New York City & Los Angeles, USA
[Closing date: 21 December 2015]
U.S. Chagas Treatment Access Project:
A joint initiative of DNDi North America and MSF USA to support scale up of Chagas diagnosis and treatment in the U.S.
Chagas disease is a parasitic disease that affects more than 8 million people around the world, the majority of whom live in Latin America. More than 10,000 deaths are estimated to occur annually from the disease worldwide, although these numbers could be underestimated due to under-reporting. Chagas is the leading parasitic killer in the Americas and it causes the highest disease burden of any parasitic disease in the region. Global migration has resulted in the worldwide spread of infected individuals. The parasite, Trypanosoma cruzi (T. cruzi), is carried by a triatomine, also known as the “kissing bug.”
Once known to be a disease only of South and Central America, Chagas is also endemic in some areas of the United States, most notably in the southern part of the country. The U.S. Centers for Disease Control and Prevention (CDC) estimates that 300,000 people in the U.S. are infected with Chagas disease, although little is known about the actual disease prevalence in the U.S. and other estimates point to much higher figures of approximately 1 million individuals affected. An estimated 40,000 pregnant North American women may be infected with T. cruzi at any given time, resulting in 2,000 congenital cases through mother-to-child transmission.
Studies have shown high rates of kissing bugs infected with the T. cruzi parasite in areas of Texas, Arizona, New Mexico, and other regions in the U.S. Autochthonous cases have been increasingly reported in the U.S. and more attention has been put towards the disease, although this has unfortunately not translated into improved access to treatment in the country.
The majority of patients who have received treatment are in Los Angeles. Under the direction of Dr. Sheba Meymandi, Olive View-University of California (UCLA) Medical Center operates the nation’s only Chagas Disease Center of Excellence, conducting research, outreach, screenings, and treatment of Chagas.
The Olive View team started a community-based approach through outreach activities in predominantly Latino areas of Los Angeles County in 2008 and to date has tested over 6,000 individuals with an overall Chagas prevalence rate of approximately 1%. The prevalence of Chagas among patients with heart failure at Olive View was found to be approximately10%, which clearly demonstrates the high burden of the disease in this community.
In the last several years, Olive View has published several papers aiming to demonstrate the relevance of Chagas as a major public health problem in the southern California region and in the U.S. more generally. However, much more needs to be done with the existing data, clinical experience, and model of care at Olive View; this experience could be strategically documented, published, and used to influence Chagas treatment policy in the U.S. and could support a dramatic scale up of diagnosis and treatment for the vulnerable – and often undocumented and under- or uninsured – populations affected by the disease.
At present, neither benznidazole nor nifurtimox, the only two treatments available to treat Chagas, are registered in the U.S., and so can only be accessed through a clinical trial protocol with the CDC, which makes the already difficult process of accessing treatment even more long and complex.
There are several other small scale Chagas treatment and research initiatives in the U.S., where other “pockets” of high prevalence can be found, for example in southern Texas, northern Virginia, and other areas. However, little has been achieved so far in terms of patient care due to a variety of factors affecting Chagas treatment access (health-seeking behavior of affected population, ability of clinicians to recognize signs and symptoms, availability of treatment, etc.).
2. Objectives of the Project
The U.S. Chagas Treatment Access Project, a joint initiative of the Drugs for Neglected Diseases initiative (DNDi) North America, and Doctors Without Borders/Médecins Sans Frontières (MSF) USA, will aim to:
- Identify and address barriers to access diagnosis and treatment for Chagas patients in the U.S.; and
- Explore the feasibility of dramatically scaling up diagnosis and treatment for Chagas patients by supporting existing treatment providers to document and expand their programs, starting with the Chagas Disease Center of Excellence at Olive View-UCLA Medical Center as the pilot site.
It is the U.S. component of a larger Chagas treatment access project being driven by DNDi (Latin America office), as the “operational” arm of the Global Chagas Disease Coalition, which aims to catalyze new initiatives to achieve the goal of Chagas treatment scale up. Pilot projects are being rolled out in selected countries with diverse epidemiological profiles, including Colombia, Mexico, the Gran Chaco region, and the U.S.
3. U.S.-based Epidemiologist Position
Position Background and Objectives
As part of the initial exploratory strategy to better understand the situation of Chagas in the U.S., the Epidemiologist will provide support to the selected U.S.-based partners (initially, Olive View-UCLA Medical Center) in the review and documentation of routinely collected data, as well as the documentation and expansion of the Chagas Disease Center of Excellence “model of care.” This work is expected to generate relevant baseline information, clinical outcomes, and additional evidence that will demonstrate the best practices of the Center of Excellence. In addition to documenting and assisting with the expansion of the program at Olive View, this work will aim to encourage replication in other areas of the country and ultimately to influence policy change in the U.S. regarding Chagas treatment. This project and the contributions of this position will be aligned with DNDi, MSF, and Chagas Coalition goals, and will be a direct support to the Olive View Center of Excellence.
- Support the development of a publishable paper documenting the key barriers to access to treatment in the U.S.;
- Review, analyze and evaluate key operational issues and components of the model(s) selected (starting with the Chagas Disease Center of Excellence at the Olive View-UCLA Medical Center);
- Provide epidemiological analysis of Chagas-related information and data;
- Support the expansion of the Olive View program into 3 other hospitals and 19 ambulatory centers, thereby formalizing the model of care;
- Participate in and provide inputs for the definition of the most pertinent papers on Chagas that can be generated with available information collected from the program(s);
- Evaluate the significance of research results and support the definition of appropriate actions to ensure that proper emphasis is given to critical issues that support scaling up efforts;
- Provide support to operational research through (co-)writing of peer reviewed articles aimed at increasing awareness about Chagas disease and Chagas treatment access gaps in the U.S., documenting clinical outcomes of existing programs, influencing relevant policies in the U.S. related to Chagas treatment access, and enabling dramatic scale up of diagnosis and treatment in the U.S.
- Minimum of five years professional experience as an epidemiologist working in public health settings;
- Education: Masters in Public Health or equivalent.
- Language: Fluent written and spoken English and Spanish required.
- Deep understanding of and commitment to global public health, medical innovation, scientific research, and access to medicines issues;
- Experience with Chagas disease a plus;
- Experience working internationally with a non-governmental organization or other non-profit organization preferred (ideally MSF or DNDi);
- Excellent written and verbal communications skills and ability to work effectively in a partnership/network dynamic;
- Independence, initiative, good judgment, energetic, strong interpersonal skills
- Start date: February 2016
- 6-month fixed-term contract with the possibility of renewal beyond the initial term of employment; full-time; based in New York City and Los Angeles
- Competitive compensation, commensurate with experience
- Some travel required (between East and West Coast of the US, possibly to Latin America)
- This is a shared position between MSF and DNDi to support the Chagas Disease Center of Excellence of the Olive View-UCLA Medical Center, therefore management and reporting will be shared between these three organizations
To apply, please email cover letter and CV/resume to:
Drugs for Neglected Diseases initiative, North America
Attn: Chagas Epidemiologist
Deadline for applications: December 21, 2015