Leonard Sowah, MBChB, MPH, FACP, AAHIVS
The year was 2005 and Dr. Leonard Sowah was in the second year of his Internal Medicine residency at the John H. Stoger Hospital of Cook County in Illinois. It was here he began providing HIV care as part of weekly clinic. “I grew up in Ghana and first heard about HIV in the early 1980s when almost all infected people died,” Sowah recalls. “In my experience at that time HIV was the newest kid on the block, like we have Covid-19 today, so I must say I was attracted by the novelty and the many unknowns. I still was not sure at residency whilst I had a weekly HIV clinic, I also had an oncology clinic.”
Prior to coming to the U.S., Leonard studied medicine at the University of Ghana in Accra. He did internships in Internal Medicine and Obstetrics and Gynecology, in Accra, Ghana. He ended up doing his Internal Medicine residency in Chicago, Illinois. This was where Leonard’s interest in HIV further developed, with his experience with a weekly HIV clinic in residency. He took his first job after residency because it offered him the option of doing HIV care. Sowah went to work at the federally qualified health center Healthcare for the Homeless in Baltimore, Maryland. From this first position, Leonard has worked in academic and community hospital settings across Maryland. He practiced mostly in urban and suburban settings but also worked two days a week providing HIV care in rural communities on the Eastern Shore of Maryland. His patient populations tended to be older but over time most of his more recent patients were younger gay Black men. Though men tended to be the majority of his patients, he also had quite a few women in his clinical practice.
In 2013, as clinical faculty at the Institute of Human Virology, he worked on a HIV workforce development project funded by CDC in Georgetown, Guyana. He collaborated with University of Guyana physicians to develop a HIV-focused Internal Medicine residency in Georgetown Public Hospital. “This was a major undertaking in a country like Guyana with a medical school but no structured Internal Medicine residency in the country,” Sowah shares, “Though we lost funding and had to leave in 2014, my sources in Guyana tell me our program still survives today.”
As an HIV Specialist physician in Baltimore city, Leonard served on the Ryan White HIV Planning Council and was the Chair at the time the Affordable Care Act was passed. In this role, Leonard and his team strategized to plan ahead on how to reallocate funding since they knew Medicaid expansion could potentially make it difficult to adequately utilize Ryan White fund according to federal rules. “We realized that as primary medical care of most Ryan White clients ended up being taken care of by Medicaid, the funding which had always been allocated at a 75/25 split between Medical Care and Support Services would have a challenge in spending money. Based on input we sought from multiple stakeholders including the late Dr. John Bartlett and now-former CDC Director Dr. Robert Redfield, we applied for a waiver from HRSA which allowed us more flexibility in the use of funds. HRSA ended up sending other EMAs (Eligible Metropolitan Areas) to our team when they were considering such initiatives.”
Today, Sowah works at the Division of AIDS at the National Institute of Allergy and Infectious Diseases (NIAID/NIH). He serves as a clinical science consultant in the development of clinical trials in the area of HIV and viral Hepatitis. His program, the Therapeutic Research Program, has about 40 clinicians and scientists who serve in various roles in HIV research. His specific focus area is in the HIV associated co-infections, mostly viral Hepatitis as well as some studies in the non-infectious complications of HIV. Dr. Sowah shares, “In my current role I do not see patients in the traditional sense. I do, however, have clinical oversight of the participants enrolled in the trials within my portfolio. So, in that regard, my patients span multiple countries and continents.”
Though he is no longer running clinics, Dr. Sowah encourages all HIV care providers, especially those with gay men in their clinic, to include anal pap in their practice. Sowah also advises, “We should learn to appropriately screen for STI like gonorrhea and chlamydia using rectal and oral swabs where appropriate. During my time at University of Maryland we started out by incorporating anal paps in our clinics and referring our abnormal screens to our colleagues in colorectal surgery. Over time, with the help of one of my colleagues, we started doing the high resolution anoscopies ourselves. This was a great addition to our practice at that time. One thing, though, that I do not believe we did well was figuring out how to make that procedure pay for itself. I still encourage providers to consider anal cancer screening as a quality improvement project for your clinics.” Sowah also believes that success in getting patients to adhere to their medications lies in knowing their most important motivations. While there is no one size fits all method for ensuring adherence, overall reduction in treatment complexity helps.
“What I like most about working in the HIV field is the clear change that I have seen in the lives of our patients over the decades. The progress that has been made in HIV treatment and research within the course of my lifetime is so transformative, I am in awe of all that has been done,” Sowah continues, “Another aspect of my work which has brought joy was being able to cure Hepatitis C. The wonder of research made possible for us to cure a person of Hepatitis C after 2-3 month treatment. The joy on the faces of patients when they hear they have been cured was enough to keep me working even in bad situations.”
When asked to consider obstacles facing HIV care providers, Sowah says, “The greatest hurdles have always been the difficulties with coverage. I hate doing prior authorizations but will still do it to get a patient treated. The worst part that also sometimes was the most rewarding on calls with the insurance company medical directors. A well-crafted argument is usually all that is required to get a treatment approved.”
When asked to look the future, Sowah says, “Cabenuva, the combination for long acting carbotegravir and rilpivirine just got approved, so my future is already here. I hope in ten years from now there will be more and easy to use long-acting agents for both HIV and associated infections like Hepatitis B and C. Most patients will see their providers once to twice a year. There hopefully will be a vaccine or other non-user dependent HIV prevention technologies available to patients.” Beyond his professional life, Dr. Sowah is an avid cyclist and has been doing century tides for the past ten years. “Most of my Spring, Summer and Fall weekends are spent either biking or hanging out with my family. I also have a blog that I use to express my views on almost any topic that piques my fancy. My blog topics are, however, mostly health related and in the past four years I wrote quite a few essays on current political situations.” Asked why he became an Academy member, Sowah shares, “I first joined because my first job after residency required me to get credentialed. In those days the Ryan White Grant Office in Baltimore encouraged its grant recipients to have their workers credentialed as HIV Specialists.”
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