Yale Rheumatology Program in Global and Community Health Promotes Collaboration and Addresses Disparities

Rheumatic and musculoskeletal diseases are a leading cause of disability worldwide, according to studies. Yet few global and community health programs address these complex conditions, says Evelyn Hsieh, MD, PhD, associate professor of medicine (rheumatology, allergy and immunology).

To help address this gap in global rheumatologic care, in 2023 Hsieh led the creation of the Yale Rheumatology Program in Global and Community Health, which connects faculty, fellows, and others in the Yale Section of Rheumatology, Allergy and Immunology who are interested in global and community health. The program strives to promote research, capacity building, education, and partnership on issues of priority in the setting of resource disparities.

“I saw the program as a way to add cohesion to the great work being done across the section,” Hsieh said. “Bringing this work together under an organized platform allows people to collaborate and build ideas off of each other.”

The program provides a network for faculty and trainees striving to better understand how diverse geographies, ethnic, genetic, and environmental variability, or health system disparities uniquely influence the epidemiology and outcomes of rheumatologic and musculoskeletal diseases. Hsieh stresses that the principles of equity, sustainability, and innovation underpin the program's various initiatives.

The Yale Rheumatology Program in Global and Community Health offers periodic research-in-progress meetings for those engaged in clinical and translational research. Hsieh points to the work of clinical fellow Mario Felix, MD, as one example. At one of the meetings, Felix spoke about his work on social determinants of health and lupus. Another participant, resident Diego Cabrera, MD, spoke on the musculoskeletal outcomes among women aging with HIV in Peru.

The meetings present opportunities to highlight the global and community health work that is taking place in the section. “It’s important for people to have a way to share their research and also learn more about what others are doing, both locally and globally,” Hsieh said.

In addition, through various global health research training programs, the program hosted scholars from Peru and China in 2023 and plans to host scholars from Uganda and Peru during the 2024–2025 academic year, while sending Yale scholars abroad.

“Through these exchanges, trainees, fellows, and faculty have the opportunity to build relationships, acquire practical skills, and collaborate on projects that are mutually meaningful,” Hsieh said.

Supported by a grant from the International League of Associations for Rheumatology (ILAR), the program offered a rheumatology virtual educational series for Rwandan internal medicine residents in 2023, led by Joshua Bilsborrow, MD, MHS in collaboration with the University of Rwanda College of Medicine and Health Sciences.

Bilsborrow, who had traveled to Rwanda during residency as part of a clinical exchange program, noted the country’s shortage of rheumatologists and resources to effectively treat rheumatic diseases.

In 2024, Bilsborrow and Hsieh collaborated on a second ILAR grant, led by Ugandan rheumatology colleague Mark Kaddumukasa, MD, PhD, at Makerere University College of Health Sciences, to conduct an educational series for Ugandan residents and general practitioners together with others from Yale and Uganda, including Abhijeet Danve, MD, MHS, Trina Pal, MD, MPH, Lillian Tugume, MD, MPH, and Anthony Makhoba, MD.

With a curriculum that included 10 different topics and used a case-based approach, the series, which ended in June, was enthusiastically received. “We had anywhere from 60 to 120 people participate in each of the virtual sessions,” Hsieh said, adding that while participants were mostly from Uganda, a few physicians from Tanzania and Kenya also joined in.

As part of the grant, faculty are currently building a patient registry to help advance understanding of the epidemiology of rheumatic disease in Uganda and the gaps and challenges in treatment.

“The scarcity of rheumatology care and providers in low- and middle-income countries like Rwanda and Uganda presents a significant challenge, as patients often face missed or delayed diagnoses, resulting in inadequate treatment,” Bilsborrow said. “Our educational series aims to help address these gaps by empowering local general medicine physicians with the knowledge and skills necessary to provide basic rheumatology care.”

Hsieh notes that the educational series is one example of how to address disparities and promote equity through a global partnership. “There’s significant investment and engagement from both faculty at Yale and in Uganda,” she said. “Everyone is actively participating as partners to make this happen.”

In addition to the focus on provider training, to help increase patients’ knowledge, Pal led a patient education series in 2023 co-mentored by Hsieh and Kaddumukasa, and in collaboration with Auther Jjunju of the Arthritis Association of Uganda, a patient advocacy group. The series, developed with direct patient input, covered topics such as understanding arthritis, diet and exercise for patients with rheumatic disease, rheumatology medications, and women’s health considerations in rheumatic disease.

“The series had a focus on self-management, with the goal of empowering patients to better understand their rheumatologic condition and recognize the ways in which they can make health behavior choices that can help optimize their disease control and overall well-being,” Hsieh said.

Additional patient-centered programs being led by program faculty include the Yale Lupus Wellness Program, led by Jacinta Renaldi, MSN, APRN.

In collaboration with the West Haven VA Medical Center Home-Based Primary Care Program, David Podell, MD, PhD, instructor of medicine (rheumatology, allergy and immunology) and former chief of medicine at Waterbury Hospital, is developing a rheumatology home visits program, through which homebound veterans can receive needed care and an assessment of their chronic rheumatologic conditions.

The program, which will help veterans who have difficulties seeing providers primarily due to their limited mobility, is anticipated to begin this fall, Podell said, adding that he is excited to have the opportunity to address this need.

The new home visits program is another example of how the Yale Rheumatology Program in Global and Community Health is helping individuals who otherwise would not be able to obtain rheumatologic care.

“Here and around the world, our goal is to work together to bridge the access gap for populations who have significant challenges,” Hsieh said.

For more information, visit the Yale Rheumatology Program in Global and Community Health.

Yale School of Medicine’s Department of Internal Medicine Section of Rheumatology, Allergy and Immunology is dedicated to providing care for patients with rheumatic, allergic and immunologic disorders; educating future generations of thought leaders in the field; and conducting research into fundamental questions of autoimmunity and immunology. To learn more about their work, visit Rheumatology, Allergy & Immunology.