Dr. Refiloe Masekela, a paediatric pulmonologist based in Durban, South Africa, has dedicated her career to addressing childhood lung disease in resource-limited settings, drawing from early experiences during South Africa’s HIV epidemic to build sustainable systems for care access.
Her operate reflects a broader effort to strengthen paediatric respiratory health across Africa, where conditions like asthma, tuberculosis, and HIV-related lung complications remain leading causes of morbidity and mortality in children. Masekela’s approach combines clinical service, research, and health system advocacy to close gaps in diagnosis, and treatment.
In the early 2000s, while completing her paediatric training at the University of Pretoria, Masekela witnessed firsthand the impact of limited antiretroviral access on children living with HIV. “In the 2000s, when the AIDS pandemic hit South Africa, we were seeing a lot of children dying from HIV. That was just before antiretroviral treatment had become fully accessible for people in the state sector,” she has recalled, noting how preventable deaths underscored the urgency of equitable healthcare delivery.
Today, as Dean of the School of Medicine at the University of KwaZulu-Natal and a faculty member at the Africa Health Research Institute (AHRI), Masekela leads initiatives aimed at improving lung health outcomes for children through early detection, community engagement, and policy influence.
Her contributions have been recognized internationally, including receiving the American Thoracic Society’s World Lung Health Award in 2023—an honor that highlights her impact on paediatric pulmonology and global health equity. The award cited her leadership in advancing clinical care, training the next generation of African healthcare workers, and generating evidence to inform public health strategies.
Building Clinical and Research Capacity in Durban
Through her role at AHRI, Masekela has helped establish integrated clinical-research programs focused on childhood lung diseases prevalent in southern Africa. These include studies on HIV-associated lung disease, post-tuberculosis lung impairment, and asthma in urban and rural populations.
One key initiative involves longitudinal cohorts that track respiratory health from infancy through adolescence, allowing researchers to identify early biomarkers of disease and evaluate interventions. Such work is critical in regions where spirometry and imaging tools remain scarce, and where symptoms like chronic cough are often under-investigated.
By embedding research within public healthcare facilities, her team ensures that findings are directly applicable to real-world constraints—such as staffing shortages, supply chain limitations, and seasonal variations in disease burden.
This model has informed national guidelines on paediatric TB management and contributed to WHO discussions on integrating lung health into HIV care programs.
Training the Next Generation of African Clinicians
As Dean of the School of Medicine at the University of KwaZulu-Natal, Masekela oversees academic programs that train hundreds of medical students annually. She has advocated for curricula that emphasize social determinants of health, clinical reasoning in low-resource contexts, and early exposure to public health practice.
Under her leadership, the school has expanded partnerships with rural clinics and district hospitals, increasing opportunities for students to gain hands-on experience in managing childhood illnesses outside tertiary centers.
She also supports mentorship programs specifically designed to encourage young clinicians—particularly women and those from underrepresented backgrounds—to pursue specialties like pulmonology, where African representation remains disproportionately low globally.
These efforts align with broader African Union goals to strengthen health workforce capacity and retain talent within the continent.
Advocating for Policy Change and Equitable Access
Beyond clinical and academic work, Masekela engages in health policy advocacy aimed at reducing barriers to essential medicines and diagnostic tools. She has contributed to national dialogues on expanding access to child-friendly formulations of antibiotics, bronchodilators, and antiretrovirals.
Her research has highlighted how stockouts and centralized distribution systems disproportionately affect rural clinics, where a single missed delivery can interrupt treatment for dozens of children. By presenting data to provincial health departments, she has helped push for more resilient supply chains and decentralized drug dispensing models.
She also emphasizes the importance of community health workers in identifying respiratory symptoms early—a strategy proven effective in HIV and TB programs that could be adapted for asthma and pneumonia screening.
Such approaches, she argues, are not only clinically sound but cost-effective, reducing hospitalizations and long-term disability when implemented at scale.
Addressing the Intersection of HIV and Lung Health
A significant portion of Masekela’s research focuses on the pulmonary consequences of HIV in children, even among those receiving antiretroviral therapy. While treatment has dramatically reduced mortality, studies show that HIV-exposed children remain at higher risk for chronic lung disease, impaired lung growth, and recurrent infections.
Her team at AHRI has investigated whether early initiation of ART, nutritional support, or prophylactic antibiotics can mitigate these risks. Findings suggest that while ART preserves immune function, lung healing may require additional interventions beyond viral suppression.
This nuanced understanding has influenced calls for lifelong pulmonary monitoring in perinatally HIV-infected individuals—a concept gaining traction in global pediatric HIV care guidelines.
By framing lung health as a longitudinal concern rather than an acute issue, her work shifts focus from survival to quality of life—a critical consideration as more children with HIV transition into adolescence and adulthood.
Looking Ahead: Expanding Reach and Impact
Masekela continues to expand her influence through regional collaborations, including partnerships with respiratory societies across sub-Saharan Africa. She supports efforts to standardize spirometry training, develop context-appropriate asthma action plans, and create registries for rare lung diseases in children.
In 2024, she participated in a WHO technical consultation on childhood lung health in low- and middle-income countries, contributing African perspectives to global strategy discussions.
When asked about future priorities, she emphasizes the need for investment in primary care infrastructure, saying, “We cannot treat our way out of problems that stem from delayed diagnosis and unequal access. Prevention and early intervention must be central to any lung health strategy.”
Her ongoing work serves as a reminder that equity in healthcare is not achieved through isolated interventions but through sustained commitment to systems that serve the most vulnerable.
For updates on her research and public health initiatives, readers can follow the Africa Health Research Institute’s official publications and the University of KwaZulu-Natal’s School of Medicine news portal.
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