Health research has always been regarded as research that adds high value to society. This is because it provides important information about disease trends and risk factors, outcomes of treatment or public health interventions, functional abilities, patterns of care and health care cost and use.
Often we look towards the west or developed countries for credible research and perhaps rightfully so, because of advancements in technology in these countries. However, this narrative is being changed right in our back yard courtesy of AHRI, a research institute with a pool of scientists from Ethiopia in partnership with scientist across the globe. The institute aspires to be the leading medical research and training institute in Africa by 2025 and is rightfully on track to become so.
The institute has taken on diseases such as TB, Leprosy, HIV, and Malaria, to name a few, with regards to its research discoveries and has recently been combating COVID-19 through its research and analysis.
Alemseged Abdissa (PhD) leads AHRI as the deputy director. Capital got hold of the seasoned microbiologist for an in-depth insight of AHRI. Excerpts;
Capital: Describe AHRI to us in an overview highlighting also the institute’s activities on a day-to-day basis.
Alemseged Abdissa: The Armauer Hansen Research Institute (AHRI) was founded in 1970 through the initiative of the Norwegian and Swedish Save the Children organizations seconded by the Ministry of Health of Ethiopia. The Institute got its name from the Norwegian physician, Gerhard Henrik Armauer Hansen, who is remembered for his identification of the bacterium Mycobacterium leprae which is the causative agent of leprosy.
AHRI was thus established as a biomedical research institute located next to the All Africa Leprosy Rehabilitation and Training Hospital (ALERT). The Institute later joined the Ethiopian Ministry of Health in 2004. AHRI foundationally receives core support for its research activities from SIDA and NORAD as well as through funds from competitive grants.
AHRI at its core is devoted to improve medical care and thus focuses on the health and wellbeing of the public by generating and delivering scientific evidence as well as developing new tools and methods through biomedical, clinical and translational research. Moreover, the institute serves as a hub for technology transfer and capacity building in medical research and training. To this end, currently, AHRI supports 66 Postgraduate (MSc and PhD) theses from universities across Ethiopia. AHRI research activities cover basic (immunology and molecular biology), epidemiological and translational research.
In addition, AHRI has published more than 900 papers in peer reviewed journals so far. It has also produced several theses and dissertations from Ethiopian and international scholars in biomedical research.
Capital: What are some notable research breakthroughs that AHRI has been a part of over the years?
Alemseged Abdissa: AHRI through its research over the years has truly been honored to be apart of discoveries that have went on to improve the health of many.
For instance, breakthroughs with regards to Multi Drug Resistant Tuberculosis (MDR-TB) have been greatly achieved. To simplify this medical term, MDR-TB, is a type of TB that is resistant to ‘rifampicin and isoniazid’ which are crucial for the treatment of this respiratory disease. For patients with MDR-TB, this means longer treatments, more expenses with regards to therapy and intolerable suffering. In a bid to combat this, a clinical trial was conducted at AHRI in collaboration with global and local stakeholders which went on to successfully reduce the duration of treatment of MDR-TB from the long 24 months to only 9 months. This enabled to unburden many patients who have long-suffered this aching disease. Moreover, through this evidence to policy breakthrough, the World Health Organization (WHO) and the Ethiopian Ministry of Health have revised the guideline of MDR-TB treatment.
More recently, our research institute in conjunction with The Netherlands’ Radboud University Medical Center noted and revealed the spread of the malaria vector, ‘Anopheles Stephensi’ in 13 towns and cities of Ethiopia. This mosquito species only appeared in Africa a few years ago and having now invaded the cities and town could lead to potential outbreaks. Historically, malaria had been considered to be a disease confined to rural locations but now ongoing urbanization and immigration to urban areas has consequently enhanced the spread of the vectors. For us, discovering this was instrumental since it helps in placing prevention and control mechanisms by relevant health institutions which in turns safeguards the health of our citizens.
Soon after the introduction of COVID-19, AHRI has been putting efforts to sequence and analyze samples from COVID-19 patients. With due support from our partners, we managed to secure resources through which we successfully performed the first ‘SARS-CoV-2’ whole genome sequencing and analysis. This is a great milestone not only for AHRI, but also our country. Whole Genome Sequencing (WGS) and analysis when taken from a wide scope of samples around the country, will allow in tracking and monitoring potential new and emerging strains of COVID-19 variants which will be critical in understanding the impact, transmissibility, disease severity and reinfection of the novel virus.
This analysis was done with a limited sample size at our institute which in turn can be replicated in large scale. We are equally capable of rising to the occasion if we are called upon to take samples across the country since our capable staff at AHRI have developed skills for; sample processing, preparing libraries, sequencing and performing metagenomics analysis. When thorough analysis is administered, it will help our country to recover faster from the pandemic in conjunction with the diagnostics and vaccines that are available.
Capital: The institute has recently been on the scientific fore front in tackling COVID-19 by developing the first Local COVID-19 antibody test kit. Elaborate for us this diagnostic procedure and highlight its difference from other COVID-19 testing.
Alemseged Abdissa: In order to better understand why we developed this local COVID-19 antibody test kit, I believe a situational background must be highlighted so as to understand the need for such a kit.
From the situational background we find that enhancing the diagnosis of SARS-CoV-2 infection is regarded as one of the strategies for controlling COVID-19. In order to do this, different molecular and serology-based tests have been invented and introduced in to the health care systems. A molecular method, qRT-PCR, has been the gold standard diagnostic approach as it detects the infecting virus itself. On the other hand, serology-based tests measure antibodies (IgM/IgG) from blood that are produced as a result of SARS-CoV-2 infection, so it is a proxy marker for SARS-CoV-2 infection (the virus that causes COVID-19). Thus, serology-based diagnostics (either in an ELISA or lateral flow assay (LFA) platform) have been suggested to be used for different purposes including contact tracing, estimating exposure to the virus among high-risk groups/the general population and used as a key index for evaluating the effectiveness of a vaccine. In resource limited countries, such data generated from serology-based tests provide valuable information regarding the spread of the disease in the general population, especially among health care workers and high-risk groups. More importantly, policymakers can use this information to prioritize control measures to mobilize limited resources to break the spread of the pandemic and avoid second and third waves or other waves to cumulatively come in future. .
Moreover, the demand and supply of vaccines are not equal which means that countries need to prioritize who to vaccinate first. Thus, COVID-19 antibody tests will help to know who have already been exposed to natural infection and need to be less prioritized than those who have not been exposed at all. Therefore, more straightforward, cheaper, faster and high throughput COVID-19 antibody test platforms are vital. One of these platforms is ELISA, a platform that uses multiple matrices or specimens, including patient serum, dried blood spot (DBS) and saliva.
AHRI, in collaboration with Oregon Health and Science University (OHSU), has successfully developed an ELISA-based COVID-19 antibody testing technology, which is affordable and easily scalable to meet growing demands. Our assay utilizes the receptor-binding domain (RBD) of the spike protein that specifically binds to SARS-CoV-2 antibodies in various sample types, including patient convalescent sera and saliva and WHO control panels were used as standard controls. Our results were compared with other in house and commercial serology-based test and proved to be very comparable. The collaborative study resulted in developing a quantitative indirect SARS-CoV-2/COVID-19 Antibody Test ELISA (named SCAT) that detects IgG antibodies produced against SARS-CoV-2 infection. The sensitivity and specificity of SCAT were compared to commercially available COVID-19 antibody detection kits (Hangzhou Realy Tech Co., LTD and Beijing Wantai Biological Pharmacy Enterprise Co., LTD).
The sensitivity of SCAT in convalescent sera from confirmed COVID-19 patients with 2 weeks post-onset of symptoms, for example, was 100% (as compared to 90% for Realy Tech and 100% for Wantai). The specificity of SCAT in pre-COVID pandemic sera was 97.5% (as compared to 92.5% for Realy Tech and 100% Beijing Wantai).
SCAT’s performance was evaluated in three different types of specimens (convalescent serum/plasma, saliva, and dried blood spot) from PCR confirmed COVID-19 patients, and found a comparable sensitivity, indicating that the three specimens can be used alternatively. This of course is impressive result which we hope to introduce and use in Ethiopia with regards to tackling the surge of the pandemic.
Capital: How commercially viable is this COVID-19 antibody testing technology?
Alemseged Abdissa: When you place it in to perspective in comparison to the ones available across the globe, it is definitely commercially viable whilst still having comparable results. The cost is of course lower because majority of the products required are replicated within our country. This SCAT developed by AHRI -OHSU is a powerful serology COVID-19 test that is not only comparable with the other commercially available test kits, but also much more affordable and can be utilized to estimate SARS-CoV-2 infection prevalence in different settings for example; health care facilities, schools and communities. Additionally, SCAT works equally well in easy-to collect and cost-effective samples such as Dried Blood Spot (DBS) and saliva, which makes our assay more suitable for conducting ‘serosurvey’ that involves mass screening in resource limited countries.
The commercial viability is almost ten times as cheaper when accounting for expense per sample. Using the commercially available LFA-based Rapid Diagnostic Tests (RDTs) will set you back at least 20 USD per sample whereas the one we have developed in partnership with OHSU costs under 3 USD per sample.
Furthermore, when we analyse economic viability, we have to also look at sustainability. The assay that has been developed by a team of Ethiopian scientists from AHRI & OHSU is considerate of this. The developed assay facilitates technology transfer, capacity development in local production and thus enhances sustainable while still allowing for specificity and sensitivity comparable to commercially available tests.
Capital: How do you plan to upscale this technology for large scale use and commercialization?
Alemseged Abdissa: It is evident that in upscaling any product engagements with the relevant stakeholders are important. As an institute we acknowledge this. We are engaged with the Ministry of Health and stakeholders in order to use this assay for epidemiological studies and support local production of the test. The assay can also be commercialized to other African countries which can then after generate revenue. Therefore, to investors and donors alike, who are interested in bettering health, this is a huge opportunity to come and engage with us. The doors of AHRI are always open for discussion.
