Key Takeaways From Our #FriendsHealthChat With Professor Quarraisha Abdool Karim

From her decades of experience studying HIV, Professor Quarraisha Abdool Karim knows the importance of looking at the whole: all of the factors that affect health outcomes and access to health care at the individual, community, healthcare system and global level. In her conversation with Friends of the Global Fight Against AIDS, TB, and Malaria, Professor Abdool Karim reflected on how this major lesson from the HIV and TB epidemics has enhanced the response to COVID-19 and underlined the benefits of investment in these ongoing epidemics.

COVID-19 has highlighted the gender inequity that leads to the multidimensional social, economic and health disparities faced by adolescent girls and young women. Professor Abdool Karim talked about the progress of technological developments in women-centered biomedical HIV prevention and treatment that have created more options for adolescent girls and young women. As Professor Abdool Karim said, “when you have options, you’re more likely to find the right match for what you need at different points in your life.”

These innovations not only address the intersectional health and socioeconomic issues faced by young women, but they address the needs of other key populations who are vulnerable to HIV infection. Healthcare services often aren’t designed for these populations and aren’t as receptive to their needs. These new technologies offer more user empowerment and are less user-dependent, addressing the issues associated with adherence. As Professor Abdool Karim put it, “The more empowered a user is, the more we can work more efficiently within a system.”

“It is the PEPFAR investments, it is the Global Fund investments and it is the government investments that enabled us to do this [scaled response to COVID-19] with rapidity.  What it teaches us is good investments in public health, good investments in epidemics, whatever the form or shape it takes, better prepares us…Africa shines in terms of a great example of how when you invest in epidemics it bears fruit and returns way beyond that initial and focused investment.”  -Professor Quarraisha Abdool Karim

One service that encapsulates this need to shift away from the provider-dependent services is multi-month drug dispensing for AIDS patients. As Professor Abdool Karim noted, during the COVID-19 pandemic, this program “helped a lot, not just for AIDS patients, but also for people with other chronic conditions.” When AIDS patients and other people with chronic diseases were reluctant to go to health facilities during the lockdown, these programs mitigated disruptions in the continuum of care.

Professor Abdool Karim highlighted the increasing attention the Global Fund and PEPFAR have paid to community monitoring, community ownership and community accountability. Community health workers link the community to primary healthcare and are especially important for engaging vulnerable populations. Global and government investments responding to the HIV and TB epidemics created a huge community health infrastructure and a qualified and experienced workforce with contact tracing capability that the COVID-19 response built on.

Reflecting on the lessons learned from the HIV epidemic, Professor Abdool Karim talked about the role of the Global Fund and PEPFAR in working with the government. “Institutions like the Global Fund, like PEPFAR, build solidarity not just within countries but globally, enabling in an unprecedented way access to the same treatment to everybody.” The system- and provider- dependence of initial HIV treatment encouraged investments in the healthcare delivery system, which has strengthened the ability of this system to respond to all health challenges. Professor Abdool Karim talked about this HIV model that illustrates to government and global organizations the long-term benefits of their investments. As she said, “good investments in public health, good investments in epidemics, whatever the form and shape it takes, better prepare us.”

The pandemic has highlighted the need to better integrate vertical programs into a comprehensive healthcare system, especially as we face future epidemics and pandemics. Professor Abdool Karim stressed that donors and investors need to sustain and enhance their investments made in HIV and TB, especially as we begin to face the economic fallout of the pandemic. “Now is not the time to reverse the gains we’ve made.”

Professor Quarraisha Abdool Karim is the associate scientific director of AIDS Program for Research in South Africa, a professor of clinical epidemiology at Columbia University and the Pro-Vice-Chancellor for African Health at the University of KwaZulu-Natal in South Africa. She also holds a position on the PEPFAR scientific advisory board and is the co-chair of the UNAIDS advisory group to the UNAIDS advisory director. Her interest and the body of her work lie in the HIV epidemic in South Africa, and in particular HIV infection among adolescent girls and young women and strategies to introduce ART in resource-constrained settings. She co-authored a landmark trial that established proof of concept for microbicides.