Meet Dr. Rakhmanina
Natella Rakhmanina, MD, PhD, AAHIVS, is a Professor of Pediatrics at George Washington University and the Director of the Special Immunology Pediatric HIV Program at Children’s National Health System. Dr. Rakhmanina received her medical degree at People’s Friendship University in Moscow, Russia and obtained her PhD in clinical pharmacology at the Erasmus University in Rotterdam, the Netherlands. She is board certified in pediatric and HIV medicine and has been treating children and adolescents with HIV infections for more than 15 years.
Dr. Rakhmanina focuses her research on the epidemiology and treatment of HIV infection in children and adolescents, and more specifically on the pharmacology and pharmacogenetics of antiretroviral drugs in women, children, and adolescents. The primary goal of this clinical research is to optimize and individualize treatment of HIV infected pediatric patients. She is a national leader in promoting routine HIV screening of adolescents and youth in healthcare settings, particularly in pediatric Emergency Departments. She is a successful clinical researcher and has served as the principal investigator of several NIH and CDC funded studies as well as the DC Department of Health and CDC funded HIV screening programs. Dr. Rakhmanina is currently the leading investigator on a study addressing the acceptance of rapid HIV testing in healthcare settings by parents, caregivers, and adolescents in the Washington, DC, metropolitan area.
Additionally, Dr. Rakhmanina has several long standing international collaborations, including the Clinton Health Access Initiative, the Children’s Investment Fund Foundation, the World Health Organization, and The Global Fund. Since 2014, she has served as a Senior Technical Advisor at the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) where she leads several multinational projects in sub-Saharan Africa and Russia. She has provided mentorship to many healthcare partners in Africa, and will be the primary mentor on two PhD projects in 2019. Dr. Rakhmanina has lectured at multiple international venues, providing her expertise on pediatric and maternal HIV as well as global HIV research, and travels regularly to the African continent for her projects and educational outreach.
In Russia, she was a co-editor of the first national textbook on Pediatric and Maternal HIV. She served as an elected chair of the HIV Drugs Committee at the International Association for Therapeutic Drug Monitoring and Clinical Toxicology and as an elected member in the Pediatric/Adolescent Medicine seat of the Board of Directors for the HIV Medicine Association. Since 2012, she has served as an elected member of the Department of Health and Human Services Panel on the Pediatric Antiretroviral Therapy and Management Guidelines at the Office of AIDS Research Advisory Council at the National Institutes of Health and as an elected member of the Pediatric AIDS Committee at American Academy of Pediatrics. Additionally, Dr. Rakhmanina is a preceptor for the Master’s of Public Health program at the George Washington University (GWU) Milken Institute School of Public Health and is a member of the GWU HIV/AIDS Institute.
Growing up in Russia, Dr. Rakhmanina completed her medical degree in Moscow before coming to the United States for her residency and fellowship. Moving to the Netherlands when her husband began a new job in Amsterdam, Dr. Rakhmanina completed her PhD in clinical pharmacology in Rotterdam. Always interested in learning other languages and experiencing other cultures, as well as having travelled and worked around the world, health for Dr. Rakhmanina was always been global. In addition, as her principal interest in HIV began to emerge, it stretched her patient population and focus to a global scale. “It is an incredibly international disease,” remarks Dr. Rakhmanina, “it never goes away, and unfortunately unlike other illnesses, we don’t have a cure for it.” In addition, she adds, “there is a lack of pediatric HIV care and treatment globally.” This international focus has come home in recent years. Since joining Children’s in 2002, Dr. Rakhmanina has observed a growing population of patients who have immigrated to the US.
Dr. Rakhmanina began her global outreach with a few smaller pediatric and maternal HIV projects in Russia. She was then contacted by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), and offered to collaborate on further projects in Siberia. Travelling back to Russia in 2013, 2014, and 2015, Dr. Rakhmanina “developed a wonderful relationships with providers there,” resulting in their collaboration to develop the first national textbook on pediatric and maternal HIV written in Russian. In 2014, as her relationship with the organization grew, she became a senior technical advisor at EGPAF in addition to her clinical responsibilities at Children’s National. This duality enabled Dr. Rakhmanina to fulfill both her passion for clinical care and her burgeoning interests in global pediatric HIV research.
Currently, Dr. Rakhmanina serves as the senior technical advisor for two principal projects: New Horizons Collaborative, and the Red Carpet Project. New Horizons Collaborative, which is sponsored by a partnership between the EGPAF, Janssen, Johnson & Johnson, and the Partnership for Supply Chain Management (PFSCM), and is currently run in ten different sub-Saharan African countries. Dr. Rakhmanina joined the project in 2014, and describes it as “very, very dear to my heart.” The collaborative is targeted toward bridging the gap between the numbers of pediatric and adult HIV infected individuals on antiretroviral medications and building the infrastructure necessary for increasing education about HIV, sustained treatment capacity, and eventual eradication of the disease.
“(New Horizons) started by distributing (antiretrovirals) to all kids in need, but they didn’t just come with drugs, they came with providers and plans, and lifestyle adjustments,” describes Dr. Rakhmanina. This additional support is crucial to making sure kids take, and keep on taking, their medications in order to keep their viral loads at a minimum. When they don’t, the virus can become resistant to their medications, and necessitate a new group of pills, called second-line treatment. If it happens again, they need another new group, called third-line. By the time kids get to third-line, making sure they stay on their medications is crucial. “This is taking something we are very very good at doing, we have a lot of experience with the third line here in America,” says Dr. Rakhmanina, and “we can take that knowledge abroad (to help these communities).” This collaborative, with Dr. Rakhmanina’s critical guidance, is helping to save the lives of thousands of children both by treating their HIV infections now, and working to prevent the spread and impact of the disease in the future.
The second major project Dr. Rakhmanina leads is the Red Carpet Program. Currently operational only in Kenya, “we work in areas where the HIV prevalence is very high, 26% of women in this area are infected,” describes Dr. Rakhmanina. The project in Kenya is based off a project of the same name, developed by Dr. Rakhmanina in 2016 in Washington, DC. Awarded a grant through the Children’s Research Institute, she was able to “begin conversations with children who were diagnosed with HIV in the last six months and discuss really how this impacts their lives,” significantly informing her understanding of children’s reaction to their diagnosis, as well as how this reaction will shape their attitude toward taking medications and their vision of themselves in the future. Developing the program with this new insight in mind, Dr. Rakhmanina has expanded the program through involving local schools to continue providing support for children outside of the hospital. “We have used it for several years in my clinic, and it has been very, very successful,” she adds.
Taking it to Kenya, to areas of extremely high levels of infection, “was very successful.” “We have 57 schools involved, it is in its 3rd year, and it is very good to be working with the local providers in Kenya and be able to (impact this community),” adds Dr. Rakhmanina. The team is looking to expand the reach of the Red Carpet Program to other sub-Saharan African countries, and is next implementing the project in Tanzania. Dr. Rakhmanina is currently negotiating with local officials and EGPAF to expand the project to three or four additional countries. She hopes the move will be made sometime in 2020.
Most recently, Dr. Rakhmanina was the co-author of a toolkit developed to aid clinical researchers in investigating pediatric and maternal HIV around the world, endorsed by the World Health Organization (WHO). As a member of the Pediatric Antiretroviral Working Group (PAWG) and advisor to the WHO, she is part of a group of specialists “who get together to discuss guidelines and drugs, and we have worked particularly, over the last few years, on how to work with pharmaceutical companies on HIV,” describes Dr. Rakhmanina. “We have to motivate pharmaceutical companies to do this work because it is more expensive and more difficult, and the market is decreasing” as rates of maternal transmission decrease, she adds. “I have been doing a lot of global advocacy in support of developing pediatric HIV drugs,” she says, of which this toolkit is an important part. “The toolkit is really just the beginning of helping people who want to work on clinical trials of pediatric HIV,” she says. It’s the start of an answer for the question,“what can we do to make it easier for (researchers) to develop pediatric HIV drugs?”
In addition to her scientific interest, as she has a doctorate in pharmacology, the need to make these drugs more palatable for children is crucial to making sure they take these life-saving medications. “Over the years, I have seen my children here struggle to take the HIV drugs, they don’t taste good, the kids do not want to take them, and the medications can be a huge task, and we have been advocating for years, please make the drugs easier for kids to take,” describes Dr. Rakhmanina. She is hopeful the toolkit will induce the research necessary to make these advancements.
At the end of the day, all of this work and her incredible domestic and international efforts are for her patients. “I mean truly, my patients here and their families are what drives me everyday,” says Dr. Rakhmanina. She is incredibly passionate about this work, and driven to expand access to life-saving treatment to all children. In the future, here at Children’s National, Dr. Rakhmanina is interested in recruiting younger providers to become interested and engaged in global health. One way to do this is through partnership with a hospital outside the US, where Children’s residents and other medical providers could build a sustainable relationship. “I think you really learn with your feet down on the ground, and I do think from that (added) perspective we have a great start,” she says, adding “we can really learn from them and them from us so I would really like to have a system setup of collaboration and educational exchange.”