In August 2020, I became the Health Equity fellow, a fellowship that is jointly offered through Purdue University and the United States Agency for International Development (USAID). Health equity is the “absence of avoidable or remediable differences among groups of people, which can be socially, economically, demographically or geographically” (WHO, 2011). During this fellowship, I will rotate through Washington D.C., Indiana, and Kenya addressing various health equity gaps in each of these sites.
It has been officially eight months since I started the fellowship, moved my family and I to the Washington D.C. area, and began working at USAID. USAID is a leader in international development and humanitarian efforts that save lives, reduce poverty, strengthen democratic governance and help people progress beyond assistance. At USAID, I work in the Bureau for Global Health, in the Office of HIV/AIDS, and within the Division of Supply Chain for Health. The predominate health disparity I am focused on at USAID, is the treatment of children living with HIV (CLHIV) in low- and middle-income countries. Of the 1.8 million CLHIV, less then 55% received antiretrovirals and the viral suppression rates of those that received treatment were unacceptably low.
While at USAID, I have had the privilege to assist in activities to prepare for the introduction of a new generic formulation of dolutegravir, a critical lifesaving medicine for CLHIV, this is superior in many ways to the existing medicines. This product received tentative US FDA approval in November 2020 and has the potential to address several health disparities that exist in this population. I co-authored an article that was published in the Journal of the International AIDS Society that details the promise of pediatric dolutegravir. In order to assess the readiness of a country for pediatric dolutegravir introduction, I designed a two-part questionnaire that was sent to 40 countries. The questionnaire focused on:
- National treatment guideline updates
- Product registration with the National Medicine Regulatory Authority
- Facility level implementation, monitoring, and uptake
- Plan for monitoring of adverse drug events
- Multi-month dispensing for CLHIV
- Stakeholder engagement
- Transition Strategy
As we received submissions of the questionnaire, I organized the data into a dynamic tracker with a heat map to show which countries were more prepared for the upcoming transition. This tracker has helped us understand the gaps in introduction plans in order to determine the appropriate technical assistance that might be warranted. In order to achieve a successful transition, continual communication is occurring with counties to understand the demand and minimize the waste of existing product, while also communicating the global forecast of this product to manufacturers.
This opportunity has allowed me to learn from some of the leading experts in the field and work towards creating policies and programs that will help end the AIDS epidemic. This experience has been extremely rich and rewarding, and I look forward to the next 16 months of this fellowship!
- USAID. (2019, October 04). Who we are. Retrieved February 17, 2021, from https://www.usaid.gov/who-we-are
- WHO. (2011, June 08). Equity. Retrieved February 17, 2021, from https://www.who.int/healthsystems/topics/equity/en/