On November 10, 2023, ICAP hosted global health experts at its 20th Anniversary Symposium, entitled “Global Health at the Crossroads,” a two-part conversation focused on the HIV response and emerging health threats. (See highlights from ICAP’s 20th anniversary year here.)

The full recording of the symposium can be watched here.

Linda P. Fried, MD, MPH, dean of Columbia University Mailman School of Public Health, welcomed attendees and spoke of ICAP’s ability to handle complex global health threats, including its record of creating innovative health solutions and scaling them to millions of people.

“I am always moved and impressed by ICAP bringing … the highest quality research to support innovative thinking and then infusing that into the building of true partnerships to advance public health in a framework of going from hope to scale,” Fried said.

Linda P. Fried, dean of Columbia University Mailman School of Public Health, provides opening remarks.

The symposium’s first session – titled “Reaching HIV epidemic control and beyond” – began with a keynote address from Jessica Justman, MD, ICAP’s senior technical director; it was followed by a panel discussion moderated by Ambassador John Nkengasong, PhD, U.S. Global AIDS Coordinator and Senior Bureau Official for Global Health Security and Diplomacy.

The panelists included: Angeli Achrekar, PhD, MPH, deputy executive director of the Programme Branch at the Joint United Nations Programme on HIV/AIDS (UNAIDS) and an assistant secretary-general of the United Nations; Rose Nyirenda, PhD, director of HIV, Hepatitis & Sexually Transmitted Infections, Malawi Ministry of Health; Peter Ehrenkranz, MD, MPH, deputy director, HIV, at the Bill & Melinda Gates Foundation; Solange Baptiste, executive director, International Treatment Preparedness Coalition; and Miriam Rabkin, MD, MPH, ICAP’s director of Health System Strategies.

In her keynote address, Justman examined many of the achievements made in confronting the HIV epidemic since 2023, the year of ICAP’s founding. For example, the number of people living with HIV on lifesaving antiretroviral (ARV) treatment is 75 times higher than 20 years ago while the number of people who are newly infected with HIV is four times lower and the number of AIDS-related deaths is around five times lower.

“How was all this achieved?” she said. “I can tell you there was no single magic bullet. Partnerships with ministries and communities were absolutely essential. Commitment at all levels from health care workers, in the clinics all the way up to the top was another essential ingredient.”

She also pointed to evidence-based programs, multiple and more sophisticated forms of surveillance, better forms of medication that are easier to take and have minimal side effects, and other forms of innovation.

Justman summarized existing gaps in the current global HIV response, and proposals for a way forward.

“In order to make progress, we have to understand where the gaps are and that requires continued measurements of how we’re doing,” she said, listing different ways of measuring, including, for example, recent infection surveillance, HIV case surveillance, population surveys, research studies, and modeling. These measurements have revealed that several gaps remain including among children, young people, men, migrants, and “key populations,” such as sex workers and men who have sex with men.  For example, the HIV prevalence among sex workers globally is 2.5 percent, a number that is four times higher than the general populations.

Going forward, Justman emphasized the importance of HIV recency testing, which relies on rapid antibody tests that can determine if a newly diagnosed person living with HIV has recently acquired their infection within the past 12 months.

“There are no other forms of surveillance that will identify the leading edge of the epidemic,” Justman said.

The second session, titled “Meeting Current and Future Global Health Challenges,” was moderated by ICAP founder and global director Wafaa El-Sadr, MD, MPH, MPA. Ambassador Nkengasong provided the keynote address, and the panelists included: Terry McGovern, JD, senior associate dean, CUNY School of Public Health and Health Policy; Jeffrey Shaman, PhD, director, Columbia Climate School; Ashwin Vasan, MD, PhD, commissioner of health, New York City Department of Health and Mental Hygiene; Mesfin Teklu Tessema, MD, senior director and head of the health unit at the International Rescue Committee (IRC); and Ruben Sahabo, MD, ICAP in Eswatini’s country director.

Jeffrey Shaman, director, Columbia Climate School, discusses the myriad health challenges connected to climate change.

The panel tackled a variety of global health challenges, including climate change, antimicrobial resistance (AMR), displacement and forced migration, pandemic preparedness, and the specific challenges faced by adolescent girls and young women in terms of HIV.

In his keynote address, Ambassador Nkengasong indicated that “factors promoting the emergence of infectious disease include an increase in population, especially in Africa, the increased movement of people, increased urbanization, conflicts, and climate change … The issues we have been dealing with have become very complex in recent years.”

Both Justman and Nkengasong spoke of the dramatic impact PEPFAR has had on both global HIV outcomes – 25 million lives have been saved as a result of PEPFAR’s work – as well as broader development outcomes in the countries where it has worked.

“What are some of the lessons that the HIV response can teach us as we think of global health going forward?” Nkengasong said. “One is sustained engagement. We’ve only gotten here because of the last 20 years with Global Fund, PEPFAR, and domestic resources that are determined to engage and stay engaged for 20 years. It wasn’t touch-and-go … we did it consistently for a long period of time.”

The other three main lessons, he continued, include the ability to set and use targets – such as the UNAIDS 95-95-95 targets; the use of data, especially data at the granular level; and steady leadership.

“The systems that we put in place … in public health are very fragile, you have to have continuous engaged leadership,” Nkengasong said.

About ICAP

A major global health organization that has been improving public health in countries around the world for two decades, ICAP works to transform the health of populations through innovation, science, and global collaboration. Based at Columbia Mailman School of Public Health, ICAP has projects in more than 40 countries, working side-by-side with ministries of health and local governmental, non-governmental, academic, and community partners to confront some of the world’s greatest health challenges. Through evidence-informed programs, meaningful research, tailored technical assistance, effective training and education programs, and rigorous surveillance to measure and evaluate the impact of public health interventions, ICAP aims to realize a global vision of healthy people, empowered communities, and thriving societies. Online at icap.columbia.edu

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