1 / 60

Responding to a Call to Action: The Pediatric AIDS Corps 2006-2011

Responding to a Call to Action: The Pediatric AIDS Corps 2006-2011. Gordon E. Schutze, M.D. Professor of Pediatrics Martin I. Lorin, M.D., Endowed Chair Vice Chairman, Department of Pediatrics Vice President, Baylor International Pediatric AIDS Initiative. Objectives.

joie
Download Presentation

Responding to a Call to Action: The Pediatric AIDS Corps 2006-2011

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Responding to a Call to Action: The Pediatric AIDS Corps 2006-2011 Gordon E. Schutze, M.D. Professor of Pediatrics Martin I. Lorin, M.D., Endowed Chair Vice Chairman, Department of Pediatrics Vice President, Baylor International Pediatric AIDS Initiative

  2. Objectives At the conclusion of this talk the participant should be able to: • Discuss the impact of HIV/AIDS in Sub-Saharan Africa • Describe the Pediatric AIDS Corps (PAC) program • Recall items that the PAC program has impacted • Discuss the benefits of a global health corps

  3. HIV/AIDS: The Global Picture • 35.3 million people living with HIV in 2012 25 million (71%) live in Sub-Saharan Africa 3.3 (2.9) million are children < 15 years of age • 2.3 million new infections in 2012 1.6 million (70%) from Sub-Saharan Africa 260,000 (230,000) in children < 15 years of age • 1.6 million deaths due to HIV in 2011 1.2 million (75%) from Sub-Saharan Africa 210,000 (190,000) deaths in children < 15 years of age UNAIDS: 2013 2009 UNAIDS Epidemic Update

  4. Children Living with HIV in Africa, 2010 UNAIDS: Epidemic Update, 2011

  5. Children and Antiretroviral Therapy

  6. UNAIDS World AIDS Day Report 2011

  7. HIV Prevalence Age GroupsSwaziland, 2006

  8. Antenatal Clinic HIV Prevalence Swaziland 1992-2010 % HIV Positive Year

  9. Let’s Compare *As of 12/2008 # HIV positive cases 12/2010 plus AIDS patients 12/2009, age < 13 years Cumulative number of Pediatric AIDS cases 12/2010 is 133

  10. Full-timed salaried professionals working side-by-side with local colleagues on the ground Placement based upon health workforce needs One year commitment with $35,000 salary • Loan repayment plan ($25,000/year served) • Twinning: physicians from US institutions to provide clinical care and educate local staff short term • Clearinghouse about groups that mobilize health care professionals

  11. Loan repayment in return for extended service Twinning Stipends • Federally funded corps of health care professionals • Public health as well as clinical skills • Working in collaboration with local governments, blended concept between Peace Corps and National Health Service Corps JAMA 2007;297: 744-746

  12. Could be available for disaster work • International Health Service Corps to train and fund both US and local providers to work, teach, learn, and enhance the health care workforce and infrastructure in low income countries • Loan repayment • Physicians, nurses, physical therapists, health technology and biomedical engineering N Engl J Med 2010;363: 1199-1201

  13. Provide training and build local health care capacity Loan repayment (up to 40,000 per year of service) paid by Baylor College of Medicine Housing allowance and travel payments made by Bristol-Myers Squibb Secure the Future Foundation • Announced June 27, 2005 • Pediatrics and Family Medicine physicians • Minimum 1-year assignment to one of the BIPAI sites • Training in the treatment of HIV/AIDS and tropical diseases at BCM prior to travel Pediatrics 2006;117: 1388-1393

  14. Goals of the Pediatric AIDS Corps

  15. Demographics Of The 128 Pediatric AIDS Corps Physicians#, 2006-2011 #MD (121), DO (5), MBChB (1), MBBS (1)

  16. Demographics Of The 128 Pediatric AIDS Corps Physicians, 2006-2011 *Infectious diseases (6), hematology-oncology (2), cardiology (2) . One physician worked in Botswana for one year, left and completed a Heme/Onc fellowship and returned to Malawi in 2010

  17. Location of Medical Schools of the128 Pediatric AIDS Corps Physicians, 2006-2011

  18. Residency Training Of The 128 Pediatric AIDS Corps Physicians, 2006-2011

  19. Financial Support of the Pediatric AIDS Corps Program, 2006-2011 • BMS Secure the Future supplied $22.5 million to support training, salary, travel, and living expenses of the PAC program • 87 (68%) came into the program with $10,262,426.31 in school loans (mean: 117,958.92, range: $31,326.17-$228,007.35) • Completely paid off 26 (30%) student loans of PAC docs while in the program ($6,057,518 in loan repayment from BCM) • Median duration of stay in Africa = 22.7 months (range: 8.83-59.5 months)

  20. Countries Where PAC Physicians Worked for > 1 Month, 2006-2011 *21 physicians worked in more than one country

  21. Pediatric AIDS Corps Evaluation • A 21 question survey was developed and used in 2011 to query all PAC doctors about their experiences in the program • A link to this survey was sent to each PAC doctor on four occasions over a two month period. • The survey contained questions concerning current occupation, location(s) of assignment, how the experience affected their career and ongoing career choices, problems encountered with illness or injury, activities participated in other than patient care, and experiences and challenges. • Participants of the survey were not required to provide an answer to every question on the survey.

  22. PAC Survey

  23. Survey Results – Experience Results

  24. Survey Results – Non-Clinical Activities • The most rewarding experiences were identified as patient care (73%) and program development (15%) • The most difficult experiences identified were that of the amount of death that the physicians saw on a daily basis (27%), the difficulty in accepting the limitations of the local health care system (24%), and managerial decisions made at the local clinics (21%). • The most important accomplishments identified by PAC physicians were in the category of infrastructure building (33%) and education (31%).

  25. Survey Results – Non-Clinical Activities

  26. Survey Results – Health and Safety Events * Data based on the 115 physicians known to be TST negative upon entry into the program

  27. Survey – Health Results

  28. Survey Results - Experiences

  29. Number of Patients at 4 COE’s: 2006-2011

  30. Impact of Clinical Care • As of June 2011, overall mortality rate (3109 deaths) among patients treated in the BIPAI COE’s since inception was 3.35/100-patient years (Health Affairs 2012;31:1636-1642) • Kenya data from August 2004-November 2008: 8.4 deaths/100-patient years • PACTG trials 219/219C: 1.47/100-patient years from 1993-2006 with a decrease to 0.5-0.8/100-patient years in the period of antiretroviral therapy • 14.6% (6929 patients) have been lost to follow-up as of June 2011 (Health Affairs 2012;31:1636-1642)

  31. Impact of Clinical Care • Retrospective cohort review of patients < 12 years of age in Lesotho, Malawi, Swaziland between 2004-2009 • 104 deaths for an overall mortality rate of 2.25/100-patient years • Increased mortality rate associated with young age (0-36 months) and WHO stage IV • 9% loss to follow-up Pediatrics 2012;130:e591-599

  32. Impact on Education By June 2011 more than 700 health care professionals per month were attending lectures on HIV/AIDS at the COE’s or primary health centers More than 500 professionals per quarter were spending, on average, at least one week at a COE to work under supervision 142 outreach sites had been established for clinical mentoring (visits 1-4 times per month) and by June 2011, 52 (36%) of these sites had graduated to be fully independent Health Affairs 2012;31:1636-1642

  33. Impact on Capacity • All staff of the COE’s is local except physician staff where needed • Uganda has been staffed with physicians from Uganda since the PAC inception • Four of the centers (Botswana, Lesotho, Malawi, Swaziland) required PAC physician staffing in 2006 • June 2011, only Malawi and Swaziland could not supply physician staffing for the COE

  34. Unforeseen Benefits Assistance to MOH on Global Fund applications Assistance to MOH on national guidelines and policy development for pediatric HIV prevention and care/treatment Assistance to MOH on national training programs Creation of local ethics committees and IRB’s Community volunteerism and program development Operational research (106 studies with 34 publications)

  35. Changes Since July 2011 • Name changed from the Pediatric AIDS Corps to the Texas Children’s Global Health Corps • Expansion of clinical mission to other non-HIV diseases • 39 physicians have joined since July 2011. One returned after a Heme-Onc fellowship and one was from Botswana and returned to Botswana • Also have included OB/GYN and Surgery

More Related