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  • in reply to: Clinical Health Week 3 Discussion Forum #32559
    Bradley Green
    Participant

    Question #1: From your perspective, what are the largest remaining barriers against worldwide HIV control?
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    The largest barrier to HIV control is funding for testing and treatment. Systems of provider education are likely the 2nd barrier. Looking at low-income countries (with the highest prevalence of HIV) are unable to tackle HIV without outside funding, as testing, visits, and medications pose a significant expense that patients are unable to self-fund in most cases. Looking to higher income countries like the United States, there are well developed systems for treatment with adequate funding from insurance, but we still have a low rate of diagnosis due to failures of the screening systems. Provider education is needed to fill this gap, with universal screening when encountering the healthcare system.
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    Question #2: Why, in your judgment, is pediatric HIV control lagging behind that of adults and what should be undertaken to reverse this status?
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    I’m certain that the answer to this question has many facets, but here’s a few that may contribute. It is exceedingly rare that medications are tested appropriately in newborn patients (as well as pregnant patients), so there will be much more limited data regarding safety of these medications for clinicians to use. Coupled with physicians (or other practitioners) who may not be as comfortable with treating the pediatric population, this will result in not just suboptimal care, but providers avoiding caring for this population altogether due to lack of comfort with these patients. An EID of 10-30% in Central and West Africa shows that it isn’t just treatment that is the issue, but there is no cohesive push towards screening for these patients. As noted in this weeks material, antibody testing is not usable in pediatrics due to maternal antibody presence, so PCR or other antigen testing is required. This testing may be more expensive or require higher level lab facilities for processing compared to POC testing. Fixing this most certainly requires government buy-in. You will need to mandate testing for at risk newborns and provide these tests at low or no cost, and then educate providers on appropriate initiation and maintenance of care for these patients. It will likely not be reasonable to bring all of these children to centers of excellence, so rural providers will be doing much of this care.

    in reply to: Clinical Health Week 2 Discussion Forum #32526
    Bradley Green
    Participant

    Response to Nancy’s post
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    I agree with this perspective on TB spread, and moreover love the mention of reactivation of latent TB, which I had not considered, and which creates an additional avenue of risk among those in poverty. This risk is replicated in the pediatric population in regards to many other conditions that were discussed in last weeks material, including malaria and other diseases. It would be interesting if there was a way to determine if this is why we are seeing COVID hit areas of poverty far more severely than wealthy areas.

    in reply to: Clinical Health Week 2 Discussion Forum #32474
    Bradley Green
    Participant

    Question #1: From your perspective, why are people living in poverty most likely to suffer from TB, and how should this fact influence efforts to control the disease?
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    There are a few reasons why people in poverty are more likely to suffer from TB. First, poverty is associated with living in close quarters and lack of personal space, which increases disease transmission. Second, people in poverty are often unable to afford treatment. If not government or NGO funded, MDT for TB can be unaffordable for those in poverty. Because of these factors, treatment for TB has to be managed on a large scale, with the creation of programs that can treat not just individuals, but entire communities to reduce transmission rates and reduce the level of debility in these populations.

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    Question #2: What, in your opinion, are two interventions that would be most effective against neglected tropical diseases?
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    I believe that neglected tropical diseases are an issue of awareness. The article starts by mentioning that the WHO has a list of 20 NTDs that are under focus. The good news is that this is relatively small number, but the bad news is that there are so many other tropical diseases that it can be difficult to get the focus on these diseases in the face of more prevalent infectious or even other non-infectious health issues. These last few years have given examples of what is possible for disease elimination with appropriate awareness. The last few years of Ebola outbreaks raised its profile to the point that there was high level governmental interest in vaccine development from countries outside of Africa, with concurrent funding, and now the availability of a vaccine. SARS-COV2 has also shown what is possible with enough awareness and financial input, with the rapid development of numerous vaccines at a pace an order of magnitude faster than previous. That said, my first intervention would have to be working to increase awareness, not among health professionals, but among people in government as well as those who may financially donate to the development of programs to treat and prevent these diseases. On a related note, we need to work harder at including drug manufacturers in these project. It doesn’t make sense that a disease like Yaws, which requires a short course of an inexpensive medication, can continue to exist when these medications are cheaply available.

    in reply to: Introduce Yourself Discussion Forum #31472
    Bradley Green
    Participant

    My name is Brad Green

    1) I’m a family medicine physician who just completed residency, currently in a Global Health Fellowship program through FSU in Fort Myers Florida. I have some (largely non-medical) overseas mission experience. I have a few years of EMS experience prior to medical school. Through residency, and currently, I have treated a diverse population of individuals of varying socioeconomic status, including large populations of underserved.

    2) I am looking to increase my knowledge and ability to care for people overseas and in the US in diverse populations, especially those with diseases of poverty. I’m planning to travel overseas immediately after this course to Liberia to do medical work for a few months, and am hopeful this course will help prepare me for that experience.

    3) Longterm, my wife (Bethany, also taking this course) and I plan to go into fulltime missions overseas, but are unsure exactly what that will look like. In the short term (while repaying loans), I will likely stay in academic family medicine.

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