Ashenafi Assefa, PhD, and Jonathan B. Parr, MD, MPH

The Study 

To investigate factors contributing to the resurgence, researchers conducted a nationwide survey at 20 sentinel sites across 11 Ethiopian regions during July and August 2024. More than 2,200 patients with symptomatic malaria were enrolled, and parasite samples were analyzed for genetic markers associated with resistance to antimalarial drugs and detection by malaria diagnostic tests.  

The study focused on mutations in Plasmodium falciparum, the deadliest malaria parasite species, including markers linked to partial resistance to first-line artemisinin-based therapies and genetic deletions that allow parasites to evade detection by widely used HRP2-based rapid diagnostic tests.  

The Findings

Researchers found that the prevalence of the most common artemisinin-resistance mutation in Ethiopia, known as pfk13, R622I, has increased substantially compared with previous years. They also identified a growing prevalence of parasites carrying deletions of the pfhrp2 and pfhrp3 genes, which can cause false-negative results on HRP2-based rapid diagnostic tests.  

Genetic analyses revealed that multiple resistant parasite lineages are circulating and expanding across the country. However, the findings suggest that resistance alone is unlikely to explain Ethiopia’s recent malaria resurgence. Instead, the results point to a combination of factors, including disruptions to malaria control programs and climatic changes, contributing to increased transmission.  

“Our findings show that malaria parasites carrying drug- and diagnostic-resistance mutations are becoming increasingly common in Ethiopia, raising important concerns for the future of malaria control in the region,” said Parr, co-senior author of the study and associate professor of medicine. “At the same time, the data suggest these mutations were not the primary cause of the recent resurgence in malaria cases. Continued investment in prevention, diagnosis and new treatment regimens are essential to protect recent gains and stay ahead of emerging resistance.”  

Among participants with confirmed malaria infections, nearly two-thirds were infected with P. falciparum. Approximately one-quarter of successfully genotyped parasites carried deletions that enable them to escape detection by HRP2-based rapid tests, while resistance-associated mutations were observed across multiple regions of the country. The findings support Ethiopia’s recent decision to adopt alternative malaria rapid diagnostic tests that do not rely solely on HRP2 detection. The researchers note that ongoing monitoring of resistance markers will be critical to malaria treatment and control strategies.  

“Efforts to address the rise in malaria cases in Ethiopia are already showing encouraging results,” Assefa said. “But the increasing prevalence of resistance-associated mutations underscores the importance of strengthening surveillance systems and evaluating new treatment approaches before resistance becomes a larger threat.” 

The study was supported by the World Bank’s Africa CDC Regional Investment Financing Project and the U.S. National Institutes of Health. Preliminary findings have already provided critical input for frontline workers and federal program managers.  

The post New Study Finds Drug- and Diagnostic-Resistance Mutations Are Increasing in Ethiopia as Malaria Cases Surge  appeared first on Institute for Global Health and Infectious Diseases.

CHAPEL HILL, N.C. — A new UNC-led study published in the Center for Disease Control and Prevention’s Morbidity and Mortality Weekly Report reveals that ticks in Buncombe County are carrying the bacteria that causes Lyme disease at rates comparable to that found in Northeastern states. The findings highlight the rapidly evolving risk of tickborne disease in the region.

Dr. Ross Boyce

The study “Southward expansion of pathogens in Ixodes scapularis ticks collected through a community-based partnership — Western North Carolina, November 2024–August 2025,” was conducted by researchers from the University of North Carolina at Chapel Hill’s Institute for Global Health and Infectious Diseases, the University of South Carolina, and North Carolina State University in partnership with the town of Biltmore Forest. In early 2024, the town had established a task force to address resident concerns about the threat of ticks in the community. Following a local newspaper story in the Mountain Express, Dr. Ross Boyce reached out to the town to see how his research team could help.

“This is one of the most compelling research projects I have conducted,” said Dr. Boyce, an Associate Professor of Medicine. “We are essentially leveraging the tools of academia to tackle a public health problem, and critically, one that that the local community has told us is important. The ability to immediately link research to impact is why we do what we do.”

Designing the Study

Between November 2024 and August 2025, the research team performed monthly surveillance across 25 properties in the town of Biltmore Forest. In total, they collected 373 ticks; more than three-quarters of which were blacklegged ticks (Ixodes scapularis), the primary vector of Lyme disease in the eastern United States. Subsequent testing confirmed that nearly 40% of adult and nymphal ticks carried Borrelia burgdorferi, the bacterium that causes Lyme disease.

Testing also identified other bacteria including Borrelia miyamotoi and Anaplasma phagocytophilum in about 6% of collected ticks, both of which can cause serious illness. Notably, this is the farthest south these bacteria have been detected, which further adds to the risk to local residents and visitors.

Researchers say western North Carolina – and the area around Asheville in particular – may be at the forefront of the southward expansion of blacklegged ticks and the pathogens they carry.  For comparison, the prevalence of Lyme disease bacteria identified in the Biltmore Forest ticks is similar to rates reported in parts of the Northeast, Mid-Atlantic, and Upper Midwest, where Lyme disease is well established.

What This Means

The discovery has important implications for public health. Many healthcare providers in the region were taught that Lyme disease was uncommon. As the ecology of ticks and tickborne pathogens evolves, Boyce emphasizes the need to educate providers about Lyme disease – and now other tickborne infections – to mitigate any impacts on health.

“Lyme disease can be a life changing diagnosis, especially if not diagnosed and treated early,” Boyce says. “The pace at which we’ve gone from zero-to-sixty, essentially within a 10-year period, means that we are behind. We need a focused and dedicated response to what I would consider a regional epidemic.”

Boyce and his team are working with the town to develop a response plan that will include efforts to reduce tick populations and improve access to appropriate care. In addition, the team is working to expand surveillance efforts to some of the more rural counties outside of Asheville.

The study was led by co-first authors Sean Sweeney, MS (University of South Carolina) and Ayla Bullock, MPH (University of North Carolina) and co-senior authors Melissa S. Nolan, PhD (USC) and Ross Boyce, MD, MSc (UNC Institute for Global Health and Infectious Diseases). Other investigators include Michael Reiskind, PhD (N.C. State University), and Angela Newnam and Jonathan Kanipe (Biltmore Forest LEADS Task Force), with the North Carolina Biltmore Forest Study Team.

The post UNC Study Shows Lyme Disease Firmly Established in Western North Carolina appeared first on Institute for Global Health and Infectious Diseases.

Mitch Matoga

Mitch Matoga, MD, MSc, PhD, a physician-scientist with UNC Project-Malawi, has been selected to serve as a member of the World Health Organization’s Technical Advisory Group (TAG) on Sexually Transmitted Infections. Dr. Matoga was one of 23 applicants (out of 280) selected to serve in the TAG for HIV, Hepatitis and STIs. TAG plays a critical role in providing independent, evidence-informed technical advice to WHO on matters related to prevention, diagnosis and treatment of sexually transmitted infections.

At UNC Project-Malawi, Matoga serves as the director of STI Research and Clinical Services, and lead of the Implementation Science Research Unit. He has more than 15 years of experience researching HIV prevention, sexually transmitted infections (such as Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum), antimicrobial resistance surveillance, and vaccine studies. For the HIV Prevention Trials Network (HPTN), he serves as co-chair of the STI Science Committee.

Dr. Matoga was recently appointed assistant professor in the department of medicine’s division of infectious diseases. He is a former trainee with the Institute for Global Health and infectious Diseases, serving as an MHIRST scholar from 2016-2017 and 2019-2024, and a UJMT post-doc from 2019-2021.

The post Matoga Appointed to WHO STI Advisory Group appeared first on Institute for Global Health and Infectious Diseases.

With the center’s latest award renewal, David Margolis, MD, will serve as contact principal investigator, joined by Angela Kashuba, PharmD, and Audrey Pettifor, PhD, as Co-CFAR Directors. The team succeeds longtime CFAR Director Ron Swanstrom, PhD, who helped secure UNC’s first CFAR award in 1998, with Myron Cohen, MD, and guided the center’s growth into one of the nation’s leading HIV research programs.

David Margolis, Angela Kashuba and Audrey Pettifor

Funded by the National Institutes of Health, CFAR is a large, collaborative center grant that supports HIV research across the university. Rather than funding a single project, the grant provides shared research resources, scientific expertise, pilot funding, mentoring, and opportunities for collaboration that help investigators across disciplines advance discoveries in HIV prevention, treatment, and cure research. The center’s success has also depended on strong administrative leadership. Prema Menezes, PhD, CFAR Associate Director, has coordinated the many moving parts of the center’s operations for many years.

The leadership transition reflects a longstanding tradition of renewal within the UNC CFAR. Since its founding, the center has supported generations of scientists, fostered collaborations across laboratory, clinical, and community-based research, and helped launch the careers of early-stage investigators.

“I am excited about the new CFAR leadership,” Swanstrom said in a message to the CFAR community. “They are more than capable of guiding us through these uncertain times. You will recognize their names as world-class scientists with years of experience in our CFAR and in center leadership.”

Swanstrom will continue his involvement with the center as an associate director while remaining active in research. Reflecting on the center’s success, he credited the broader CFAR community. “It is you who have created a CFAR that is considered one of the best CFARs in the group of 20,” he wrote. “For me, the CFAR is a place where people join a community with the expectation that opportunities for help and collaboration are always available.”

“Nearly thirty years later the program continues to thrive,” Cohen wrote in a CFAR announcement. “Under Ron’s leadership our CFAR members have made numerous discoveries, trained many students across different disciplines, and developed a strong relationship with the community.”

The post UNC CFAR Begins New Chapter With New Leadership appeared first on Institute for Global Health and Infectious Diseases.

(Left) Screenshot showing the home page of the portal. (Right) The implementation team with Terra Dotta representatives preparing for the launch.

Implementation began in December 2025, with a successful soft launch in late Spring. Both offices are now using the system to manage applications, review and fund awards, and track participant requirements for UNC School of Medicine and UJMT LAUNCH programs.

Screenshot showing ‘Program Discovery,’ bringing global health programs together in a searchable, easy-to-navigate experience.

“Having one system to manage our many processes, collect data, and generate reports has significantly improved efficiency,” explained Heidi White, MIS, Associate Director of OGHE, whose prior experience with Terra Dotta helped guide its implementation.

“This will save time, strengthen collaboration with our School of Medicine partners, and give us the flexibility to continually improve the user experience based on feedback. We’re excited to expand its use for all medical student, resident, and fellow global health programs in the coming months.”

As a centralized destination for program information, applications, and participant management across both IGHID units, the new Global Health Portal has a user-friendly interface, with the ability to simplify tasks that were previously handled through email or a combination of multiple software applications.

Screenshot showing “Spanish Language and Clinical Placements in Cusco, Peru”

“We are pleased to be able to offer this intuitive and efficient experience for trainees,” said Dzidzai Muyengwa, MPH, Program Manager for the UJMT LAUNCH fellowship training program.

“The portal will help us deliver better support while ensuring compliance, integrated advising tools and enhanced data security.”

Early feedback has been overwhelmingly positive. Medical students, residents, and fellows participating in the soft launch reported a smooth and user-friendly experience, reinforcing the value of a shared platform that streamlines operations while improving access to global health opportunities.

Visit the new Global Health Portal to explore programs offered by both Institute units.

The post The Institute Launches Platform to Streamline Program Administration for Global Health Education and Training appeared first on Institute for Global Health and Infectious Diseases.

(L-R) Zahra Khalaf, PhD (NC A&T); Becky White, MD; Anna Stillwell; Sharon Parker, PhD, MSW (Georgia); and Nikanth “Neil” Calimlim-Khot, MPH (on screen). Not pictured: Jade Nolan, MPH; Alex Blair; and Amanda Lee.

Women involved in the criminal justice system face disproportionately high risk for HIV and often have limited access to biomedical prevention, particularly during the first year after release, when they are navigating unstable housing, employment, transportation, family reunification, and recovery from substance use.

“We already know that PrEP works,” said Dr. White. “The real question is whether we can build a system that actually helps women leaving prison get connected to and stay engaged in HIV prevention care during one of the most difficult times in their lives.” 

Zahra Khalaf, PhD, and Becky White, MD

The feasibility study is designed to understand what it takes in the real world to make HIV prevention accessible to women leaving incarceration. In the initial phase, the team will recruit a small group of women in the state women’s prison who are at risk for HIV and will be released to Guilford County, provide education about HIV, PrEP, and post‑release challenges, and refine recruitment strategies, educational materials, and data collection tools in partnership with participants and the prison system. A subsequent phase will enroll a larger group of women to test an intervention that begins before release and continues afterward, connecting them to community health workers and community health clinics that can provide PrEP. 

The model builds on the  North Carolina Formerly Incarcerated Transition (NC FIT) Program, led by Family Medicine, which has successfully linked people leaving prison to primary care, substance use treatment, and mental health services. Dr. White’s team will test whether this navigation model can be adapted specifically for PrEP and HIV prevention services in already resource‑stretched clinics.  

“Clinics are already working at full capacity,” Dr. White said. “We want to know if this kind of HIV prevention program is truly feasible for women, for the prison system, and for community health centers.” 

Anna Stilwell and Sharon Parker, PhD, MSW

The study is a collaboration between UNC-Chapel Hill,  NC A&T State University, and the University of Georgia, working closely with the North Carolina prison system, the NC FIT Program, and community health centers in Guilford County. Key collaborators include Zahra Khalaf, PhD, associate professor of psychology, NC A&T, specializing in qualitative and sexual health research; and Sharon Parker, PhD, MSW, associate professor of social work at the University of Georgia, with extensive experience in HIV prevention in criminal justice settings. 

For Dr. White, the project grows directly out of years of caring for women with HIV. “Having seen so many women with HIV throughout the years and watching so many women suffer, I am determined—if we can—to prevent suffering, to prevent disease and prolong life,” she said.  

“For decades, I’ve seen the toll HIV takes on women and families,” said Dr. White. “If we can prevent new infections and reduce preventable suffering, we can change the trajectory not only for individual women, but for their children and communities.” 

About the UNC Institute for Global Health and Infectious Diseases
The UNC Institute for Global Health and Infectious Diseases brings together clinicians, scientists, and partners around the world to prevent and treat infectious diseases through innovative research, clinical care, and training. The Institute’s work spans HIV, emerging infections, global health partnerships, and implementation science that translates proven interventions into real‑world impact. 

The post Starting Over, Staying Healthy: Study Will Connect Women Leaving Prison with HIV Prevention  appeared first on Institute for Global Health and Infectious Diseases.

CHAPEL HILL, N.C. — A study led by PhD candidate Lester Gutiérrez, MS, with Luther Bartelt, MD, DTM&H, and Sylvia Becker-Dreps, MD, MPH, senior authors with the Institute for Global Health and Infectious Diseases, found Giardia infections during early childhood are strongly associated with impaired linear growth, particularly when infections occur repeatedly or persist over time. The findings reinforce how this common intestinal parasite may contribute to childhood stunting through mechanisms distinct from traditional inflammatory pathways. 

(L-R) Luther Bartelt, MD, DTM&H; Lester Gutiérrez, MS, PhD, Sylvia Becker-Dreps, MD, MPH, and Filemon Bucardo, PhD

Published in PLOS Neglected Tropical Diseases, the study followed 76 children in León, Nicaragua, from birth through age three, collecting more than 2,300 stool samples alongside detailed growth measurements and biomarker analyses. Nearly 58% of children experienced at least one Giardia infection, with most infections occurring without diarrhea or other symptoms. 

The Findings

The study found that children with Giardia infections had significantly poorer length-for-age growth outcomes than uninfected children. The strongest effects were observed among children with persistent or recurrent infections and among those infected during the first 18 months of life. 

Giardia trophozoites

“This work adds to growing evidence that endemic childhood giardiasis can have meaningful consequences for growth and development, even when infections are asymptomatic,” said Bartelt, associate professor of medicine and senior author of the study. “Understanding the biological pathways involved is critical for developing interventions that can reduce the long-term impact of these infections on child health.” 

Bartelt recognized typical treatments for giardiasis have not been effective in these settings and that exposures are so high that reinfection almost always occurs. “Since new anti-giardia drugs haven’t been identified, we need to examine disease pathways that could lead to new treatments in parallel with ways to limit exposure and more effectively eliminate the parasite,” he said.

Gutiérrez, first author and post-doc in the Nicaraguan Emerging and Endemic Diseases (NEED) Training Program, with the Fogarty International Center, said the findings point to a need for broader attention to Giardia beyond its role in causing gastrointestinal illness. 

“Many of the children we studied showed no obvious symptoms when infected, yet we still observed measurable impacts on growth,” said Gutiérrez. “Our results suggest that repeated exposure to Giardia may affect nutrient absorption and growth signaling pathways in ways that have been underappreciated.”

The research also identified poverty-related household conditions, including earthen floors and inadequate sanitation, as significant risk factors for infection. Geographic analysis revealed concentrated areas of transmission, highlighting opportunities for community-level prevention efforts. 

Importantly, the study confirmed findings from other cohorts that growth deficits were not linked to chronic intestinal inflammation typically associated with environmental enteric dysfunction. Instead, infected children exhibited biomarkers consistent with intestinal epithelial damage and reduced growth signaling, including lower levels of insulin-like growth factor-1 (IGF-1), a hormone essential for childhood growth. 

“These findings help explain why Giardia-associated growth impairment has been so difficult to understand,” Bartelt said. “The parasite appears to affect growth through pathways involving intestinal function and metabolism rather than classic inflammatory responses.” 

Authors include Nadja A. Vielot, Yaoska Reyes, Roberto Herrera, Christian Toval-Ruiz, Javier Mora, Michael B. Arndt, Rebecca Barney, Robert K.M. Choy, Filemón Bucardo and Samuel Vilchez. 

Lester Gutiérrez was featured in this earlier story, recognizing his visits to UNC to use laboratory tools not available in León.

The post Study Links Early Childhood Giardia Infections to Stunted Growth in Nicaraguan Children  appeared first on Institute for Global Health and Infectious Diseases.