Molecular Epidemiology of tuberculosis at Human-Animal interface in the pastoral areas of Ethiopia with subsequent development of improved diagnostic approach

Against the available diagnosis and treatment advances, tuberculosis remains a relentless disease that is one of the leading causes of death from a single infectious agent worldwide. More importantly, the highest burden of tuberculosis is attributed to low- and middle-income countries such as Ethiopia, where limited resources and high population density intersect. Since zoonotic mycobacteria have  numerous host ranges that serve as reservoirs, it can complicate the fight against animal and / or human tuberculosis and have negative consequences and have significant economic problems and threaten livelihoods. Human-to-animal transmission of Mycobacterium tuberculosis complex, including M. Tuberculosis, is well documented in many parts of the world, including Ethiopia, which could have an implication in the epidemiology and control of tuberculosis in human and animal populations. However, livestock farmers and other herdsmen and slaughterhouse workers can also contract the disease via contaminated air droplets via aerosols from infected animals with pulmonary tuberculosis. This is particularly important in Ethiopia, where tuberculosis is endemic, milk pasteurisation is limited and human-animal interaction is unavoidable. Reverse transmission of Mycobacterium tuberculosis complex and other atypical mycobacteria between camel and humans in areas of intense human-animal contact is one of the driving factors for the onset and maintenance of tuberculosis in environments such as camel-herding pastoral areas of Ethiopia. By endorsing the ''Global End TB Strategy'' by 2035, Ethiopia's National End TB Strategy aimed to eliminate tuberculosis epidemics by reducing tuberculosis-related deaths by 95% and by reducing incidental tuberculosis cases by 90% between 2015 and 2035. One of the huge obligations of this programme is to improve access and equitable tuberculosis services for vulnerable and marginalised populations where tuberculosis is concentrated and where most delays occur due to socio-economic and legal barriers. Moreover, research and innovations are also the top priorities that the program has highlighted to sharply bend the country's tuberculosis epidemic curve to meet its ambitious 2035 targets. On the other hand, as part of its livestock master plan, Ethiopia planned to increase its GDP by increasing the production and export of live animals and animal products, and also to meet the growing national demand for affordable animal protein. And camel production is focused on development to meet in the pastoral areas of Ethiopia, where camels are herded primarily as a livelihood and survival strategy of the pastoral communities. However, the sector is not contributing as expected to the national economy and the livelihoods of livestock farmers due to various constraints, diseases such as tuberculosis of which are huge barriers to livestock productivity, exports, food security and public health. Tuberculosis in dromedaries threatens the well-being and livelihoods of pastoral communities, in addition to having a significant economic impact through reduced meat and milk production and creating barriers to international trade in dromedaries and their products. It would therefore be very important to assess the occurrence of Mycobacteria infection at the human-animal interface in the  pastoral communities of camel rearing in Ethiopia, describe the type species and/or strain circulating among humans and camels, and relate the transmission risks while describing the epidemiology and transmission dynamics of Mycobacteria. Such a study is also essential in devising context-appropriate tuberculosis control and prevention interventions. However, the accuracy of diagnostic tests for tuberculosis infection used in animals, mainly camels, is often elusive when diagnosing tuberculosis, and yet there is no reliable diagnostic test for accurate early ante-mortem diagnosis of tuberculosis in dromedaries, indicating the need for exploration and development of a new diagnostic tool. Against this background, this project is designed to study the molecular epidemiology of tuberculosis at the human-animal interface and to assess the bidirectional zoonotic transmission of Mycobacteria species between humans and animals in the dromedary camel-rearing pastoral communities in Ethiopia, and the subsequent development of proof-of-concept for an improved diagnostic approach to animal and human tuberculosis using camelids, nanobodies and phage technology. Key words: Tuberculosis, Mycobacterium, Camel, Pastoral, Ethiopia, Diagnosis, Nanobodies