Thus, in 1989 Klausner took off and studied in Zaire in central Africa. At that time, the AIDS epidemic and the profound effect of HIV/AIDS in Africa was just being described. “I met great scientists and epidemiologists from the World Health Organization, Institute of Tropical Medicine in Belgium, National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC),” he recalls. “It opened my eyes and mind to the possibilities in public health and research. Maybe I was a bit grandiose, but I then knew I wanted to take what was great in American medicine, its technology and know-how, and apply that to health problems in the developing world.”
Returning to the U.S., Klausner pursued his medical training among underserved populations and completed his medical residency at New York University-Bellevue Hospital Center in New York City during the early 1990s when AIDS mortality was at its highest, and 10 years after the introduction of HIV into high-risk populations in New York. “With little to do except try to manage the symptoms, provide compassion and hope,” he recalls. “it was frustrating; that frustration became the foundation for my interest in prevention.” Without any treatments for AIDS, the only avenue was to learn how to prevent acquisition and continued spread of HIV, so Klausner believed it best to study other sexually transmitted diseases (STDs), such as syphilis and gonorrhea. The U.S. had brought these infectious diseases under control; perhaps similar lessons could be applied to HIV.
Fast forward to 2010: Jeffrey D. Klausner, MD, MPH, can be found in Africa again, this time the post of chief ofthe HIV and tuberculosis (TB) Care and Treatment Branch, CDC, in South Africa's capitol Pretoria, home of CDC's main office for South Africa which has the world's highest burden of HIV and TB. After leading public-health efforts to prevent STDs and control HIV infection in San Francisco from 1998-2009 where there has been a 34% decline in the number of new HIV infections, Klausner decided it was time to address new challenges. He moved to South Africa with his wife and three children in August 2009 and will stay for at least two years. “We sought an opportunity to raise our children outside of the U.S. for a period and enable them to understand the broader global community and increase their cultural awareness and sensitivity. While San Francisco is diverse, the chance to live in South Africa has really been conscience-raising for us,” he says.
“People here are from all over the world, have lived in multiple countries, and have a great sense of adventure,” Klausner reports. South Africans have been wonderful and are truly welcoming. The scientists are fantastic, smart, and highly productive. South Africa is the second-ranked country in NIH funding after the U.S. The overall optimism in the country is high due to the successful World Cup and a growing economy.”
Klausner's goals for his South African stint are to assist its government in implementing effective HIV and TB programs and, ultimately, through the judicious use of U.S. resources made available by PEPFAR to improve the health of South Africans, where HIV and TB are the main causes of premature death and the No. 1 cause of infant deaths. “We support and enhance programs to prevent the acquisition of HIV infection through antiretroviral prophylaxis in a) the prevention of mother-to-child transmission, b) performing medical male circumcision, and c) identifying persons with HIV and TB through routine screening and provide effective treatment,” he says. “Finally, we are working to create better systems to monitor and evaluate those programs.”
Klausner maintains the most important advance in lab STD testing in the past 20 years was the advent of nucleic-acid amplification tests (NAATs). “By using molecular tests that identify and amplify the nucleic acids of organisms such as Neisseria gonorrhoeae, Chlamydia trachomatis, and other pathogens, we can collect specimens non-invasively (e.g., urine), enable patients to collect their own specimens (e.g., vaginal swabs), and safely and easily transport specimens and obtain results in hours.”
Most sexually transmitted infections are asymptomatic, a key reason why their spread continues. In San Francisco, Klausner pioneered the use of those tests in non-traditional anatomic sites (e.g., throat and rectum) where high rates of asymptomatic infection have been found, and learned they serve as reservoirs of untreated infection and are a source of new infections. San Francisco's public-health lab discovered how to use NAATs to determine antimicrobial resistance. “It is only a matter of time before such molecular applications to measure resistance are commercialized,” Klausner believes.
Klausner plans to publish evaluations of his work in South Africa. “It is critical that we share the success of the South African HIV and TB programs with the world, and teach others about what we have learned. We can enhance what we do in response to the global pandemic by studying how to identify and treat millions of people with HIV infection. In addition, we can learn a great deal about how to control TB, a disease that has plagued humankind for thousands of years. I am hoping that epidemiology and public-health Fellows who come here through the CDC's support of the American Schools of Public Health Global Fellowship program can contribute to that knowledge base and develop skills on how to practice public health in this environment.”
Among his pearls of wisdom for laboratory personnel, Klausner advises following your heart. “It is natural for clinicians and scientists to succumb to the logic of their brain when making important life decisions. I have never regretted any decision when I have allowed my heart to inform me.”
Karen Lynn, is a freelance medical writer.
