Taking a Global View: CHAI Doctor Helps Change Global Pediatric HIV/AIDS Care
Dr. Shaffiq Essajee, director of clinical operations and senior advisor in pediatrics for the Clinton HIV/AIDS Initiative (CHAI), characterizes his clinical work before joining CHAI as that of a “regular pediatric infectious disease doc.” But Shaffiq’s career-long commitment to improving the standard of treatment for children living with HIV/AIDS has been anything but “regular.”
In 2005, when Shaffiq first started working with the Clinton Foundation, CHAI had just received funding to explore how its successful program to improve access to antiretroviral drugs for adults in developing countries could be adapted to provide children with these lifesaving treatments.
As part of the exploratory team, Shaffiq knew there was a formidable treatment gap in the developing world. In 2004, one in two children living with HIV in Africa would not live to see the age of two, and 80 percent would die before the age of five. With almost 2 million children estimated to be infected, and the cast majority of these lacking access to treatment, the continued plight of HIV-infected children was in sharp contrast to the progress made in many countries in the treatment of HIV-positive adults.
It is precisely this imbalance of treatment between children and adults – and between children in developed and developing countries – that motivates Shaffiq’s work and that of CHAI’s global pediatric program. As a clinical scientist on the faculty of New York University’s Medical School, Shaffiq spent much of his medical career treating children in the United States and researching the way HIV and the immune system interact. But even before joining the CHAI team, he felt the tug of responsibility to his home in Kenya and a larger global community.
“I got into pediatrics because I have compassion for children [but] I started to wonder, ‘What are the boundaries of my compassion?’” Realizing he didn’t want to stop at treating children in the United States, he explains, “I needed to go beyond that, and treat children globally. It isn’t always possible in practice to reach everyone, but in principle, you need to have an equitable approach to treating children everywhere. The standard of high-quality care found in the U.S. needs to be available around the world.”
In 2001, Shaffiq opened the Family Care Clinic at Coast Province General Hospital in Mombasa, which has served as a model for a successful, locally operated pediatric AIDS care center. This first-hand experience treating patents locally in Kenya has proved invaluable to his work with CHAI to develop larger-scale strategies for governments and health agencies in developing countries to deliver treatment on a national level.
When he started working with CHAI, Shaffiq adjusted his view from treating individual patients to taking a unique large-scale view of global treatment by examining delivery systems for health care for HIV/AIDS patients. But a mission to improve the standard of treatment for patients worldwide is something he shares with CHAI.
Shaffiq explains: “What CHAI does is look at the layers between the drug manufacturer on one end and the child on the other. What we do as an organization is to cut through and peel off layers in order to deliver the service that is needed.”
To do this, Shaffiq works directly with the Ministries of Health and national AIDS programs in the 34 countries in which CHAI’s pediatric AIDS programs operate throughout Africa, Asia, and Latin America and the Caribbean. “Countries face a lot of internal constraints that prevent them from putting their policies in place,” he says. “A lot of what I do is help take those policies, those international recommendations, and turn them into practices that are more practical.”
One of the most essential means of improving access to treatment is cutting the cost of the drugs themselves. By guaranteeing drug manufacturers large-scale purchases of pediatric anti-retroviral drugs by foreign governments, CHAI – working with UNITAID – has been able to cut the costs of these lifesaving drugs by approximately 60 percent.
CHAI also emphasizes the importance of highly skilled and motivated healthcare workers on the ground in countries experiencing an AIDS crisis. CHAI has developed training programs, developed specialized tools to help clinicians dose accurately, deployed clinical mentors to provide training, developed nutritional interventions to support treatment, and recruited local healthcare workers.
This work at the international level realizes big results on the individual treatment level as well. Shaffiq is pleased that he has been able to help the CHAI pediatric program grow from an “embryonic program with modest reach to something that has become transformative in the global pediatric landscape.”
After nearly five years of work, the CHAI global pediatric program is helping to support the treatment of more than 220,000 children outside the United States, two-thirds of the total children receiving treatment in the world. Despite the great success, Shaffiq is focusing on the work that still remains: “The work is far from done, and we have yet to realize some of the extraordinary achievements that prevention of HIV can bring.”
To read more about CHAI’s global pediatric program, download this pdf.
