Dr. Pragna Patel says “Taking the road less travelled and working for CDC on HIV and NCD has been a worthwhile journey”
As a young girl growing up in New York City, I would often help out at my father’s pediatric clinic in an indigent neighborhood of the Bronx. My father was a caring and compassionate doctor whom I truly admired and wanted emulate by providing a service to society in a meaningful way. At that time, I never imagined that I would follow in his footsteps and become a physician. Taking the road less travelled, joining the US Public Health Service (USPHS) and working with CDC has been a circuitous, but rewarding experience and well worth the journey.
Growing up as a daughter of immigrant parents from India, I always had a desire to return to their native country, and in some way, ‘give back’. Years later while I was a medical student, I spent two months living and working in a village in India and saw things that I never imagined possible. One day, I was standing in the operating room and my only hope in that moment was that the fly buzzing around my head would not land in the open abdomen of the patient on the table. As I stood there wearing blood-stained flip flops and gloves that had been autoclaved for re-use, I began thinking about the conditions in India and the need to improve the country’s medical care system. Seeing a ward full of beds occupied by two people and families providing nursing care for their loved ones was very sobering for me and sparked my interest in public health.
While serving as the attending physician on the adult male ward during my residency at a clinic in the Rift Valley in Kenya, my interest in public health was deepened even further. The average age of my patients was 35 years old and all were dying of two diseases – tuberculosis and HIV. My medication kit consisted of four antibiotics…none of which could treat these men and save their lives. It was during that time that I got my ’aha moment’ and realized the importance of public health practices and policies. Right there and then, I made a conscious decision to become an Epidemic Intelligence Service Officer and work with CDC to improve the health of populations.
Joining the USPHS and CDC and leveraging the PEPFAR Infrastructure
Since joining the USPHS and CDC in 2002, I’ve spent 13 years working on several important public health initiatives including acute HIV screening and characterizing the natural history of HIV in the era of effective therapy, which largely consists of chronic diseases. In 2013, furthering my interest in global health issues,
I accepted a position with CDC’s Global Noncommunicable Diseases (NCD) Unit . While my main focus is hypertension management and control, I use my HIV background considerably and leverage the PEPFAR infrastructure to provide NCD management to HIV-infected patients.</p.
Managing the ‘Silent Killer’
I am no stranger to heart disease as my paternal grandfather died after three hearts attacks at age 56 and my cousin met his demise of a massive heart attack at age 32. I know that their premature deaths were likely preventable and not uncommon. Cardiovascular disease is the number one killer in the world and each of us is touched by it.
Worldwide, by 2025, an estimated 1.56 billion people are expected to have high blood pressure, also referred to as hypertension. Each year, hypertension is estimated to cause 9 million preventable deaths.
Hypertension is commonly referred to as the “silent killer” because it often has no warning signs or symptoms. Many patients being treated for hypertension either do not seek medical attention or adhere to treatment regimens because they don’t have symptoms, and are unaware that they are at risk for cardiovascular disease and can without warning, suffer a stroke or heart attack.
Although hypertension can be life-threatening, the good thing is that it is fairly easy to treat. There are effective, affordable medications that are not difficult to take but in some settings, these medications are not widely available.
Global Standardized Hypertension Treatment Project
In recognition of the need to meet the challenge of improving the control of hypertension worldwide, CDC in collaboration with the Pan American Health Organization (PAHO), launched the Global Standardized Hypertension Treatment Project (the Project). The Project’s goal is to improve hypertension treatment and reduce associated morbidity and mortality by developing and implementing a framework for standardizing the pharmacologic treatment of hypertension globally. The Project proposes a Framework that includes three key elements:
- Using a core set of medications for the treatment and control of hypertension
- Increasing the availability and affordability of these medications
- Strengthening health care delivery systems to improve controlled hypertension at a population level and sustain long-term control for every patient
Value of the Hypertension Toolkit
The main objective of this toolkit is to provide health care providers and clinic administrators with the tools they need to improve blood pressure control among their clinic population. The materials provided include information on how to create registries to manage panels of patients and track indicators, as well as how to use standardized hypertension treatment protocols to improve the treatment and control of hypertension in clinical settings. Also included are educational materials for patients and providers as well as clinical tools for hypertension management and for improving medication adherence. The toolkit is available online at: http://www.cdc.gov/globalhealth/ncd/hypertension-toolkit.htm
These tools have been used successfully for the control of tuberculosis and for hypertension in the United States and can be leveraged for other diseases.
In low- and middle-income countries, a major challenge of controlling hypertension is medication availability and affordability. Therefore, CDC is currently working with partners to improve access to antihypertensive medications. For example, PAHO has included these medications on their list for the PAHO Strategic Fund to improve availability in the Latin American and Caribbean region: http://www.paho.org/hq/index.php?option=com_content&view=category&layout=blog&id=1159&Itemid=986&lang=en. The Barbados Drugs Service has done the same: http://drugservice.health.gov.bb/
While there have been many advances in electronic data collection, the technology necessary for electronic registries is not available in most low- and middle-income countries. CDC and the Lighthouse Trust are working with Baobab (http://baobabhealth.org/) in Malawi to develop hypertension modules to enhance local electronic medical record systems. We hope this enhancement will be widely adopted in Malawi and will facilitate the scale-up of hypertension screening and treatment programs within the country.
CDC’s NCD Unit is also working with partners to stand up hypertension treatment programs by leveraging existing infrastructure, such as enhancing HIV care delivery at PEPFAR-funded sites to include hypertension screening, diagnosis, and treatment in Malawi. In addition, CDC is providing technical assistance to improve quality of care at clinical sites in Barbados, where many of the Project’s components are being implemented. Health care institutions and other public health partners can help disseminate information about the project and engage ministries of health, academic institutions, and private organizations in adopting the components of the Project’s framework into their clinical care delivery sites. Raising awareness about the disease and its associated complications is important as well.
For further information on the Global Standardized Hypertension Treatment Project , please contact Dr. Pragna Patel, at firstname.lastname@example.org