The Intersection Between

Health Equity and Pharmacy

JEFFREY M. SAMUEL, PHARM.D.

HEALTH EQUITY FELLOW
FEBRUARY 8, 2022
My Story

2007 2009 2011 2013 2015 2018 2020

• Low-income Neighborhood
• Food Desert
• Unsafe Streets
• Housing Exploitation
• Under Resourced School
• Health Disparities
Fellowship Timeline

2020 2021 2022

Ø Bureau for Global Health

Ø Office of HIV/AIDS
Ø Supply Chain for Health Division
Ø HIV Program Team
Health Equity for
Children Living with HIV (CLHIV)
USAID
 Progress Over Two Decades
2000 2010 2020
PLHIV 25.5 million 31.1 million 37.7 million

• 1.7 million children

living with HIV PLHIV 560,000 7.8 million 27.5 million
accessing
ART
• 150,000 children newly
infected %PLHIV on 2.2% 25.1% 73%
ART
• 1 in 6 pregnant women
living with HIV are not Children 520,000 320,000 150,000
on HIV drugs newly
infected with
HIV
AIDS related 1.5 million 1.3 million 680,000
deaths

Source: UNAIDS Fact Sheet 2021 Data as of December 2020

 The Results and Impact of PEPFAR

Source: https://www.state.gov/results-and-impact-pepfar/ As of September 30, 2020

Goal: To End the AIDS epidemic by 2030
 Challenges with getting kids on
HIV treatment
u Only 54% of Kids living with HIV u Limited options available
had access to treatment u Administration Challenges
- Compared to 74% of adults u Slow development
u Only 40% of Kids living with HIV u Small but complex market
had viral load suppression
u Cost is high $$$
- Compared to 67% of adults
u Pill Burden

- Poor palatability - Should not be broken, - Side effects: Nausea,

- Time-consuming for
- Cold chain requirements crushed, chewed Vomiting, Diarrhea
caregivers
The Outcome
• Without treatment, 50% of all children born with HIV
will die by the age of two

• 120,000 kids died from AIDS-related illness last year

 Increased Efficacy and Less Resistance

Dolutegravir
Recommendations:
• For Adults in 2013
• For pediatrics (first-line)
in 2018
• For pediatrics (second-line)
in 2020

Source: Turkova et al CROI 2021

 Administration Benefits of DTG

pDTG = $4.50
LPVr = $18.25

Source: FDA Label TIVICAY®PD (Dolutegravir) 5 mg, June 2020

 USAID
Projects

1. DTG in National Guidelines

2. Readiness Questionnaire

3. Supply Chain Logistics (supply)

4. Global Orders (demand)

5. DTG Transition Tracker

Global Collaboration
 Collaboration with Stakeholders
US Government
• Centers for Disease Control (CDC)
• The State Department
• Office of the Global AIDS Coordinator
• Food and Drug Administration (FDA)

Global Stakeholders
• Clinton Health Access Initiative (CHAI)
• Antiretroviral Procurement Working Group (APWG)
• World Health Organization (WHO)
• Global Pediatric DTG Task Team
• UNICEF Headquarter and Field Offices
• GHSC-PSM Headquarter and Field Offices
• GHSC-QA / FHI360
Fellowship Timeline

2020 2021 2022

Ø Bureau for Global Health

Ø Office of HIV/AIDS
Ø Supply Chain for Health Division
Ø HIV Program Team
Health Equity through Legislation

Policy

Evaluation Translation to
Clinical Care

Implementation
Health Equity for Under Resourced
Communities
Policy

Evaluation Translation to
Clinical Care

Implementation
Health Equity for People
Experiencing Homelessness
Policy

Evaluation Translation to
Clinical Care

Implementation
Health Equity through Education

Policy

Evaluation Translation to
Clinical Care

Implementation
Fellowship Timeline

2020 2021 2022

Ø Bureau for Global Health

Ø Office of HIV/AIDS
Ø Supply Chain for Health Division
Ø HIV Program Team
Thank You!
Questions?

Jeffrey M. Samuel
samueljm@purdue.edu