Initiation & Scale-up of Drug Resistant-TB Care in Ethiopia
The seven surviving patients of the original eight patients initiated on DR-TB treatment in Ethiopia in February 2009. Celebrating after their completion of the first 6 months of hospitalization for the intensive phase of their treatment on the isolation ward at St Peter’s Hospital. CHC’s Dr. Sok Thim (middle row second from left), and the Ethiopian National DR-TB manager at the time, Dr. Ridwan Bushra (kneeling in first row on the right) and St Peters DR-TB nurse (in while coat) with patients who reached this critical milestone for themselves and the Ethiopian National Program.
Healing the world one life at a time
33 year old Gizachew, was Global Health Committee (GHC)’s first patient at Gondar University Hospital in northern Ethiopia when GHC expanded drug resistant (DR)-TB care there from Addis Ababa in 2010. Gizachew had been waiting for 3 years for DR-TB drugs to be available in Ethiopia, and he had been living in a closet (Top left and middle photos) in his family home to protect his wife and children from acquiring DR-TB. He said he had not kissed his children for 3 years. He had high fever and extensive TB in both lungs when the GHC team found him (see Xray in top right photo). In the photo below on the left, he is improved on DR-TB drugs under the clinical managment of Dr. Daniel Meressa (GHC Medical Coordinator from 2009-2023). After a year and half of DR-TB therapy, Gizachew was cured and was back at work, feeling well, and at his pre-illness weight (Bottom middle and right photos). Gizachew gave his permission for us to use his photos and story as has each person has who is shown on the website.
Global Health Commitee’s Impact on DR-TB in Ethiopia and globally (2009–2025):
From February 2009 to May 2025, GHC treated 2972 individuals for drug resistant TB (DR-TB) in partnership with the Ethiopian Federal Ministry of Health (FMOH) and Angelina Jolie and the Jolie-Pitt Foundation. 20% of those treated have been children/teens and 22% were also living with HIV/AIDS.
By 2015, the GHC reported the best clinical outcomes for drug resistant (DR)-TB in sub-Saharan Africa in the British Medical Journal, Thorax, despite the severe resource constraints and patients with very advanced disease DR-TB disease in the Ethiopian program. GHC’s publication raised the bar for other programs in Africa and globally for cure and survival from DR-TB.
As of May 2025, GHC is working in 5 DR-TB treatment sites in diverse areas of Ethiopia, which were chosen for maximal impact on DR-TB in Ethiopia: St Peters Hospital in Addis Ababa (since 2009); Gondar University Hospital in Gondar, Amhara (since 2010); Yirgalem Hospital in the Southern Nations, Nationalities, and People’s Region (SNNPR) (since 2012); Dupti Hospital in Afar Province (since 2023); and at Mekele General Hospital in Tigray, providing technical advice and nutritional assistance to the DR-TB patients, and hot meals to the survivors of gender-based violence in the hospital’s One Stop Clinic (since 2023) .
As a core member of the Ethiopian National Technical Working Committee for DR-TB , GHC shared protocols for managing drug side effects, supplemental nutrition and social support, and through didactic and hands-on training helped the national in scale-up of DR-TB care. An additional +5800 individuals were initiated by the national program as of June 2024.
The GHC/St Peters collaborative program on DR-TB significantly contributed to the game-changing international STREAM Trial led by the UK’s Medical Research Council and the TB UNION as the major clinical site in Ethiopia. This work showing that DR-TB could be shortened from ~2 years and use all oral drugs for 9 months, which provided the World Health Organization with the data in support of new short course oral treatments for DR-TB.
How GHC Launched DR-TB Treatment in Ethiopia
In 2008, an estimated 6,000 Ethiopians were sick with drugs resistant (DR)-TB also called multidrug resistant (MDR)-TB. However, drugs that were promised to treat DR-TB drugs from the World Health Organization’s ‘Greenlight Committee’ were only approved for 45 people, and these drugs had not arrived. Indeed, they would be delayed for over another year.
CHC trained Ethiopia’s DR-TB medical team in Addis Ababa and then brought the core treatment team to Cambodia for hands-on training in late December 2008/early January 2009 with the support of Angelina Jolie. A key to beginning the program and sustaining it in the beginning was a generous donation from Eli Lilly for the most expensive drug of the regime of 5 drugs, capreomycine for the first 175 patients. The other 4 drugs were purchased by GHC and all were hand-carried from the U.S. or Cambodia.
In February 2009, the first 8 patients in the GHC program at St Peters Hospital in Addis Ababa, Ethiopia began their 1.5-2-year regimens for DR-TB. GHC tried to contact a waiting list at St Peters Hospital of 221 patients the hospital had confirmed had DR-TB. Tragically, 42 of the 221 had already died waiting for treatment, and over 100 of the 221 more could not be found and were presumed dead while waiting for treatment. To expand access to care, GHC also reached out to the Missionaries of Charity Homeless Shelter to find waiting patients.
Key factors contributing to the success of the Ethiopian DR-TB program were:
South-to-south transfer of knowledge and skills from CHC Cambodia to GHC Ethiopia
Outpatient care team and home visits
Intensive patient-centered focus on treatment of adverse effects
Nutritional supplementation and adherence interventions
Social support including rent when necessary and transportation for clinic visits
Providing support for lab tests during national stock outs, for X-rays when hospital facilities were non-functional, and for essential imaging studies (CT scans) or procedures such as chest tube placement.
Flexible funding to address the needs.
Together, GHC’s efforts overcame extreme barriers to care and laid the foundation for Ethiopia’s national DR-TB program—powered by south-to-south collaboration. For more details on the South-to-South support from Cambodia to Ethiopia and how GHC overcame the challenges associated with initiating DR-TB treatment in Ethiopia, please click here.
MDR-TB care in war-affected Tigray and Afar provinces and mitigation of starvation 2023-2025
In 2023, GHC mounted an emergency response to the humanitarian needs in the northern province of Tigray and neighboring Afar following the large-scale two-year civil between Tigray and the Ethiopian government. GHC focused on re-establishing the war-disrupted programs for MDR-TB in Afar Province and in Tigray’s capital city, Mekele.
In Afar, where the war spilled over the border shared with Tigray, the MDR-TB ward in Dupti Hospital had been converted into a ward for wounded soldiers and was then empty, but needing repair such as restoring water, to be functional. GHC rehabilitated the ward so that it could be used again for a reinvigorated MDR-TB program, and continues to provide ongoing mentoring to the staff and social and food support for patients.
In Mekele Hospital, GHC found that the MDR-TB patients hospitalized at Mekele Hospital were extremely malnourished and most had BMIs bordering on, or crossing over to, starvation in an environment of continued food insecurity. Thus, GHC focused on providing a daily high-protein hot meal for patients with drug resistant TB and secured plumpy nut for those who were the most malnourished.
In addition, women who were seeking care in the Mekele Hospital’s ‘One-Stop Clinic’, for women who had survived rape and abuse, were also severely malnourished with borderline BMIs. GHC provided those who came for an appointment a high-protein hot meal. Between July 2023 to Dec 2024, GHC provided 22,513 hot meals for MDR-TB patients and One-Stop Clinic patients.
GHC has received critical support for this program from Angelina Jolie and JPF, the Eli Lilly MDR Partnership, the Lilly Foundation, Janssens Global Public Health, the Johnson&Johnson Foundation, Wallis Annenberg and the Annenberg Foundation, Nancy & Steven Crown, Mimi & Bud Frankel, Jeanne Sullivan, Holly Myers & Kirk Neely, Albro and Cathi Lundy and Mimi and Bud Frankel.
Fetene was in the first group of 8 patients to receive treatment for DR-TB in Ethiopia. At age 19 year he already had gone through several courses of treatment for regular TB as a child and teenager and never recovered. His family asked him to leave the home because they were afraid he would infect the family; and he ended up in Addis Ababa homeless. He found his way to the Missionaries of Charity Homeless Shelter in the city, which housed over 900 homeless men and women. The CHC team diagnosed Fetene with MDR-TB with severe infection of both lungs (see X-ray in top left photo). He had severe malnutrition and chronic diarrhea. He also had a swollen abdomen with TB of the abdominal lining (Middle photo). He was feeling and doing better after a few weeks of treatment (photo to the right), and fought valiantly to survive, but unfortunately a few weeks after the photo to the right was taken he went into respiratory failure and died after two months in St Peter’s Hospital. He was the one person who died from the first cohort of 8 patients who were treated by the GHC/St Peters team.
Fetene gave his permission for us to use his photos and story as has each person has who is shown on the website.
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18 month old Isak on his way to DR-TB cure after 6 months of treatment at St Peters Hospital for DR-TB (left). Isak and his mother were living in an internally displaced camp due to the civil war in Tigray and he was exposed to a person who had interrupted her TB treatment in the camp, who turned out to have DR-TB. Isak was originally diagnosed with regular TB and was started on medication for regular (drug sensitive) TB for 3 months with no improvement at the internally displaced persons camp. Deteriorating clinically, he was brought to St Peters Hospital in Addis Ababa in 2022 and found to have diffuse DR-TB pneumonia. See photo to the right of his CT scan showing diffuse DR-TB pneumonia with an asterisk showing a particularly bad region of pneumonia.
When Isak arrived at St Peters he was in critical condition requiring oxygen, blood transfusions, and intensive care, and the team was extremely worried about his prognosis. Isak has done very well on treatment and was cured by age 3. He has accomplished all of his pediatric milestones such as walking, running, talking in complex sentences and is home with his mother in Tigray.
ISAK and his MOTHER and the IMPACT of WAR
Patients on their way to cure of Drug-Resistant TB
16 year old student
Vital sign check
young mother to be
A very malnourished patient with DR-TB on his way to cure at St Peters
20 year old construction worker
grandmother, getting some air during treatment for DR-TB
Dr. Rocio comforts a patient on the St Peter’s DR-TB ward.
Dr. Mehret Befekadu, GHC’s Chief Clinical Coordinator, takes Dr. Atul Gawande, former Assistant Administrator for Global Health of USAID on rounds at St Peters in 2024 (Above). With 3 year old patient Lemi who was receiving therapy for drug resistant TB (right).
Two young men on the road to cure of DR-TB getting some air on the St Peter’s DR-TB Ward.
Dr. Daniel Meressa (in the middle), GHC medical Coordinator from 2009-2023 and the STREAM Trial, Site Principle Investigator, on rounds with Dr. Bekele (left front).
Dr. Yohannes with Dr. Anne at the Gondar University Hospital DR-TB ward. Yohannes was infected with DR-TB as a medical student and was in the first group of patients who received DR-TB treatment in the the GHC/MOH collaborative program in Ethiopia. See photo at the very top of this page where he holding Dr. Thim’s hands in the middle of the first group of 7 DR-TB patients who made it through the first phase of treatment at the time in June 2009.
patients at the DR-TB Ward enjoying a music concert.
Dr. Rocio and senior DR-TB staff member, Dr. Bekele, examine Sultan’s chest tube and breath sounds at St Peter’s DR-TB Ward.
MULU and her family
Mulu, a 30 year old mother of four children, was diagnosed with severe DR-TB pneumonia and malnutrition 2 months after the birth of her daughter Obse in her arms at the left.
Mulu was in respiratory failure on admission requiring oxygen and DR-TB that had spread throughout her body. Baby Obse was found to have acute malnutrition and DR-TB pneumonia. The baby also developed septic shock with respiratory failure requiring oxygen and blood transfusions shortly after they arrived at St Peter’s hospital. Mulu has been cured as has the baby who has done very well on her treatment and has met her developmental milestones after 18 months of DR-TB treatment.
The baby’s 3 year old brother Lemi (on the left) and 8 year old sister Gadiseh (not shown) were also both coughing and were evaluated by the GHC team and both were also found to have DR-TB.
Mulu and these 3 children were all successfully treated living together on the ward until they completed their treatments as their village is in a remote region of Oromia. Another sibling, a 10 year old sister was also evaluated and tested negative for DR-TB and was living with her father, who also tested negative, in their home village.
Healing the world one life at a time
Photo taken at St. Peter’s DR-TB ward 4 months into treatment.