MPH program): 900 patients' CRFs double data entered, analysed and filled.
Mission and Goal
• Comparison of Drug Resistance between
Lineage Seven and Other Lineages of
The mission of the unit is to contribute quality
Mycobacterium tuberculosis in Ethiopia
data management and statistical analysis for
(Shiferaw Bekele, MSC program): data
researchers and students.
entry done for a lot of leprosy cases and
The Goal is to provide close to 100%
satisfaction for health researchers / students by
• Malaria project( Sisay, PhD program) : 225
providing quality data and report at the end of
data Done double data entry
the Ethiopian year to help policy makers.
• Characterization
Susceptible Patterns of Blood culture
Project Title and Work Done
Isolation from Septicemic Patients(CASP) at St Paul Hospital: 555Done double data
• STREAM project: AHRI and St. Peter's
Hospital: lots of Patients' CRFs data double
• PCV10 vaccine (Dr Wondewosen
entered; entry, queries and verification on-
Tsegaye, PhD) : 786 data double entered
going. : Data filed: 170 data form one there
• TB ( Manaye, MSC): 284 lab and case
is lots of forms are entered for each
data double entered.
• Childhood vaccination and preparedness
against seasonal and pandemic influenza: prospects for cellular immunity Double data
Data Management and Biostatistics
entry done: 106 patients' CRFs data
• Bio-Equivalence
Place: Addis Ababa University
Ciprofloxacin BE Study and We started
Organizer: Emory University
Bioequivalence study of oral co-trimoxazole
Objective of the Training: The objective of
prepared SOP for the Data Management
the training is to develop the skills in R-
including preparing data management
statistical software for data management
quality control and quality assurance SOP
and data analysis.
and check list; Designed CRF and
Form of presentation: lecturing and online
Designed the database with OpenClinica
Taken by: Samuel Ayele, Hiwot Tilahun,
• Leprosy Mapping Study (Dr.Saba Lambert):
data entry done for a lot of leprosy cases in
GCP refreshment Training for Bio-Equivalence
specificity and scope of the research such as large
consortium driven externally funded projects, local MSc or PhD student research, and individual staff
scientist research. In general, the lab team is being
continually upgraded to cope with the increasing demand in services and standards.
AHRI-GSK GCP Training
The major activities performed by the team in the
• AHRI was chosen among other contenders by
last year have been: 1) facilitating laboratory
GSK to conduct GCP training for Clinical Trials
practical attachments for 263 under-graduate and
staff from Gondar and Jimma Universities; a
post-graduate students from different Universities
confirmation for the trust in AHRI as a centre
throughout the country, 2) facilitating procurement
of excellence for clinical trials. The training
of the two large autoclaves and security doors for
was in mid- July, 2014 for four full days. A
the laboratory, 3) coordinating the the World TB
good number of AHRI staff members were
day celebration which involved inviting 86 students
among the Trainers and Facilitators.
from government and private schools and others from civil society to visit the research laboratory
Upcoming Training: AHRI-AAU Emory Bioethics
and explain about the research works on TB. These
activities are oriented to help motivate students in the area of biomedical science and create
• AHRI staff including the Data Manager
awareness to the civil society. The Laboratory
together with other trainers will be providing
Team was also involved in preparation of needed
documents to fulfil the ISO 15189 requirements to
grantees from 11 – 13 November, 2014 at the
training centre. There will also be 27 SIDA
accreditation. In addition to this, the lab team gave
applicants who will be joining the course.
technical assistance and support to different projects including MSc and PhD students. AHRI
Laboratory Management Unit
participated in research evaluating the performance of
microscopy for diagnosis of TB lymphadenitis by
established in order to organize the infrastructure
fine needle aspirates.
and maintenance of the laboratory to create an optimal research environment. The research laboratory comprises six units, namely clinicaltrial,
Project Managment, Finance and
Procurement
Bacteriology, and Pathology Laboratories.
One of the major contribution areas of AHRI for
These laboratories are equipped with high tech
national competence in health research and
biomedical equipments such as Real Time and
practice is institutional strengthening. In order to
conventional PCR machines, FACSCanto and
develop research capacity, the existence of skilled
FASCan flow cytometers, Luminex machine,
and well-functioning research support services
machines, and clinical laboratory machines such as
management and research Ethics is vital.
a Clinical Chemistry and Hematologyanalyzers. Each of the six units have their own coordinator
This year, a great milestone was achieved in
and the whole process led by a laboratory
manager. The lab engineer is primarily responsible
procurement unit for AHRI which was previously
for handling preventive and curative maintenance
structured as part of the ALERT centre whose
and calibration of the biomedical equipment.
mission is primarily patient care. The unit is setting up a system under a newly employed coordinator
Currently, various research activities are underway
who is accountable to AHRI's Scientific Director.
in these laboratories based on their technical
As this is the first year that the unit has been
functional there have been short term growing
major objective has been accomplished which was
pains as the unit transitioned from ALERT, but a
to identify gaps in the previous system and
establish a better functioning system for the future.
project operations: effective use of funding
Recent reviews have also identified on the
accounting practices that AHRI should work on
government, senior management and collaborators,
such as updating the accounting system with the
monitoring project progress, initiating researchers
latest software. Currently, skilled human power has
to respond to grant calls and facilitate submission.
been employed, SOPs drafted, procurement
This year, a new Research Training coordinator
administration training has been given to all
has been employed particularly to follow up and
researchers and Finance and procurement team by
monitor progress of Postgraduate Research
the experts from public and procurement agency.
Training Program at AHRI which is expanding and recruiting research trainee's from the universities in
To create a conducive research environment and
most parts of Ethiopia to strengthen National
result, the Project management office is also
competence to health care needs though informed
providing support to researchers in following up
AHRI/ALERT Ethics Review Committee
The AHRI/ALERT Ethics Review Committee
Committee also received recognition from the
(AAERC), as the name stands, reviews research
Strategic Initiative for Developing Capacity in
protocols and facilitates the conduct of research
Ethical Review (SIDCER) in 2009 and since then, it
that are planned to be conducted at AHRI or
continues to strive for better performance in its
elsewhere in collaboration with AHRI and ALERT.
organization, review process, report delivery and
The Committee has its own standard operating
documentation and archiving. The Committee held
procedures (SOP) that helps it to function optimally
two internal audits since its recognition from
with competence and consistency. In addition to the
SIDCER; reviewed its internal practices, prepared
existing SOP, the Committee also developed two
and submitted manuscript for publication to one of
new SOPs on reviewing protocols involving
the local journals for educational purpose by other
biorepository/biobank specimens and social and
similar committees in the Country. Apart from the
behavioral studies involving human subjects. With a
regular review practices, the AAERC also provides
technical and advisory support from the World
short term trainings on research ethics, good
Health Organization, Special Program for Research
and Training in Tropical Diseases (WHO/TDR), the
Members of the AAERC during one of the internal
audit report meetings (taken in 2013)
AHRI Alumini
Melat Tsegaye,
University of Gondar
PhD student at
Penn state
I joined AHRI during a
University, USA
time when I did not have good know how about
I joined AHRI in the
the various aspects of
year 2013 through
the yearly graduate
proposal development,
student recruitment
program that the
institute undertakes
knowledge of different advanced laboratory
where accepted students get fully funded to
techniques, scientific presentations and write-
conduct their thesis research in the institute.
ups. These are fundamental components one
Once accepted, I was able to choose from
should know to be a good researcher. I was
prodigious researchers an advisor in my area of
lucky to get an opportunity to conduct my
interest that mentored me throughout my thesis
research (MSc and part of my PhD work) at
AHRI which enabled me to exploit the above
opportunity to learn from scientists that I aspire
mentioned components during my stay. Even
to be like in the future. My thesis research was
though I am now working at the University of
titled "HIV-1 Gag specific polyfunctonal,
Gondar, I still have working link with AHRI and
proliferative and cytolytic CD8 T-cell response
currently am doing several collaborative
in elite controllers and long term non-
progressors in Addis Ababa, Ethiopia. Aside
publications beyond my thesis work. I gained
from providing lab bench and the necessary
the experience of working in a team from AHRI,
reagents, AHRI provided me the logistic and
too. Indeed, the impact of AHRI on my current
administrative support that I needed to
status and to build my future carrier has been
complete my research. As a whole, AHRI was
immense and indispensable. Apart from the
not only a work place, but also a platform that
research area, I gained knowledge and
presented the crucial exposure I needed to
experience of leadership, team spirit, and how
grow as a phenomenal researcher. I am now a
to overcome challenges. My MSc work was
PhD candidate in Penn state University,
"Genotyping of human papillomavirus in
Pennsylvania, USA, and I credit my success to
paraffin embedded cervical tissue samples from
the work I did in AHRI that served as a stepping
women in Ethiopia and the Sudan''. My PhD
stone to where I am now. I am ever so grateful!
work was "Impact of Helminth infections on the immunological and clinical features of active Tuberculosis: a double blind randomized trial." I am working with assistant professor rank in the Department of Immunology and Molecular Biology, University of Gondar. In addition, I am the head of the newly established research center "Tropical and Infectious Diseases Research Center" at the University of Gondar.
Baye Gelaw,
Girmay Desalegn, PhD student at
PhD, University
Hannover Medical School in Hannover,
of Gondar
I did my master's
thesis entitled "M.
frequency of lipid
specific Functional
tubercle bacilli in human sputum" .
HIV and Latent TB
Co-Infections with
fourspoligotyping and drug susceptibility
assays were accomplished at AHRI and
Ethiopia, Armauer Hansen Research Institute
was fully sponsored by AHRI. At the same
timeAHRI also secured my living expenses
Postgraduate support program of AHRI in so
during my stay in Addis Ababa which was
many ways ranging from covering my thesis
around two months. Moreover, my sample
expenses to teaching me what science
transportation to England was also with the
practically is with hands-on lab works. In
help of AHRI. Dr Abraham Aseffa was my
addition, I have met numerous amazing and
in country supervisor.
inspiring people who taught me a lot in-and out-
Currently, I am working at University of
side the lab. I loved the attitude and spirit I saw
Gondar teaching Medical microbiology
in AHRI, which was a huge lesson to me. AHRI
courses for medicine and other Health
helped me participate in several summer
Science students. I am also supervising 4
school, workshops and conferences which I
to 5 MSc students each year and also I
used them to expose myself and get to know
have 4 research projects (2 as PI and 2 as
co-investigator) together with laboratory
backgrounds. This is why I am grateful to AHRI
services for the hospital of College of
for letting me explore my path and put me
Medicine and Health Sciences, University
of Gondar services for the hospital of
College of Medicine and Health Sciences,
University of Gondar.
Publications
1.
Abate E, Elias D, Getachew A, Alemu S, Diro E,
Ethiopia: a cytopathlogic analysis. Ethiop Med J
Britton S, Aseffa A, Stendahl O, Schön T. Effects
2014; 52(1):19-25.
of albendazole on the clinical outcome and
11. Bobosha K, Tjon Kon Fat EM, van den Eeden SJ,
immunological responses in helminth co-infected
Bekele Y, van der Ploeg-van Schip JJ, de Dood CJ,
tuberculosis patients: a double blind randomised
Dijkman K, Franken KL, Wilson L, Aseffa A et al:
clinical trial. Int J Parasitol 2014.
Field-evaluation of a new lateral flow assay for
Abdissa A, Yilma D, Fonager J, Audelin AM,
detection of cellular and humoral immunity against
Christensen LH, Olsen MF, Tesfaye M, Kaestel P,
Mycobacterium leprae. PLoS Negl Trop Dis 2014;
Girma T, Aseffa A et al. Drug resistance in HIV
8(5):e2845.
patients with virological failure or slow virological
12. Bobosha K, Wilson L, van Meijgaarden KE,
response to antiretroviral therapy in Ethiopia. BMC
Bekele Y, Zewdie M, van der Ploeg-van Schip JJ,
Infect Dis 2014; 14:181.
Abebe M, Hussein J, Khadge S, Neupane KD et al.
Abseno M, Aseffa A, Shimelis E, Wassie L, Abebe
T-cell regulation in lepromatous leprosy. PLoS
M, Mitikie G, Yamuah L, Ali A: Tuberculosis
Negl Trop Dis 2014; 8(4):e2773.
among Addis Ababa city bus drivers and cash
13. Deribe K, Brooker SJ, Pullan RL, Sime H,
collectors. Ethiop Med J 2014; Suppl 1:31-35.
Gebretsadik A, Assefa A, Kebede A, Hailu A,
Alemayehu M, Gelaw B, Abate E, Wassie L,
Rebollo MP, Shafi O, Bockarie MJ, Aseffa A,
Belyhun Y, Bekele S, Kempker RR, Blumberg
Reithinger R, Cano J, Enquselassie F, Newport MJ,
HM, Aseffa A. Active tuberculosis case finding
Davey G. Epidemiology and Individual, Household
and detection of drug resistance among HIV-
and Geographical Risk Factors of Podoconiosis in
infected patients: A cross-sectional study in a TB
Ethiopia: Results from the First Nationwide
endemic area, Gondar, Northwest Ethiopia. Intl J
Mapping. Am J Trop Med Hyg 2015;92(1):148-58
Mycobacteriol 2014; 3.
14. Ferraro CF, Trotter CL, Nascimento MC, Jusot JF,
Aseffa A, Mihret A, Habte A, Gadisa E, Beyene D:
Omotara BA, Hodgson A, Ali O, Alavo S, Sow S,
Seizing the opportunity for better organization of
Daugla DM et al. Household crowding, social
health research. Ethiop Med J 2014, Suppl 1:2 p
mixing patterns and respiratory symptoms in seven
countries of the african meningitis belt. PLoS One
2014; 9(7):e101129.
Aseffa A, Rusen ID. Strengthening operational research in Ethiopia: beyond training for a
15. Gebreegziabiher D, Desta K, Desalegn G, Howe R,
sustainable and successful country OR programme.
Abebe M. The effect of maternal helminth infection
Public Health Action 2014; 4 (Sup 3): S1-S1(1).
on maternal and neonatal immune function and immunity to tuberculosis. PLoS One 2014;
Ashenafi S, Aderaye G, Bekele A, Zewdie M,
Aseffa G, Hoang AT, Carow B, Habtamu M, Wijkander M, Rottenberg M et al. Progression of
16. Gebreegziabiher D, Desta K, Howe R, Abebe M.
clinical tuberculosis is associated with a Th2
Helminth infection increases the probability of
immune response signature in combination with
indeterminate QuantiFERON gold in tube results in
elevated levels of SOCS3. Clin Immunol 2014;
pregnant women. BioMed research international
2014; 2014.
Bekele S, Bekele Y, Mulatu F, Lemma T, Tilahun
17. Geluk A, van Meijgaarden KE, Wilson L, Bobosha
H, Gadisa E, Negussie S, Yamuah L
K, van der Ploeg-van Schip JJ, van den Eeden SJ,
Quinten E, Dijkman K, Franken KL, Haisma EM,
Leekassa R, Bizuneh E. Recent trends of
Haks MC, van Hees CL, Ottenhoff TH.
cutaneous leishmaniasis in Alert Hospital, Addis
Ababa. Ethiop Med J 2014; Suppl 1:37-41.
expression profiles in type 1 leprosy reactions. J
ClinImmunol 2014; 34(2):245-55
Berhe G, Enquselassie F, Aseffa A. Assessment of Risk factors for development of active pulmonary
18. Ghansah A, Amenga-Etego L, Amambua-Ngwa A,
tuberculosis in Northern part of Ethiopia: a
Andagalu B, Apinjoh T, Bouyou-Akotet M,
matched case control study. Ethiop Med J 2014;
Cornelius V, Golassa L, Andrianaranjaka VH,
Ishengoma D, et al. Monitoring parasite diversity for malaria elimination in sub-Saharan Africa.
10. Bezabih M, Abdissa A, Gadisa E, Aseffa A.
Science 2014; 345(6202):1297-1298.
Patterns of enlarged cervical lymphnodes among HIV positive and negative patients in southwestern
19. Golassa L, Enweji N, Erko B, Aseffa A, Swedberg
G: High prevalence of pfcrt-CVIET haplotype in
isolates from asymptomatic and symptomatic
Aseffa A, Parida SK: T cell response to alpha
patients in south-central Oromia, Ethiopia. Malar J
crystallin and Mycobacterium tuberculosis specific
2014; 13:120.
antigens using ex-vivo elispot assay for detecting latent tuberculosis infection in Addis Ababa,
20. Herrador Z, Sordo L, Gadisa E, Buño A, Gómez-
Ethiopia. Ethiop Med J 2014, Suppl 1:15-22.
Rioja R, Iturzaeta JM, de ArmasLF, Benito A, Aseffa A, Moreno J, Cañavate C, Custodio E.
29. Mariam SH, Zegeye N, Tariku T, Andargie E,
Micronutrient deficiencies and related factors in
Endalafer N, Aseffa A: Potential of cell-free
school-aged children in Ethiopia: a cross-sectional
supernatants from cultures of selected lactic acid
study in libokemkem and fogera districts, amhara
bacteria and yeast obtained from local fermented
regional state. PLoS One 2014; 9(12).
foods as inhibitors of Listeria monocytogenes, Salmonella spp. and Staphylococcus aureus. BMC
21. Herrador Z, Sordo L, Gadisa E, Moreno J, Nieto J,
Res Notes 2014; 7:606.
Benito A, Aseffa A, Canavate C, Custodio E. Cross-Sectional
30. Mariam SH: Identification and survival studies of
Associated Factors among School Aged Children in
Mycobacterium tuberculosis within Laboratory-
Rural and Urban Settings of Fogera and Libo
Fermented bovine milk. BMC Res Notes 2014;
Kemkem Districts, Ethiopia. PLoS One 2014;
31. Medhane M, Tunheim G, Naess LM, Mihret W,
22. Kahsay A, Mihret A, Abebe T, Andualem T.
Bedru A, Norheim G, Petros B, Aseffa A,
Isolation and antimicrobial susceptibility pattern of
Rosenqvist E: Avidity of IgG antibodies against
Staphylococcus aureus in patients with surgical site
meningococcal serogroup a polysaccharide and
infection at Debre Markos Referral Hospital,
correlations with bactericidal activity in sera from
Amhara Region, Ethiopia. Arch Public Health
meningitis patients and controls from Ethiopia.
2014; 72(1):16.
Scand J Immunol 2014; 79(4):267-275.
23. Kamau E, Campino S, Amenga-Etego L, Drury E,
32. Mekonnen D, Gebre-Selassie S, Fantaw S,
Ishengoma D, Johnson K, Mumba D, Kekre M,
Hunegnaw A, Mihret A. Prevalence of hepatitis B
William Y, Mead D et al. K13-propeller
virus in patients with diabetes mellitus: a
comparative cross sectional study at Woldiya
parasites from sub-Saharan Africa. J Infect Dis
General Hospital, Ethiopia. Pan Afr Med J 2014;
24. Kebede S, Medhin G, Berhe N, Teklehaymanot T,
33. Mekonnen SK, Aseffa A, Medhin G, Berhe N,
Gebru T, Clause R, Velavan TP, Aseffa A: Return
of chloroquine-sensitive Plasmodium falciparum
parasites and emergence of chloroquine-resistant
Plasmodium vivax malaria by nested PCR
Plasmodium vivax in Ethiopia. Malar J 2014;
detection in southern Ethiopia. Malar J 2014;
13(1):244.
25. Kebede S, Aseffa A, Medhin G, Berhe N, Velavan
34. Mengistu G, Mulugeta G, Lema T, Aseffa A.
TP. Re-evaluation of microscopy confirmed
Plasmodium falciparum and Plasmodium vivax
Patterns of Salmonella serovars and Shigella
malaria by nested PCR detection in southern
species. J Microb Biochem Technol 2014.
Ethiopia. Malar J 2014;13(1):48.
35. Mihret A, Abebe M, Bekele Y, Aseffa A, Walzl G,
Howe R: Impact of HIV co-infection on plasma
RA, Shimeles E, Kebede B, Fiseha D, Tsegaye
level of cytokines and chemokines of pulmonary
F, Leimane I, Teklai Y, Dacombe R, Aseffa A. The
tuberculosis patients. BMC Infect Dis 2014; 14:125.
Ethiopian initiative to build sustainable capacity for
36. Mihret A, Bekele Y, Aytenew M, Assefa Y, Wassie
L, Abebe M, Yamuah L, Aseffa A, Howe R:
learned. Public Health Action 2014; 4 (Sup 3): S2-
Human immunodeficiency virus infection among
new smear positive pulmonary tuberculosis patients
27. Lopez-Perea N, Sordo L, Gadisa E, Cruz I, Hailu T,
in Addis Ababa, Ethiopia. Ethiop Med J 2014;
Moreno J, Aseffa A, Canavate C, Custodio E:
Knowledge, attitudes and practices related to
37. Mihret A, Loxton AG, Bekele Y, Kaufmann SH,
visceral leishmaniasis in rural communities of
Kidd M, Haks MC, Ottenhoff TH, Aseffa A, Howe
Amhara State: a longitudinal study in northwest
R, Walzl G: Combination of gene expression
Ethiopia. PLoS Negl Trop Dis 2014; 8(4):e2799.
patterns in whole blood discriminate between
28. Mamo G, Mihret A, Taffesse M, Gebru G,
tuberculosis infection states. BMC Infect Dis 2014;
Afework M, Yamuah LK, Wassie L, Abebe M,
38. Mihret W, Yusuf L, Abebe M, Yamuah LK, Bekele
46. Sutherland JS, Loxton AG, Haks MC, Kassa D,
L, Abate E, Wassie L, Engers H, Aseffa A: A pilot
Ambrose L, Lee JS, Ran L, van Baarle D,
Maertzdorf J, Howe R, Mayanja-Kizza H, Boom
humanpapilloma virus isolated from clinically
WH, Thiel BA, Crampin AC, Hanekom W, Ota
diagnosed Ethiopian women having cervical
MO, Dockrell H, Walzl G, Kaufmann SH,
intraepithelial neoplasia. Ethiop Med J 2014; Suppl
Ottenhoff TH; GCGH Biomarkers for TB
consortium. Differential gene expression of activating Fcγ receptor classifies active tuberculosis
39. Mihret W, Zenebe G, Bekele A, Abebe M, Wassie
regardless of human immunodeficiency virus status
L, Yamuah LK, Woldemeskel D, Kassahun Y,
Microbiol
Medhin G, Engers H et al: Chronic meningitis in
immunocompromised adult Ethiopians visiting Tikur Anbessa Teaching Hospital and Ye'huleshet
47. Tadele A, Beyene D, Hussein J, Gemechu T,
Clinic from 2003-2004. Ethiop Med J 2014; Suppl
Birhanu A, Mustafa T, Tsegaye A,Aseffa A,
Sviland L. Immunocytochemical detection of Mycobacterium Tuberculosis complex specific
40. Seid A, Gadisa E, Tsegaw T, Abera A, Teshome A,
antigen, MPT64, improves diagnosis of tuberculous
Mulugeta A, Herrero M, Argaw D, Jorge A,
lymphadenitis and tuberculouspleuritis.
Kebede A et al: Risk map for cutaneous
Infectious Diseases 2014; 14:585
leishmaniasis in Ethiopia based on environmental factors as revealed by geographical information
48. Tekola-Ayele F, Adeyemo A, Aseffa A, Hailu E,
systems and statistics. Geospatial health 2014;
Finan C, Davey G, Rotimi CN, Newport MJ:
Clinical and pharmacogenomic implications of genetic variation in a Southern Ethiopian
41. Seyoum B, Asmamaw D, Iwnetu R, Yamuah LK,
population. Pharmacogenomics J 2014.
Wassie L, Abebe M, Amanuel YW, Aseffa A: Characterization of the etiological agents of
49. Tekola-Ayele F, Adeyemo A, Chen G, Hailu E,
tuberculous lymphadenitis in Dera Woreda, North
Aseffa A, Davey G, Newport MJ, Rotimi CN.
Showa, Ethiopia. Ethiop Med J 2014; Suppl 1:7-14.
Novel genomic signals of recent selection in an Ethiopian population. Eur J Hum Genet 2014.
42. Seyoum B, Demissie M, Worku A, Bekele S,
Aseffa A. Prevalence and Drug Resistance Patterns
50. Tesgaye F, Defar A, Beyene T, Shafi O,
of Mycobacterium tuberculosis among New Smear
Klinkenberg E, Howe R. Documentation and
Positive Pulmonary Tuberculosis Patients in
treatment outcomes of smear-negative and extra-
Eastern Ethiopia. Tuberculosis research and
pulmonary tuberculosis in Ethiopia. Public Health
treatment 2014; 2014.
Action, 2014; 4 (Sup 3): S1-S1(1). 525-530
43. Shibabaw A, Abebe T, Mihret A. Antimicrobial
51. Tschopp R, Aseffa A, Zinnstag J. Cattle
susceptibility pattern of nasal Staphylococcus
Productivity under Traditional Village Husbandry
aureus among Dessie Referral Hospital health care
System in Sellale, Central Ethiopia: A Four and a
workers, Dessie, Northeast Ethiopia. Int J Infect
Half Year Herd Follow-Up. International Journal of
Dis 2014; 25:22-25.
Agriculture Innovations and Research. 2014; 2 (5):
2319-1473
44. Sime H, Deribe K, Assefa A, Newport MJ,
Enquselassie F, Gebretsadik A, Kebede A, Hailu A,
52. Wedajo W, Schon T, Bedru A, Kiros T, Hailu E,
Shafi O, Aseffa A, Reithinger R, Brooker SJ,
Mebrahtu T, Yamuah L, Angeby K, Werngren J,
Pullan RL, Cano J, Meribo K, Pavluck A, Bockarie
Onyebujoh P et al. A 24-well plate assay for
MJ, Rebollo MP, Davey G. Integrated mapping of
simultaneous testing of first and second line drugs
lymphatic filariasis and podoconiosis: lessons
against Mycobacterium tuberculosis in a high
learnt from Ethiopia. Parasit Vectors 2014
endemic setting. BMC Res Notes 2014; 7(1):512.
53. Yitayal M, Aseffa A, Andargie G, Wassie L, Abebe
45. Smitson CC, Tenna A, Tsegaye M, Alemu AS,
M. Assessment of cost of tuberculosis to patients
Fekade D, Aseffa A, Blumberg HM, Kempker RR:
and their families: a cross-sectional study at Addet
No association of cryptococcal antigenemia with
Health Center, Yilmana Densa District, Amhara
poor outcomes among antiretroviral therapy-
National Regional State. Ethiop Med J 2014; Suppl
experienced HIV-infected patients in Addis Ababa,
Ethiopia. PLoS One 2014; 9(1):e85698.
Staff List
Contract Employees
First Name
Middle Name Education/Qualification
MSc, Medical Microbiology
BSc, Med Lab Technology
Diploma, Med lab Technician
BSc, Med Lab Technology
Diploma, Nursing
BSc, Biotechnology
BSC, Medical Microbiology
MSc, Biochemistry
BSc, Med lab Technology
Diploma, Med Lab technician
Diploma, Accounting
Diploma, Clinical Nursing
Diploma, Management
Diploma Clinical Nursing
Diploma, Nursing
Diploma, Nursing
BSC, Med lab Technology
BSc, Electrical Engineer
BSc, Med lab Technology
Diploma, Med lab Technician
BSc, Med lab Technology
Diploma Secretarial S
Diploma, Med lab Technician
MSc Medical Microbiology
Diploma, Clinical nursing
Diploma, Accounting
BSc, Med lab Technology
BSc, Med lab Technology
BSc, Med lab Technology
MSc, Information science
MSc, Chemical Engineer
MSc, Medical Microbiology
Government Employees
Abebe Habetie Dessie
Alemayehu Kifle Tesema
Almaze Kiros Mebiratu
Asayech Dagne Wubete
Banchayehu Gualu Geremew
Belayinesh Beyene Asfaw
Birhanie Tedela W/Mariam
Hiwot Tilahun Debalkie
Kidist Bobosha Aboma
Martha Zewdie Gebeyehu
Meheret Teshome Teferi
Menberwork Chanyalew Negatu
Miteku Werede Engeda
Saba G/Tsadik Woya
Semene Begashaw Masresha
Tarekegne Feleke Yebrgol
Wogayehu Alemu G/Hiwot
Wondu Wagaye Yanda
Wude Miheret W/Medhin
A Tribute to Agerie Tadele (12th AHRI Tore Godal Prize award winner)
Agerie was one of the young outstanding researchers at AHRI admired for her dedication and commitment.
We are very saddened by her untimely death. We remember her always as an amazing person who had been cheerful, smiling and hardworking
With our deepest sympathy, Rest in peace Agerie!
Institute Information
Armauer Hansen Research Institute (AHRI)
Jimma Road, ALERT campus
Tel +251-113-483752
Fax +251-113-211563
www.ahri.gov.et
Source: http://www.ahri.gov.et/sites/default/files/AHRI%20all%20files/Annual%20Report%202014%20new.pdf
Proposal of a Methodology for Implementing a Service-Oriented Architecture in Distributed I. Medina Buloa,, A. García Domíngueza, F. Aguayob, L. Sevillac and M. Marcosd aDepartment of Computer Languages and Systems. University of Cádiz. School of Engineering. c/ Chile 1, 11002, Cádiz. bDepartment of Design Engineering. University of Seville. Polytechnic University School. c/ Virgen de
Hôpital de La Chaux-de-Fonds Service des Urgences N°31 , novembre 2006 Auteur : Dr G. John Responsable : Dr C.Sénéchaud l'haloperidol (Haldol) peut être utile. Bien que les neuroleptiques atypiques comme l'olanzapine (Zyprexa) ou la risperidone (Risperdal) devraient entraîner moins de problèmes cardiaques et de syndromes extrapyramidaux, il n'existe pas encore d'étude clinique prouvant leur supériorité dans cette indication. Si l'état
