NORTH CHESTERFIELD, Virginia — Global public health is an area of study, research and practice that improves physical and mental health and well-being while prioritizing health equity worldwide. In 2003, when an estimated 2.4 million people died annually from HIV and AIDS-related diseases in sub-Saharan Africa, ICAP at Columbia University began its journey to make HIV care and treatment accessible to those that had no access to such life-saving treatment. Since then, the organization has expanded to four continents while responding to a wide range of health threats.
The Borgen Project interviewed the founder and director of ICAP, Wafaa El-Sadr, MD, MPH, MPA, on the initiative’s approach and achievements over the past 20 years of implementing global public health projects.
How ICAP Advances Global Public Health
It all starts with a passionate leader. Dr. El-Sadr, who began her career over four decades ago, who is an expert in infectious diseases and public health. As the head of ICAP at Columbia University, she leads projects in more than 30 countries and guides over 2,000 staff members. Under her direction, ICAP has provided HIV testing for 47.6 million people, 11.1 million being pregnant women and has enabled access to HIV treatment for 2.3 million people worldwide.
However, while the organization initially primarily focuses on HIV, ICAP addresses multiple health issues, including tuberculosis, malaria and non-communicable diseases (cancers, cardiovascular diseases and mental illness) while supporting such critical efforts as laboratory strengthening, maternal health and quality improvement. In response to the recent pandemic, ICAP mobilized to address COVID-19, bringing the organization’s experience and expertise to support the global response.
Dr. El-Sadr explained how ICAP’s four-point model – service and programs, research, education and training and impact assessment – leads to ongoing global health impact.
Service and Programs
When ICAP pinpoints a health issue, it provides proactive support for the design and implementation of services and programs to address it. In a single year, for example, ICAP’s innovative work led to 93,510 cervical cancer screenings, 1,050,581 vaccinations for COVID-19, and 123,629 people receiving treatment for HIV.
One project, in particular, demonstrates how ICAP executes its services and programs. In Burundi and Nigeria, ICAP noted that only approximately 31% and 45%, respectively, of children living with HIV, had received treatment during 2020, according to a 2021 impact report. In response, ICAP advocated for multi-month dispensing for younger patients, to provide convenience for the caretakers and the children.
With funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development (USAID), ICAP collaborated with community-based organizations to provide medication refills and optimized treatment regimens for young people while reducing the risk of coronavirus exposure at health facilities.
Situated at the renowned Columbia University, ICAP supports research that aims to improve health services and the delivery of these services while evaluating the efficiency of public health interventions. Dr. El-Sadr labels research as a way to “identify important questions that need to be answered” and “answer those questions.”
For example, ICAP’s study on older New Yorkers revealed that COVID-19 affects mental health differently depending on age, race and gender. Dr. El-Sadr is a strong believer in what she calls “bi-directional learning,” meaning that what we can learn elsewhere around the world can be quite relevant to issues faced in the United States and vice versa. As ICAP responds to COVID-19, findings found domestically can be used to answer questions on COVID-19 and mental health that may arise globally in the future.
Education and Training
ICAP supports training and mentoring programs to empower a new generation of health providers. In a single year, ICAP launched 230 trainings on COVID-19, 1,444 training on HIV/AIDS and trained 15,890 nurses and midwives, according to a 2021 impact report.
In Kenya, ICAP enhanced the knowledge of infectious disease prevention and control in two Kenyan hospitals: Kenyatta University Teaching, Referral & Research Hospital and MP Shah Hospital. Using online training that the U.S. Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO) and the University of Washington Global Health eLearning program developed, ICAP trained health care providers on health care-associated illness, the importance of washing hands, transmission prevention and waste management, according to the same report.
ICAP also provides education to counter HIV stigma and discrimination. “When people are stigmatized, they don’t seek the health services they need,” Dr. El-Sadr claimed. “I think we, over the years, have made it a priority to work with communities, informing them on what HIV is and what it isn’t.” ICAP recognizes that overcoming HIV stigma still has a long way to go, which is why ICAP continues working to promote the facts and support people at risk for or those living with HIV.
In the area of measuring the impact of public health programs, Dr. El-Sadr spotlighted ICAP’s Population-based HIV Impact Assessment (PHIA) Project that PEPFAR funded through the CDC, which conducts representative surveys on the severity of HIV epidemics globally. Household-based and voluntary, PHIA surveys collect data from over 15 countries through interviews and HIV testing.
According to Dr. El-Sadr, the surveys provide information that indicates the status of the HIV epidemic in a particular country, enabling ministries of health to tailor their policies and programs, and guiding UNAIDS – the Joint United Nations Programme on HIV/AIDS – in monitoring a country’s progress towards its 90-90-90 targets, meaning that 90% of that country’s population know of their HIV status, receive HIV treatment, and reach viral suppression.
PHIA surveys provide also provide insight into factors contributing to HIV infections, such as food insecurity and weather changes. “The purpose of these surveys is to measure where we are in terms of the epidemic,” Dr. El-Sadr shared. “That helps guide what we should do next…in terms of investment, the need to mobilize resources, as well as guide countries in knowing where to focus.” Beyond the PHIA surveys, ICAP recognizes that since policies, distributions of resources and services must rest on data, ICAP works around the world to strengthen data and information systems.
A New Year and the Start of a Third Decade for ICAP
When asked what advice she’d give her younger self, Dr. El-Sadr suggested seeking to become a lifelong learner, surrounding oneself with others who share the same passion. ICAP at Columbia University continues its work in the field of global public health aiming for its vision of a world with healthy people, empowered communities and thriving societies.
– Blanly Rodriguez