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International Health

Building Clinical, Structural and Research Capacity to Treat HIV/AIDS & TB in Ethiopia

Since 2005, Department faculty have been lead members of the Johns Hopkins Technical Support for the Ethiopian HIV/AIDS Initiative (TSEHAI). This comprehensive program provides hands-on mentoring and technical assistance in all aspects of HIV treatment, care, and research. The program is a multi-million dollar investment that brings together worldwide experts, and is a prime example of how Hopkins faculty from across the university can pool their expertise to lead an interdisciplinary and multifaceted nationwide health care program.  

TSEHAI Team Participants in Ethiopia's Great RunLike many other countries in sub-Saharan Africa, Ethiopia had a large number of HIV-infected and affected individuals with limited access to care and treatment. With support from the Global Fund and from the President’s Emergency Fund for AIDS Relief (PEPFAR) much needed HIV treatment became increasingly available. In 2005, the Centers for Disease Control and Prevention funded TSEHAI as a PEPFAR partner. The project focuses on providing technical assistance and capacity building to multiple levels of the health care system that provide free Anti-Retroviral Treatment for HIV/AIDS. The TSEHAI program works in four regions of Ethiopia—Addis Ababa; Benishangul Gumuz; Gambella; and Southern Nations, Nationalities, and People's Region—while other CDC-funded partner universities UC-San Diego, Columbia, and the University of Washington cover the rest of the country. 

Over 200 JHU staff work in the country supporting over 90 facilities that serve urban, rural and refugee populations. Associate Professor Andrea Ruff is the principal investigator, who along with other Bloomberg and Medical School faculty, provide core technical assistance and expertise. Regions of Ethiopia

Hopkins-based TSEHAI Team
Andrea Ruff, Associate Professor, IH
Aida Abashawl, Assistant Scientist, IH
Rahel Adamu, Research Associate, IH

Jean Anderson, Professor, School of Medicine 
John Bartlett, Professor, Epidemiology and School of Medicine
Meg Doherty, Assistant Professor, IH and School of Medicine 
Elham Hassen, Research Associate, IH
Elizabeth Holt, Assistant Scientist, IH
Nancy Hutton, Associate Professor, School of Medicine
Harold Lehman, Associate Professor, Health Policy and Management and School of Medicine
Nicole Simmons, Associate, IH

Bill Weiss, Assistant Scientist, IH
Larry Wissow, Professor, Health, Behavior and Society
Solomon Zewdu, Assistant Scientist, IH

Infrastructure  Capacity
“One of my favorite success stories is the capacity building we have been able to help support including completion of a state-of-the-art MDR-TB lab [multiple disease resistant tuberculosis] in Addis Ababa, as well as clinical reference lab at Tikur Anbessa Hospital at Addis Ababa University,” states Professor Ruff. The university at one time had eight small labs with limited capabilities. Ruff continues:

Through PEPFAR funding we were able to build one state-of-the-art lab that can test for a whole range of clinical conditions and infectious diseases. Tikur Anbessa is a referral hospital and as such should have a quality lab. The MDR-TB lab has become a regional resource. Since 2006, the program has upgraded scores of additional labs and trained hundreds of lab technicians in testing methods for TB, HIV and other sexually transmitted infections.  

Provider Capacity
Hopkins faculty and staff are involved in a wide range of clinical mentoring and training activities. One of the most rewarding is case management. TSEHAI has helped implement a telemedicine program that not only reduces travel costs but also archives sessions for later instruction. Every week, physicians from Hopkins, NIH, Eastern Carolina University, and the Mayo Clinic meet in a virtual space to discuss real cases with providers working in clinics across Ethiopia. These sessions are broadcast and archived through the Johns Hopkins Center for Clinical and Global Health Education. All sessions are archived and accessible on the Center's website.

PEPFAR Treated on ARTs
Numbers Receiving ARTs at JHU TSEHAI-Supported Facilities

Research Capacity
One innovative research activity is the Advanced Clinical Mentoring (ACM) project. This is a collaborative effort between seven major Ethiopian universities and hospitals across the country. Hopkins staff work at each of the sites to help manage and collect HIV patient data. The data are then stored in a central database at the Ethiopian Health and Nutrition research Institute and provide accurate and comprehensive information regarding HIV treatment to health care providers, hospital and clinical managers, researchers and policy makers. These data provide a valuable evidence base that can lead to better patient care and clinical management. In addition, outside researchers can apply to use the data in their own independent research studies. A steering committee, with national and university representation, oversees the database and determines appropriate use of the data.

These are only a few highlights from a program that has successfully trained hundreds of health care providers and researchers. TSEHAI has made significant progress in its mission to increase human and structural capacity for treating HIV/AIDS & TB patients. The eventual goal of the JHU team is to transition its activities to local partners – to that end it is assisting partners with other capacity building initiatives such as MEPI (see sidebar).

For more information on all the program’s activities, visit the TSEHAI website.

New Hopkins Training Activity in Ethiopia
Medical Education Consortium for
Quality Medical Education & Retention

Through the PEPFAR-funded Medical Education Partnership Initiative (MEPI), Johns Hopkins faculty will be partnering with other universities and hospitals to combat Ethiopia’s severe medical personnel shortage. The lead institution will be Addis Ababa University.

The consortium will address 3 strategic objectives
1. Improvement of the medical education system by increasing the number of physicians and quality of training
2. Human capacity building and retention through enhanced recruitment and retention of qualified academic medical faculty
3. Enhancement of research and bioethics capacity through development of expertise and opportunities to conduct clinical, public health and implementation science research.

Partners: Hawassa University, Haremaya University, Defense Forces Medical School, University of California San Diego, Emory University, University of Wisconsin

Hopkins Student Involvement in TSEHAI

Programmatic area

Cassandra Althauser

Prevention of mother  to child HIV transmission

Sarah Bernot

Strategic Information

Loraine Beraho

Care and support of HIV-exposed and infected children (co-trimoxazole prophylaxis)

Carmen Coombs

Care and support of HIV-exposed and infected children (co-trimoxazole prophylaxis)

John Cranmer

Care and support of HIV-infected adults (nutrition)

Sosena Kebede

Health system strengthening

Sarah Kim

Care and support of HIV-exposed and infected children (nutrition)

Adi Noiman

Advanced Clinical Monitoring

Lisa Nutting

Care and support of HIV-exposed and infected children (TB prevention and treatment)

Horacio Ruisenor

Care and support of HIV-infected adults (TB)  
Keena Seyfarth  STI

Keena Seyfarth


Nakiya Showell

Care and support of HIV-exposed and infected children (nutrition)

--Brandon Howard, February 2011