Office of Global Health Hosts 12th Annual Global Health Day

On Thursday, March 16, 2023, the Department of Internal Medicine’s Office of Global Health (OGH) sponsored its 12^th annual Global Health Day on the theme of “Health and Humanitarian Crises.” The day itself included a Medical Grand Rounds presentation by Frederick Altice, MD, MA, professor of medicine (infectious diseases), Yale School of Medicine (YSM), and of epidemiology (microbial diseases) at Yale School of Public Health, “Disruptions in HIV Prevention Delivery in Ukraine During Covid-19 and the War” and a noontime panel discussion, “Yale Faculty Working in Humanitarian Settings.” Earlier in the week, OGH held several related noontime events.

“Global Health Day has been a summit over the course of the year in the School of Medicine to focus on global health and global health-related work that's occurring throughout the school and throughout the department,” said Sheela Shenoi, MD, MPH, associate director of OGH and associate professor of medicine (infectious diseases). The first Global Health Day took place in 2011, and it has continued each year except 2020, when the event was canceled due to Covid-19. It always includes an invited speaker from YSM or elsewhere to present at Medical Grand Rounds and incorporates other presentations highlighting global health faculty from across the university. In 2013, the event expanded to include an annual poster session, in which students, trainees, faculty, and staff from the Yale health professions schools share global health scholarship, most of which has previously been selected for presentation at regional, national, and international conferences. In 2019, Global Health Day expanded from a single day to four, and in 2021, it migrated to Zoom. This year, all events took place on Zoom, with the exception of the hybrid Medical Grand Rounds event.

According to OGH Director Tracy Rabin, MD, SM, associate professor of medicine (general medicine), YSM, and clinical professor of nursing, Yale School of Nursing, the mission of OGH is “to confront the disparities in global health through research, education and health services in partnership with institutions serving resource-limited communities around the world.” OGH works domestically and internationally with partner institutions, emphasizing health equity in these collaborations via bidirectional exchange, and supporting research and educational programs for students, trainees, and faculty with a focus on building capacity for improved clinical care and education. The office runs the Yale/Stanford Global Health Scholars Program, through which Yale and Stanford residents in their last year of training engage in clinical rotations at one of the program’s partner institutions in both international (Rwanda, South Africa, Uganda) and domestic (rural Tennessee or Arizona, the latter through the U.S. Indian Health Service) settings. Physicians and nurses from the international partner institutions also visit Yale for training and support. Rabin and Shenoi also run the Global Health & Equity Distinction Pathway (GHEDP), an extracurricular opportunity for internal medicine residents to develop additional skills focused on understanding and addressing health disparities and serving as advocates for patient/population health both domestically and abroad. And of course, the office sponsors the annual Global Health Day.

Global Health Day 2023 started with Professor Altice’s Medical Grand Rounds presentation about his nearly two decades of implementation science research on adoption and scale-up of evidence-based HIV prevention and treatment in Ukraine. Much of that work has focused on the interrelationship between infectious diseases and opioid use disorder, Altice said, since effective treatment of opioid use disorder reduces the spread of HIV (and Hepatitis C) among people who inject drugs, the key population affected by HIV in Ukraine. Since 2004, Altice has worked with collaborators in Ukraine—including the Alliance for Public Health and the Ukrainian Institute on Public Health Policy—to collaborate with Ukrainian experts to provide effective treatments for opioid use disorder. These treatments, called opioid agonist therapies (OAT), work by reducing injection of opioids and for those with HIV, to increase their engagement in HIV care. Throughout the Covid-19 pandemic, the war in Ukraine, and other events that could disrupt the implementation of healthcare strategies, the scale-up of OAT was navigated using effective implementation strategies without major disruption, Altice said. Instead, the number of people who began treatment on OAT steadily increased, thanks in large part to increasing transition to take-home dosing. Letting patients take OAT at home, rather than in a hospital or doctor’s office, allowed clinicians to spend less time supervising patients daily and instead allowed them to focus more time finding new patients and stabilizing others, Altice said. Alongside the story of this success, Altice shared the implementation strategies he and his collaborators used to make it happen, such as the NIATx (Network for the Improvement of Addiction Treatment) model and the i-PARiHS (Integrated Promoting Action on Research in Health Service) implementation framework.

Altice’s scientific research about the intersection of HIV and opioid use disorder is fascinating and important, Shenoi said. “And another lesson is how to work with partners around the world in an equitable, scientific way,” she added. “I think he was able to show and highlight that these kinds of robust equitable relationships can be incredibly successful.”

During Thursday’s noontime panel discussion, “Yale Faculty Working in Humanitarian Settings,” Pooja Agrawal, MD, MPH, FACEP, associate professor of emergency medicine and director of Global Health Education, discussed refugee mental and physical health internationally and in New Haven; Danielle Poole, ScD, MPH, associate research scientist at YSPH, described the use of data analysis to detect war crimes; Kaveh Khoshnood, PhD, MPH, associate professor of epidemiology (microbial diseases) at YSPH, presented work that the Humanitarian Research Lab has done to document war crimes; and Julia Rozanova, PhD, associate research scientist in medicine (infectious diseases), presented collaborative research on aging and HIV in Ukraine and how that work has been influenced by the ongoing conflict with Russia.

Global Health Day events that took place earlier in the week reflected the multifaceted work of OGH. On Monday, March 13, Yale trainees and recent graduates shared their diverse global health experiences in a panel discussion. Sam Choi, MD (GHEDP ’21), presented his work on homelessness in New Haven, Tim DeVita, MD (GHEDP ’23), discussed his experience working with UNICEF as part of the Leadership in Global Health Fellowship offered by the Yale Institute for Global Health, and Amed Logrono, MD (GHEDP ’20), instructor (general medicine), YSM, discussed the two-year Global Health Medical Education & Capacity Building Fellowship that he completed through OGH in 2022. On Tuesday, March 14, eight trainees, including medical, physician associate, PhD, and MPH students, gave Powerpoint presentations about their global health-related work and competed for two awards. This year, Anne Havlik, MPH, won the Rastegar Global Health Medical Education & Capacity Building Award for her presentation, “Availability of resources for diabetes care in Samoa.” Kenneth Gunasekera, MD, PhD, won the Friedland Global Health Research Award for his presentation, “Development and validation of treatment-decision algorithms for children evaluated for pulmonary tuberculosis: an individual participant data meta-analysis.” A virtual poster session took place during the same time slot. “Our goal here was to give a sense of the kinds of scholarly work that are being done across campus particularly highlighting the institution’s trainees,” Shenoi said. On Wednesday, March 15, Yao-Chieh “Jack” Cheng, MD (GHEDP ’23), presented about his experiences as a Global Health Scholar in Rwanda. OGH staffer Laura Crawford, MPH, is instrumental annually in the day’s success.

The Covid-19 pandemic posed challenges for OGH, and some presentations reflected that. Global Health Scholars rotations during the 2020-21 academic year were canceled, and doctors from that program’s partner institutions overseas had to cancel their reciprocal visits Yale. Logrono, who presented during the March 13 panel discussion, had planned to spend six months of his Global Health Medical Education & Capacity Building Fellowship in Colombia but he had to cancel that trip and, due to the pandemic, changed the focus of his fellowship to concentrate on global health issues in the New Haven area.

But this was only one of the ways that OGH was able to “get creative and innovate” to continue their work during the pandemic, Shenoi said. For example, hematologists and pulmonologists in Uganda and infectious disease doctors in Rwanda were able to Zoom into weekly conferences at Yale. The office also created a local global health elective for trainees, Shenoi said, leveraging global health frameworks and relationships with partner organizations in New Haven to provide learning opportunities for GHEDP residents and support to the partners. As Shenoi and Rabin both emphasize, “global health is local health” - a maxim that continues to guide the activities of OGH as they look toward the future.

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