Dr. Jay Osi-Samuels is a Harvard-trained public health expert with a burning passion for driving the radical change required in Africa’s healthcare system. After graduating from medical school at the University of Ibadan, he went on to work at the Lagos State General Hospital. It was at this time he felt he was living below capacity.
He wanted to make a huge impact in society and figured he needed to pivot to actualise that dream. This decision led to his journey to the Harvard School of Public Health, where he was part of the AIDS Prevention Initiative in Nigeria (APIN) team, a body funded by the Bill and Melinda Gates Foundation to curtail the prevalence of HIV/AIDS in the country.
The work done by the APIN team is a huge part of why fewer people are living with HIV/AIDS in Nigeria.
In this interview with Business Elites Africa, Dr. Jay, who is the current Deputy Chief Executive Officer at APIN, elaborated on his journey into public health and how APIN found the right formula to combat HIV prevalence in Nigeria.
What sparked your interest in Public Health?
I think my interest in public health started after my graduation from medical school, during my National Youth Service Corps (NYSC) at the General Hospital in Lagos, Nigeria. I realised that I was utilising less than ten percent of what I spent about seven years of my life studying in medical school. I was treating patients coming down with illnesses that were preventable, like malaria and all. So, it became rapidly boring for me because I was seeing the same thing over and over again.
The situation made me pick interest in the prevention of these common illnesses. So I began to look deeper into public health. I did some research and came to the conclusion that this would be a lot better for me to pursue. That was how I started my journey in public health.
Where did you start from?
I would say I got a lucky break. I applied for a fellowship at Harvard and incidentally, it was a project that had just been awarded by the Bill & Melinda Gates Foundation to fund HIV/AIDS intervention in Nigeria. Part of the package of that grant was the training of personnel within Nigeria as public health experts to be the ones to carry out the implementation of that project. That project was the Aids Prevention Initiative in Nigeria (APIN) Grant by the Harvard School of Public Health. They were looking for two Postdoctoral fellows and five Master of public health candidates from Nigeria, I applied for the Postdoctoral fellowship and I was ones of the lucky ones. That was where my journey in public health began.
My postdoctoral fellowship was on the molecular epidemiology of HIV/AIDS in Nigeria. This involved going to the Harvard school of Public Health, Boston, and getting tutelage in their Kanki laboratory owned by Professor Phyllis Kanki, who was the principal investigator of that project in Nigeria. Since then I never looked back.
What is really the object of a public health drive?
Public health is more or less preventing people from suffering from common illnesses. For instance, if you have malaria, you go to the hospital for treatment but the essence of public health is to implement policies, interventions, and practices that would prevent you from coming down with malaria in the first place.
We look at the causative factors, the epidemiology of malaria, areas of the community that are prone to malaria, and the wholesome assessment of the malaria epidemic. As a public health specialist, you devise strategies to target those areas. So that at the end of the day, if it’s mosquitoes that are causing it, you want to eliminate them. Then in the areas where malaria is prevalent, you want to provide insecticide-treated nets. Then, you need to access the impact – let’s say 100 people were coming down with malaria in a day in that area, you want to bring that to 0 or significantly reduce the number so that doctors that are employed in the hospitals can focus more on complicated illnesses.
What has been the impact of APIN in Nigeria over the years?
Let me give you another example of the impact of public health intervention in preventing diseases. At the time Bill & Melinda Gates Foundation targeted Nigeria for the AIDS intervention program, the prevalence of HIV was approaching 5% and with the study and history of how epidemics evolve, the concern was that if nothing is done, the disease the spread exponentially and that would be devasting considering Nigeria’s population. We have seen a gradual decrease over the years due to the work financed by this grant and so many other people that have come onto the field. The last review that was done shows that the prevalence has really gone down and it’s very visible to all that this intervention over the years have really worked.
Some of the important work we also did was identifying different strains of HIV. A lot was not known about the molecular epidemiology of HIV/AIDS back then. We only knew there is HIV 1 & 2 but there are different strains of HIV that were not known.
All the drugs that were used at that time were built on the candidate prevalent variant in the western world. That was not what was obtained in Africa. Even in Africa, we had different strains. The strain in West Africa was different from the strain in East Africa and South Africa. But with the molecular epidemiology study that we did, we were able to see that there different characteristics of these strains. We found that the strains in South Africa were more virulent and the same thing in East Africa, but the strains in West Africa were less virulent. So due to this, people were dying like chickens in South and East Africa.
So, we threw more light on the strains and showed that we cannot use a one-size fits all approach for the HIV/AIDS fight. We had to localise the viruses and also target interventions and the pharmaceutical companies also modulated their responses based on this study as it relates to treatment. This is why we have seen significant improvement over the years.
What role does the government play in your work?
You cannot underplay the role of government. Number one, before you can even start to disburse the funding coming from these foreign bodies, you must have the buy-in of the government. And the issue we always have in Africa is inadequate funding of the healthcare sector. But with the right engagement, we are seeing improvement.
We are lucky we have a disease like HIV that is well funded, even though the funding is dwindling now, at least in the initial stage the funding was sufficient. We were able to do a lot of advocacy in terms of showing evidence for results, and with that, we were able to get the buy-in of different stakeholders but largely I’d say we can do more with investment in the right places in health. One thing I say to people is that HIV medicine changed healthcare delivery in Africa, especially in Nigeria, in the sense that before you can determine someone has HIV, you need to carry out a test and once you diagnose that person to have HIV, you have to determine if the person is eligible for treatment. Although it is immediate treatment now, that wasn’t the case back then.
HIV is heavily dependent on lab medicine, and our lab infrastructure was very poor at the time. But with the advent of the HIV disease and the interventions that followed, we’ve been able to develop our laboratories in Nigeria because once the patient starts taking drugs, you have to monitor them to make sure the drugs are not toxic, so we have come a long way.
The Bill and Melinda Gates funding also covers the antiretroviral drugs?
Yes. The funding is 100% holistic. Once you’re diagnosed with HIV/AIDS, the drugs are provided for free. It’s only in the last few years that some patients have to pay for their labs but not all of the labs – some of the labs like dermatology and chemistry. But the CD4, the viral load are all free. These are expensive tests. The drugs have also evolved over the years, from multiple doses to just one tablet a day.
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