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Merson M.H.,Duke University | Curran J.W.,Emory University | Griffith C.H.,Duke Global Health Institute | Ragunanthan B.,Duke University
Health Affairs | Year: 2012

The Presidents Emergency Plan for AIDS Relief (PEPFAR) has made a major contribution to the reduction of the global HIV/AIDS burden. The program initially focused on rapidly scaling up treatment and prevention services in fifteen low-income countries, then transitioned to an approach that emphasizes sustainability, defined as the capacity to maintain program services after financial, managerial, and technical assistance from the United States and other external donors essentially ceases. Today, PEPFAR continues to expand its HIV prevention, treatment, and care activities while also supporting capacity building initiatives, coordination efforts, and implementation science. The latter is research focused on improving service delivery, maximizing cost-effectiveness, and achieving public health impact. Recent advances in both scientific knowledge and the provision of prevention, treatment, and care services have bred cautious optimism about greatly reducing the spread of HIV. However, success will require a substantial increase in resources, strengthened health systems, renewed commitment to HIV prevention, and well-financed efforts to develop an effective HIV vaccine. © 2012 Project HOPE-The People-to-People Health Foundation, Inc.

Annan J.,International Rescue Committee | Green E.P.,Duke Global Health Institute | Brier M.,University of Pennsylvania
Journal of Aggression, Maltreatment and Trauma | Year: 2013

Findings from a representative survey of youth in northern Uganda suggest that former female child soldiers experience a range of distress symptoms, have initial problems reintegrating, and have fewer education and employment opportunities than males. Given the multiple layers of needs, the findings pose a question of where best to intervene. Would broad-based economic programs address this population's poverty while also indirectly addressing mental health symptoms by reducing stress and improving social capital This article describes how these findings led to the development and evaluation of an economic and social program designed to reduce daily stressors and improve this population's economic, social, and psychological outcomes through livelihoods training, a cash grant for small business development, and follow-up support. © 2013 Copyright Taylor and Francis Group, LLC.

Liu P.,Peking University | Guo Y.,Peking University | Qian X.,Fudan University | Tang S.,Duke Global Health Institute | And 3 more authors.
The Lancet | Year: 2014

China has made rapid progress in four key domains of global health. China's health aid deploys medical teams, constructs facilities, donates drugs and equipment, trains personnel, and supports malaria control mainly in Africa and Asia. Prompted by the severe acute respiratory syndrome (SARS) outbreak in 2003, China has prioritised the control of cross-border transmission of infectious diseases and other health-related risks. In governance, China has joined UN and related international bodies and has begun to contribute to pooled multilateral funds. China is both a knowledge producer and sharer, offering lessons based on its health accomplishments, traditional Chinese medicine, and research and development investment in drug discovery. Global health capacity is being developed in medical universities in China, which also train foreign medical students. China's approach to global health is distinctive; different from other countries; and based on its unique history, comparative strength, and policies driven by several governmental ministries. The scope and depth of China's global engagement are likely to grow and reshape the contours of global health. © 2014 Elsevier Ltd.

Jeuland M.,Duke Global Health Institute | Whittington D.,University of North Carolina at Chapel Hill
Water Resources Research | Year: 2014

This article presents a methodology for planning new water resources infrastructure investments and operating strategies in a world of climate change uncertainty. It combines a real options (e.g., options to defer, expand, contract, abandon, switch use, or otherwise alter a capital investment) approach with principles drawn from robust decision-making (RDM). RDM comprises a class of methods that are used to identify investment strategies that perform relatively well, compared to the alternatives, across a wide range of plausible future scenarios. Our proposed framework relies on a simulation model that includes linkages between climate change and system hydrology, combined with sensitivity analyses that explore how economic outcomes of investments in new dams vary with forecasts of changing runoff and other uncertainties. To demonstrate the framework, we consider the case of new multipurpose dams along the Blue Nile in Ethiopia. We model flexibility in design and operating decisions - the selection, sizing, and sequencing of new dams, and reservoir operating rules. Results show that there is no single investment plan that performs best across a range of plausible future runoff conditions. The decision-analytic framework is then used to identify dam configurations that are both robust to poor outcomes and sufficiently flexible to capture high upside benefits if favorable future climate and hydrological conditions should arise. The approach could be extended to explore design and operating features of development and adaptation projects other than dams. Key Points No planning alternative is likely to dominate across plausible future conditions We present a method for generating information for the selection of robust planning alternatives Downside and upside metrics can assist enhanced decision making © 2014. American Geophysical Union. All Rights Reserved.

Morley C.A.,Emory University | Kohrt B.A.,Duke Global Health Institute
Journal of Aggression, Maltreatment and Trauma | Year: 2013

The experience of child soldiers during postwar civilian reintegration is recognized as a major contributor to mental health. For some children, postwar social relations may be more important than war trauma in determining psychosocial well-being. Mixed methods incorporating epidemiology and qualitative case studies were employed to evaluate the effects of family, peer, and community relations after reintegration on psychosocial outcomes: hope, functional impairment, and post-traumatic stress disorder (PTSD). Participants were 142 child soldiers, including 9 qualitative case studies. Peer support predicted increased hope, decreased functional impairment, and decreased PTSD symptoms. Conversely, problems with peer relations predicted less hope and more PTSD symptoms. Maximizing peer support and minimizing stigma from peers should be prioritized within psychosocial reintegration programs, especially among former child soldiers with PTSD. © 2013 Taylor and Francis Group, LLC.

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