research projects global health

Usman Iqbal 2024 Convocation Alumni Speaker

A Letter to Our Graduates, the Class of 2024

Global health research projects ..

Global Health research spans a wide range of interrelated and complex public health topics. Please explore our current projects by their primary theme listed below. Be sure to investigate more detailed descriptions of projects that have hyperlinked project titles .  Many project areas overlap, so please explore them all.

Academic Interests of the DGH Faculty

If you are looking for a particular faculty member, research area, or location, please use Ctrl + F or command F to scan the list.

Point of Care Diagnostics

Technology to improve decision making and neonatal outcomes in special neonatal care units (sncus) in india.

There have been major improvements in childhood mortality around the world over the last 20 years, but it has been more difficult to reduce mortality of babies in the first month of life. The study is evaluating how to optimize design and use of medical equipment and point of care diagnostics to improve care of newborns in India.

Patricia Hibberd

Diagnostic and Prognostic Biomarkers for Bacterial Infection in Pediatric Clinical Pneumonia

Bacterial pneumonia is one of the leading causes of childhood mortality, particularly in resource-limited countries. The disease burden can be partially attributed to the lack of an accurate and reliable diagnostic test to allow promptly starting antibiotic therapy. Lack of a diagnostic test also results in accelerated resistance to available antibiotics. Previously, we identified a combination of blood inflammatory proteins that could accurately diagnose bacterial infection in Mozambican children with clinical pneumonia. We are currently validating and improving upon this combinations in Gambian children with clinical pneumonia to further start development of a point-of-care diagnostic test with partners.

Clarissa Valim

Emerging Infectious Disease Surveillance and Research

Geosentinel – the global research and surveillance network of the international society of travel medicine in partnership with the cdc.

This is an emerging infectious global surveillance and research network consisting of 72 sites in 30 countries, which uses travelers, immigrants, and refugees as sentinel indicators of disease outbreaks worldwide. GeoSentinel research major projects include studies of fever etiology and outcomes among travelers, artemisinin resistance, mpox, neurocognitive impact of malaria, and COVID-19.

Davidson Hamer

BU-UL Partnership to Enhance Emerging Epidemic Virus Research in Liberia (BULEEVR)

This grant supports a training program is for Liberian Researchers to combat emerging infectious disease outbreaks, such as Ebola. Faculty at BUMC/BUSPH and the University of Liberia co-mentor trainees.

Andrew Henderson

Global Health Research Training

Fogarty global health training fellowship.

This program provides mentored research opportunities to train and prepare a new cadre of health professionals in the US and LMICs in global health research by enhancing the trainees’ ability to independently plan, implement, and assess innovative clinical or operations research focused on reducing mortality and morbidity associated with HIV/AIDS and associated co-infections, NCDs including cardiovascular disease and diabetes, mental health, and MCHN. Academic partners include Harvard University (Harvard T. H. Chan School of Public Health, Harvard Global Health Institute), Boston University (Schools of Public Health and Medicine), Northwestern University (Center for Global Health, Feinberg School of Medicine) and the University of New Mexico (School of Medicine, Center for Global Health).

Bangladesh, Botswana, Ghana, India, Kenya, Nigeria, Mali, Peru, South Africa, Thailand, Uganda, Zambia

Health Services Research

Indlela: a nudge unit to build capacity in behavioral economics and increase hiv program effectiveness in south africa.

Indlela is the first-of-its-kind unit focused specifically on improving the effectiveness of the public sector in delivering health care and achieving better health outcomes in South Africa. In the unit’s first 3 years it will focus specifically on building capacity to expand the use of behavioral economics within HIV prevention and treatment programs in South Africa and strengthen the ability of health service delivery providers and key research institutions to develop and test contextually appropriate interventions that are informed by behavioral insights. In future years, the scope will expand beyond HIV to include other public health issues in South Africa.

Lawrence Long

South Africa

Providence/Boston Center for AIDS Research (CFAR)

The major goals of this project are to foster HIV Research and collaborations between Brown and Boston University Developing young investigators.

Matthew Fox

US, Ukraine, Kenya, South Africa, the Philippines

Dartmouth-Boston University HIV-TB Research Training for the Infectious Disease Institute at Muhimbili University of Health and Allied Sciences (MUHAS)

The major goals of this project are to train Tanzanian citizens in clinical HIV/AIDS research and to estaqblish san Infectious Dsieases Institute at MUHAS.

Robert Horsburgh

Boston University’s Contributions to the Enhanced Mentor Mother Program (EMMA) Study for USG FY2021-22.

During 2014-2019, BU collaborated with the Walter Reed Project and the Kenya Medical Research Institute to complete a study titled: “Evaluating the effectiveness of implementing Option B+ under routine conditions with and without the PMTCT Patient Coordinator Program: A site-randomized impact evaluation among maternal and child health centers supported by the South Rift Valley PEPFAR program in Kenya.” The focus of this additional grant is to complete final data extraction and analysis for infant HIV testing outcomes (testing and HIV status at 18 months of age).

Bruce Larson

AMBIT: Alternative Models of ART Delivery: Optimizing the Benefits 

Many high HIV-prevalence countries are scaling up differentiated service delivery (DSD) models for providing antiretroviral treatment for HIV. DSD models adjust the location, frequency, provider cadre, and other aspects of service delivery to make HIV treatment more patient-centric and more efficient. Little is known about the true impact of DSD models on the health system or patients, however. AMBIT is a research project in sub-Saharan Africa comprising synthesis of existing data, new data collection, data analysis, and modeling activities aimed at generating information for near- and long-term decision making for scaling up DSD models in Malawi, Zambia, and South Africa.

Sydney Rosen

Malawi, Zambia, South Africa

Evaluating the Cost of Scaling PrEP Access through Novel Delivery (EXPAND). 

Blurb: This is an economic evaluation of three demonstration projects that are testing different service delivery approaches for PrEP in South Africa. Each of the demonstration projects uses a different delivery model to reach populations at increased risk for HIV acquisition to offer them oral PrEP. These models will also be adapted for the delivery of long-acting injectable PrEP as soon as this becomes available in South Africa. The economic evaluation includes qualitative work, baseline assessment, patient costs, and the cost of delivery PrEP from the provider perspective. We also include a cross-cutting component focused on local capacity building in costing and economic evaluations.

Retain6: Models of care for the first 6 months of lo treatment

For HIV-positive patients in sub-Saharan Africa and globally, the first six months after initiating lifelong antiretroviral therapy (ART) pose the greatest risk of loss to follow up. Patients who make it through the first six months have a good chance of being retained on ART for the long term, but many drop out before reaching the six-month point. The Retain6 project aims to develop new models of differentiated service delivery for patients in their first six months on ART, in an effort to improve retention in care during this period.

Zambia, South Africa

CAB-RPV LA Implementation Strategies for High-Risk Populations.

This will be an evaluation of a new injectable antiretroviral treatment for HIV-positive individuals receiving care at the Boston University Medical Center and its associated community-based outreach clinics. It includes qualitative research on preferences of patients and providers and a randomized controlled trial to assess feasibility and impact.

Mari-Lynn Drainoni (BMC)

The SUpporting Sustained HIV Treatment Adherence after INitiation ( SUSTAIN study)

Early detection of poor adherence to antiretroviral treatment (ART) and linkage to support for new patients is critical. The objective of this study is to improve ART adherence, retention and viral outcomes in people commencing ART in the South African public sector, a low-resource setting, over 24 months using five evidence-based adherence strategies to enable rapid identification and management of people with poor adherence. We will test the combinations of these components using a Multiphase Optimization STrategy (MOST) design, which allows us to explore the benefit of various combinations of these five effective and feasible ART adherence monitoring or support components.

Faculty/PI: Lora Sabin (PI), Nafisa Halim (Co-I), Bill MacLeod (Co-I), Allen Gifford (Co-I)

Location: South Africa

Zambia Infant Cohort Study

The ZICS study will determine if antiretroviral regimens used to successfully prevent mother to child transmission of HIV have also decreased morbidity and mortality among the children born to these mothers but who, themselves, have escaped infection with HIV. If not, then further investigation of the cause of poor outcomes in these children will be necessary. We will also determine if the mother’s immune status is a determinant of poor health outcome in their uninfected children, and in their infants early immune status.

Donald Thea

Zambia Infant Cohort Study: Brain Optimized to Survive and Thrive (ZICS-BOOST)

Children exposed to HIV in-utero but uninfected (CHEUs) number 14.8 million globally. In Zambia, an estimated 56,000 CHEUs are born annually, a staggering fraction of the national birth cohort. Multiple studies establish that CHEUs are more neurodevelopmentally vulnerable than HIV-unexposed peers. In Zambia, there are existing effective early childhood developmental (ECD) interventions that target other vulnerable populations, but never trialed specifically for CHEUs. GAP: Research is needed to evaluate the effectiveness of a scalable early childhood development (ECD) intervention for CHEUs. Zambia is scaling up ECD as part of its national strategy, but CHEUs are not currently targeted. There is need to better understand the scope and mechanism of HEU-related neurodevelopmental differences and what interventions are most effective. HYPOTHESIS #1: An ECD intervention delivered by community health workers via bi-weekly home visits will improve neurodevelopmental outcomes in CHEUs. HYPOTHESIS #2: CHEUs have significantly worse neurodevelopmental outcomes than unexposed peers at 24 months, mediated by preterm birth, disease stage or ARV exposure. METHODS: In order to observe differences in neurodevelopment between HIV-exposed and HIV-unexposed children, we will build upon an existing Zambian birth cohort by extending follow-up from 6 months to 2 years (n=450). Neurodevelopmental assessments will be measured by multiple context-validated tools at 12 and 24 months. In addition, a randomized control trial of a bi-weekly community health worker-delivered ECD intervention for CHEUs will be conducted to assess its impact on CHEU neurodevelopment. RESULTS: Pending. IMPACT: Despite growing evidence, HIV-exposure is not currently prioritized as a risk factor for poor development by policy makers or ECD programs. By capitalizing on the wealth of prenatal and infant data collected in our ‘parent’ study, we can investigate the mechanism that links HEU to neurodevelopment and test a potential therapy. Addressing developmental vulnerability in CHEUs is paramount to ensuring that future generations of children are school ready, and able to reach their full developmental potential.

Julie Herlihy

EVIDENCE: Evaluation to Inform Decisions using Economics and Epidemiology

EVIDENCE is a 5-year HIV/AIDS project funded by PEPFAR through USAID. With the project lead in South Africa, the Health Economics and Epidemiology Research Office (HE2RO), we conduct health economics and epidemiology evaluations and provide technical assistance in support of the goals of the South African National Strategic Plan for HIV, TB and STIs (NSP) and the PEPFAR Country Operational Plan. BU faculty and staff work closely with HE2RO on project evaluations, cost modeling, outcomes research, and financial management to improve guidelines, policies, programs, and resource allocation.

Economic Impact of HIV Policy Briefs

This project synthesises the evidence on the economic impact of HIV into a series of 17 policy briefs that can help decision-makers in ministries of finance and health in low- and middle-income countries (LMIC) decide on the future financing of their country’s HIV programme. The project incorporates a series of seminars with an academic and LMIC government staff audience aimed at refining the content and presentation of the briefs, the presentation of the evidence base to LMIC decision makers during a comprehensive workshop, and the publication of the briefs on a website and in peer-reviewed journals.

Gesine Meyer-Rath

infectious disease

Vaccine impact modelling consortium (vimc) 2.0  .

VIMC   is an international community of modelers providing high-quality estimates of the public health impact of vaccination to inform and improve decision making. This project contributes to the estimation of cervical cancer disease burden and human papillomavirus (HPV) vaccine impact in low- and middle-income countries. In addition, this project examines policy-relevant research questions for HPV vaccines in order to advance the research agenda in the field of vaccine impact modeling.

 Allison Portnoy

Low- and middle-income countries worldwide

INSECT: Implementing Novel Strategies for Education and Chagas Testing  

This project, funded by a CDC cooperative agreement, aims to increase Chagas knowledge in the medical community and to roll out screening programs for high-risk populations (such as women of childbearing age from endemic areas) nationwide.

Boston, Massachusetts

Chagas disease biorepository

We have developed a biorepository using biological samples from a cohort of Chagas disease patients at Boston Medical Center. The primary goal of the biorepository is to develop and maintain a large, geographically diverse collection of well-characterized samples to be used as a resource for future Chagas diagnostics research.

Incorporating Behavioral Feedback in the Infectious Disease Transmission Modeling

Transmission dynamic modeling is a powerful tool to understand the epidemiology of infectious diseases and evaluate the impact of control measures. However, the lack of empirical data on human behavior and its temporal variation has hindered the progress and application of these models. Therefore, this project aims to 1) understand how people experiencing acute infections change their social contact patterns over the course of their illness and 2) develop mechanistic models that incorporate these data to generate more reliable estimates of key transmission parameters and intervention impacts. Our project aims to provide policy makers and public health officials with more informed decision-making tools to develop interventions, ultimately leading to improved health outcomes.

Kayoko Shioda

United States

EPISTORM: Real-time Evaluation of Vaccine Effectiveness and Safety

Real-time monitoring of the effectiveness and safety of vaccines is essential for controlling infectious diseases. However, there are both practical and methodological hurdles. Our project aims to address two key challenges: 1) issues with linking public health data from different sources, and 2) analytic challenges associated with evaluating multi-dose vaccines, using causal inference techniques. Boston University has been selected to be part of the national network for outbreak and disease modeling led ( CDC Insight Net ), and this project will be conducted through this network.

Cryptococcal Meningitis Screening in South Africa

Cryptococcal meningitis (CM) is a fungal infection that causes infection in the brain and spinal cord. CM is a leading cause of AIDS-related deaths globally, mainly among patients with low CD4 cell counts. Through screening HIV patients with low CD4 cells counts for cryptococcal antigen (CrAg), it is possible to identify CrAg-positive patients before they develop meningitis. Treating these patients with antifungal medications can then substantially reduce risks of progression to CM and death. Through support from the CDC Foundation (May 2015 – June 2021), the purpose of this program of research has been to evaluate costs and effectiveness of alternative CrAg screening strategies and CM treatment regimens.

Using Behavioral Economics to Improve the Uptake of and Persistence on Pre-exposure Prophylaxis in Men Who Have Sex With Men to Prevent HIV Infection

South Africa’s HIV incidence remains high, in particular amongst populations such as men who have sex with men (MSM) who may be at increased risk. HIV pre-exposure prophylaxis (PrEP) is considered key to reducing incidence in these populations, yet pilot studies show sub optimal uptake and poor persistence amongst those most at risk. This research will focus on understanding why PrEP uptake and persistence amongst MSM in South Africa is low and how the delivery of PrEP to this population could be altered to encourage those most at risk to start treatment using behavioral insights.

Impact of Undernutrition on Immunity Elicited by Vaccines in the Gambia

Moderate and severe undernutrition are highly prevalent in several resource-limited countries. There is conflicting evidence on the impact of undernutrition on the immunity elicited by childhood vaccines, as well as the specific supplements that could be used to overcome vaccine hypo-responses associated with undernutrition. In a pilot project in The Gambia, we are comparing antibody vaccine responses against a panel of EPI vaccines of children with severe wasting and stunting with well-nourished children. Furthermore, through a metabolomics assay, we will assess whether specific amino acid deficiencies are associated with decreased responses in undernourished children.

IPV (intimate partner violence)

Testing the effectiveness of an evidence-based transdiagnostic cognitive behavioral therapy approach for improving hiv treatment outcomes among violence-affected and virally unsuppressed women in south africa.

This study will evaluate the impact of the Common Elements Treatment Approach (CETA), an evidence-based intervention comprised of cognitive-behavioral therapy elements, at improving HIV treatment outcomes among women with HIV who have experienced intimate partner violence (IPV) and have an unsuppressed viral load on HIV treatment. To evaluate CETA, we will conduct a randomized controlled trial of HIV-infected women, with or without their partners, who have experienced IPV and have an unsuppressed viral load to test the effect of CETA in increasing viral suppression and reducing violence.

The Intransigence of Malaria in Malawi: Understanding Hidden Reservoirs, Successful Vectors and Prevention Failures

Under the aegis of the Malawi International Center of Excellence of Malaria Research (ICEMR) program, several cohort studies have been conducted focused on studying malaria control measures and understanding why measures such as bed nets have failed to control malaria in Malawi. Examples of these studies are the one led by Dr. Valim aiming to identify the transmission reservoir group(s) for malaria in Malawi and to assess the impact of current interventions on these human reservoirs. Another study conducted under the aegis of ICEMR aims to assess the effectiveness of the RTS,S malaria vaccine in conjunction with other malaria prophylactic measures.

Maternal and Child Health

Global network for women’s and children’s health research.

The Global Network conducts observational studies and clinical trials in 8 locations in low and middle income countries in Asia, Africa and Central America. The goals of the research are (1) to evaluate whether low-cost, sustainable interventions improve maternal and child health; and (2) build local research capacity and infrastructure. Whenever possible common protocols are implemented in all 8 locations. The Boston University site works with the Lata Medical Research Foundation in Nagpur, India. The grant funds several studies.

Synbiotics for the Early Prevention of Severe Infections in Infants (SEPSIS)

SEPSIS, a collaboration between icddrb (Dhaka), Hospital for Sick Kids (Toronto), and BU consists of a few related studies including an observational cohort of severe infections and the intestinal microbiome in young infants in Dhaka, Bangladesh and a phase II randomized, placebo-controlled trial of the efficacy, safety, and tolerability of neonatal administration of Lactobacillus plantarum ATCC 202195 with or without fructooligosaccharide for one or seven days

Antimicrobial Resistance

A-plus trial: multi-site efficacy and safety trial of intrapartum azithromycin in lmics – amr sub-study and effect of azithromycin on the developing microbiome ..

The Global Network is conducting a trial to evaluate whether Azithromycin given during labor reduces maternal and neonatal infections and mortality. This grant supports studying the effect of azithromycin on development of antimicrobial resistance and the gut and airway microbiome.

Sequencing of Klebsiella pneumoniae isolates from Zambia

Bloodstream isolates (K. pneumoniae and E. coli) from the Sepsis Prevention in Neonates in Zambia study are being sequenced to determine serotypes and antibiotic resistance characteristics.

Non-communicable Diseases

World health organization. global ncd reporting mechanism..

Veronika Wirtz & Peter Rockers

In 2021, the World Health Organization introduced the Global Diabetes Compact, targeting equitable and affordable access to diabetes care, particularly in low- and middle-income countries. Acknowledging the support from the private sector, WHO formulated a list of 31 asks to prioritize expansion of access to essential insulin and related health technologies. Boston University is now supporting WHO in developing a Global Reporting Mechanism (GRM) to encourage the reporting and tracking of industry commitments aligned with the 31 WHO Asks.

Noncommunicable Disease Management in South Africa: Insights from the National Health Laboratory Services (NHLS) Multi-morbidity Cohort.

The K01 Award (K01DK116929) addresses the growing challenge of Type 2 Diabetes Mellitus (T2DM), focusing on care disparities and treatment efficacy, particularly among populations living with and without HIV in low- and middle-income countries. Central to this project is the innovative application of a probabilistic record-linking algorithm to develop a patient cohort from the National Health Laboratory Services (NHLS) database in South Africa, which contains over 68 million laboratory records from more than 30 million individuals and covers conditions like HIV, tuberculosis, diabetes, kidney disease, and cardiovascular disorders from April 1, 2004, to March 31, 2017.

The creation of the NHLS Multi-morbidity Cohort has facilitated in-depth analysis of data including anonymized patient identifiers, demographics, test specifics, and geographic information. This cohort is instrumental for the project’s aims to examine examining the T2DM care cascade in populations with and without HIV, evaluate the Integrated Chronic Disease Management (ICDM) model’s impact on diabetes care using quasi-experimental methods, studying chronic kidney disease progression , and evaluating compliance with national diabetes guidelines . These efforts aim to enhance understanding and improve management of noncommunicable diseases in South Africa.

Alana Brennan

World Bank Global compendium of primary care service delivery models for non-communicable diseases

(link to report should be available in June 2024)

Addressing the challenges within non-communicable disease programs and primary healthcare centers, the World Bank embarked on a project to gather a comprehensive collection of primary care service delivery models for non-communicable diseases. This initiative highlighted the critical need for a cohesive approach to primary healthcare, which includes the promotion, prevention, and management of non-communicable diseases, aiming to improve care across the entire spectrum, from reducing risk factors to managing chronic conditions at the primary care level effectively. The project’s goal was to develop an online, action-oriented collection for the World Bank, filled with innovative design solutions and digital enhancements to boost access, efficiency, effectiveness, and the quality of care for non-communicable diseases. This collection intended to present a wide array of primary healthcare models designed for chronic conditions, supporting countries in their shift towards integrated, chronic care services and moving away from a reliance on acute, episodic care.

The project culminated in a comprehensive matrix featuring 158 models, alongside 60 concise two-page case reports and 15 detailed five-page case reports. These documents collectively highlight a diverse range of primary care service delivery models for non-communicable diseases, spanning various geographic regions and income categories. Sub-Saharan Africa was prominently featured, accounting for 26.6% of the models, with East Asia and the Pacific at 22.8%, and South Asia at 20.2%. Most of these models were found in upper-middle-income and lower-middle-income countries, making up 45.6% and 42.4% of the implementations, respectively. Diabetes stood out as the most common focus, being the target of 50.0% of the models, followed by hypertension at 41.8% and mental health disorders at 38.0%. The main strategies highlighted in these models were task-shifting/task-sharing (40.5%), the integration of new services or conditions (35.4%), and educational or training initiatives (33.5%). The implementation settings varied, with mixed areas being the most common at 41.8%, and rural and urban areas following at 24.7% and 22.1%, respectively. The scale of implementation predominantly ranged from small to medium, accounting for 55.1% of the models, but there were also notable instances of large-scale and national-scale projects at 20.2% and 10.1%, respectively, highlighting the extensive reach and potential impact of these initiatives.

Alana Brennan, Nancy Scott , Sydney Rosen

low-and middle-income countries

Opportunistic screening for hypertension and type 2 diabetes mellitus using COVID-19 infrastructure

South Africa continues to grapple with a substantial burden of non-communicable diseases, particularly type 2 diabetes and hypertension. However, these conditions are often underdiagnosed and poorly managed, further exacerbated by the strained primary healthcare system and the disruptive impact of the COVID-19 pandemic. Integrating non-communicable disease screening with large-scale healthcare initiatives, such as COVID-19 testing and vaccination campaigns, offers a potential solution, especially in low- and middle-income countries. We investigated the feasibility and effectiveness of this integration in two separate cohorts.

Study 1: Integration of point-of-care screening for type 2 diabetes mellitus and hypertension with COVID-19 rapid antigen screening in Johannesburg, South Africa

In a prospective cohort study at the Germiston taxi rank in Johannesburg, South Africa, we assessed the integration of screenings for type 2 diabetes mellitus and hypertension with rapid antigen tests for COVID-19. The study involved 1,169 participants and included measurements of blood glucose, blood pressure, waist circumference, smoking status, height, and weight. Participants showing elevated blood glucose levels (fasting levels equal to or greater than 7.0 or random levels equal to or greater than 11.1 millimoles per liter) and/or elevated blood pressure readings (diastolic pressure equal to or greater than 90 and systolic pressure equal to or greater than 140 millimeters of mercury) were directed to receive clinical follow-up. Our results indicated an overall diabetes prevalence of 7.1%, incorporating both previously diagnosed individuals and those newly identified with elevated blood glucose measurements. We also observed a hypertension prevalence of 27.9%, which included both known cases and new detections of elevated blood pressure during the study. However, the rates of connecting these individuals to subsequent medical care were low, with only 30.0% of those with elevated blood glucose and 16.3% with elevated blood pressure engaging in follow-up care. This opportunistic approach to screening helped identify potential new diagnoses in 22% of participants, yet it also underscored the necessity for better strategies to ensure these individuals receive the necessary ongoing care, highlighting the critical need for additional research to determine the feasibility and effectiveness of such integrated screening programs on a larger scale.

Study 2: Integration of point-of-care screening for type 2 diabetes mellitus and hypertension into the COVID-19 vaccine programme in Johannesburg, South Africa

In a prospective cohort study at four health facilities in Johannesburg, South Africa, we screened 1,376 participants for hypertension and type 2 diabetes mellitus during COVID-19 vaccination campaigns. This integration aimed to address the significant problem of undiagnosed conditions in a strained healthcare system. We measured blood glucose, blood pressure, waist circumference, smoking status, height, and weight, referring individuals with elevated blood glucose (fasting levels equal to or greater than 7.0 or random levels equal to or greater than 11.1 millimoles per liter) and/or blood pressure (diastolic pressure equal to or greater than 90 and systolic pressure equal to or greater than 140 millimeters of mercury) for further medical evaluation. Our findings showed a 4.1% prevalence of diabetes, combining known cases and new detections of elevated blood glucose levels. The hypertension prevalence was 19.4%, including both existing and newly identified cases of elevated blood pressure. Notably, 46.1% of participants exhibited waist circumferences indicative of metabolic syndrome, more frequently observed in females. Additionally, 7.8% of the screened individuals were potentially newly diagnosed with diabetes or hypertension, emphasizing the importance of integrated screening initiatives. Approximately half of the individuals with newly identified risk factors successfully sought follow-up care within a month, highlighting the effectiveness of using routine healthcare interactions for extensive screenings, particularly vital in settings with limited resources, and underscoring the need to improve linkage to care for efficient management of non-communicable diseases.

Alana Brennan, Gesine Myer-Rath

Assessing the effects of HIV disease on dysglycemia in a cohort of tuberculosis patients in South Africa’s Western Cape

Our planned research will focus on compare rates of dysglycemia (both hyperglycemia and hypoglycemia) in people living with HIV (PLWH) and HIV-uninfected persons receiving tuberculosis (TB) treatment using pilot data from the The Impact of Alcohol Consumption on TB Treatment Outcomes (TRUST) Study . HbA1c’s were only collected at enrollment the TRUST. As such, we will collect blood samples to measure HbA1c and blood glucose levels at patients 18-month study visit. This will allow us to assess changes in blood glucose levels from study enrollment by HIV status. Second, we will assess the role stress and inflammation play in relation to blood sugar levels in PLWH and HIV-uninfected individuals. Research suggests that the hosts immune response to active TB and/or HIV disease results in a prolonged state of systemic inflammation which can have negative metabolic effects. We will collect samples to measure markers of stress and inflammation at the 18-month study visit when all patients will be one year post TB treatment completion and when transient hyperglycemia due to TB infection should be resolved. This will be preliminary data to assess if there are differences in these specific stress and inflammatory markers post TB treatment amongst PLWH and HIV-uninfected individuals and potentially identify underlying mechanism(s) causing abnormal blood sugar levels.

Programme Evaluation of Timor-Leste PEN-HEARTS Intervention

This project will evaluate early implementation in Timor-Leste of PEN-HEARTS, a community-based intervention supported by the WHO designed to improve health outcomes among individuals with non-communicable diseases such as diabetes. Building on a similar evaluation in Bhutan, a BU team of faculty and students will design and implement the evaluation with WHO and Ministry of Health officials in Timor-Leste. The evaluation will use mixed methods and involve data collection in both intervention and comparison sites in four districts of Timor-Leste.

Timor-Leste

Pharmaceutical Policy

Medicines, technologies, and pharmaceutical services.

The Medicines, Technologies and Pharmaceutical Services (MTaPS) project aims to strengthen pharmaceutical systems in low and middle income countries. Boston University is a core partner of the USAID funded MTaPS project led by Management Sciences for Health. The objectives are (1) to generate evidence on the development, implementation and strengthening of data management that can support decision-making in pharmaceutical systems; (2) to develop, implement and evaluation accountability mechanisms in pharmaceutical systems.

Veronika Wirtz

Tuberculosis

Methods to estimate the impact of interventions on the transmission and incidence of tuberculosis.

The major goals of this project are to develop models that can be used to monitor the success of TB interventions. This project is a collaboration with Dr. Helen Jenkins and Dr. Leo Martinez and is led by Dr. Laura White of the BUSPH Department of Biostatistics

Intensified patient-finding intervention to increase the detection of children with tuberculosis

Children with tuberculosis are vastly under detected and under diagnosed. An intensified patient-finding intervention using systematic verbal screening at health facilities was undertaken in two locations to increase the detection of children who may be at high risk for tuberculosis disease. These projects aim to identify gaps along the pediatric tuberculosis care cascade; understand age-specific clinical presentation and risk factors for tuberculosis disease, extrapulmonary presentations, and poor treatment outcomes; refine clinical algorithms to expedite decision-making for treatment initiation; and explore other topics related to pediatric tuberculosis epidemiology.

Meredith Brooks

Pakistan and Bangladesh

SAIA-TB: Using the Systems Analysis and Improvement Approach to Prevent TB in rural South Africa

Description: South Africa estimates 80% of their population has TB infection, and 14% of the population lives with HIV, with an estimated 5-15% of South Africans at high risk of developing TB disease from recent infection or immunocompromised status. Therefore, utilization of routinely collected data to optimize the comprehensive TB care cascade – screening, evaluation, diagnosing, linkage to care, treatment, and TB-free survival – is important to assess at the clinic level to improve clinic flow and patient outcomes. This study—funded by NINR/NIH—will leverage an evidence-based implementation science strategy, the Systems Analysis and Improvement Approach (SAIA), and recent TB cascade analyses piloted in the proposed site, to adapt and evaluate the effectiveness of SAIA-TB using a stepped wedge crossover cluster randomized trial across 12 clinics in rural Eastern Cape, South Africa.

Improving Childhood Tuberculosis Treatment Outcomes and Post-TB Lung Functioning and Quality of Life in Rural South Africa

Description: We will assess the TB care cascade in children, expanding it to include a child-specific definition of post-TB lung disease (PTLD), among children in a high TB/HIV burden setting in Eastern Cape South Africa, and identify risk-factors for completing each step of the newly expanded TB care cascade. Additionally, we will collect rich data regarding nutritional status, air pollutant exposure, lung capacity, and quality of life to estimate their effect on TB disease outcomes and PTLD in children. Funded by the Charles H. Hood Foundation.

Household Contact Tuberculosis Preventive Therapy Programs in Rural Eastern Cape, South Africa (KWIT-TB)

Description: We will assess the geospatial components, including access to care and population-level characteristics to gaps in the TB preventive therapy care cascade.

Adaptive Design to Aid in the Planning of community-based Tuberculosis screening services (ADAPT-TB)

Description: Community-based screening via mobile units can close gaps in missed diagnoses by bringing screening services into communities, making screening more convenient for individuals with limited access to appropriate services. Questions remain, however, about how to efficiently operate these mobile units. Leveraging longstanding relationships in Lima, Peru, including existing collaborations involving mobile screening units, I will collect data from health facilities and mobile screening units to [Aim 1] establish spatial and temporal trends of the local tuberculosis burden and [Aim 2] build neighborhood-level models reflecting local risk of tuberculosis. I will then [Aim 3] develop a baseline decision model via a restless multi-armed bandit framework to make data-driven decisions about where, when, and how long to place the mobile units in the community. The overall goal is to optimize the real-time movement of these units throughout a community to increase the detection of individuals with TB and allocate resources more efficiently. Funded by a Carlin Foundation Award for Public Health Innovation and a Population Health Data Science (PHDS) Seed Funding Award.

Optimizing tuberculosis elimination initiatives for high-risk populations

Certain populations are at increased risk of tuberculosis infection and progression to tuberculosis disease. In Mexicali, Mexico, we are assessing the impact of novel diagnostics for tuberculosis infection testing in three high-risk populations–people who use drugs, household contacts of people with tuberculosis, and people confined to a penitentiary setting–to inform tailored algorithms for tuberculosis testing and initiation of tuberculosis preventive treatment. We also assess gaps identified along the tuberculosis comprehensive care cascade to guide local tuberculosis prevention and management guidelines.

Tuberculosis in teens: a geospatial approach to predict community transmission

Description: Adolescents are a unique population that have been routinely neglected from tuberculosis guidelines. However, due to their ability to spread tuberculosis and their high number of social contacts, adolescents may be a key node fueling cycles of local community tuberculosis transmission in high incidence settings. Through a K01 Award from NIAID, NIH, we use geospatial and genotypic analyses to complete the following objectives: (1) To characterize the spatial heterogeneity of tuberculosis transmission events in adolescents. (2) To predict the spatial distribution of tuberculosis transmission events in adolescents. (3) To estimate and compare, through simulation, the impact of adolescent-tailored screening and treatment interventions on reducing community tuberculosis transmission.

Predictors of Resistance Emergence Evaluation in MDR-TB Patients on Treatment.

Dr. Horsburgh and Dr. Tim Sterling of Vanderbilt are leading a prospective cohort study of patients with MDR-TB. The aims of the study are to determine if decreased TB drug levels predispose to the development of additional drug resistance on treatment and to develop early indicators of such emergence of resistance.

US, India, Brazil

RePORT India Consortium

The major goal of this project is to collaborate with partners in India in clinical studies of tuberculosis infection and disease.

Akshay Gupte

Transmission of Tuberculosis among illicit drug use linkages

The goal of this project is to assess the risk for TB transmission between persons who smoke drugs. This is a prospective cohort study of persons with and without drug use in South Africa.

Karen Jacobson

US, South Africa

Prevention Policy Modeling Lab

The Goal of this Project is to develop cost-effectiveness models for TB prevention. This project is a collaboration with Dr. Nick Menzies at Harvard School of Public Health and Dr. Josh Solomon at Stanford School of Medicine.

DRAMATIC Phase 2 Duration Randomized MDR-TB Treatment Trial

The major goal of this project is to identify a shorter, less toxic treatment for MDR-TB.  This project is a collaboration with Dr. Payam Nahid at University of California, San Francisco. It is randomizing patients with fluoroquinolone-susceptible MDR-TB in Vietnam and the Philippines to four different durations of a 5-drug regimen.

US, Vietnam, the Philippines

Phenotype, Progression and Immune Correlates of Post-Tuberculosis Lung Disease

Pulmonary tuberculosis (PTB) is associated with lung injury which can persist despite successful therapy. Lung sequelae of treated PTB are increasingly recognized as an independent risk factor for chronic obstructive pulmonary disease (COPD) and, an important contributor of excess morbidity and mortality. This project aims to: 1) characterize the early natural history of post-TB lung disease (PTLD) and provide rationale for long-term monitoring and bronchodilator therapy in affected cases, 2) characterize the functional and morphological phenotype of PTLD by serial pulmonary function testing and multi-detector computed tomography, 3) identify immune profiles measured during early, late and post-therapy associated with PTLD.

RePORT-India Lung Health Study

Pulmonary tuberculosis (PTB) is the most common form of TB disease and is characterized by granuloma formation, necrosis, and cavitation in the lung tissue. This lung injury in PTB may affect tuberculosis treatment outcomes. Granulomatous lesions, fibrosis, and cavitation impair drug penetration in affected lung tissue and may lead to persistent foci of bacterial replication and drug resistance. The overall goal of this project is to identify clinical and imaging markers of lung injury that are associated with unfavorable treatment outcomes in PTB.

Multiomic signatures of Lung Injury in Tuberculosis

Pulmonary tuberculosis (PTB) is associated with lung injury which can persist despite successful therapy. Lung sequelae of treated PTB are increasingly recognized as an independent risk factor for chronic obstructive pulmonary disease (COPD) and, an important contributor of excess morbidity and mortality. Furthermore, PTB is characterized by granuloma formation, necrosis, and cavitation in the lung tissue which can impair drug penetration in affected lung tissue leading to persistent foci of bacterial replication, drug resistance and poor treatment outcomes. The overall goal of this study is to explore host metabolomic and genetic signatures associated with lung injury in PTB patients with and without diabetes and HIV.

Point-of-care Questionnaire and mHealth Assisted Diagnosis of Post-TB Lung Disease

Pulmonary tuberculosis (PTB) is associated with lung injury which can persist despite successful therapy. Lung sequelae of treated PTB are increasingly recognized as an independent risk factor for chronic obstructive pulmonary disease (COPD) and, an important contributor of excess morbidity and mortality. Spirometry is the gold standard for diagnosing lung function defects, however it is technically challenging and expensive to perform, and may not be available at the point-of-care in many TB-endemic settings. The overall goal of this project is to develop and validate a questionnaire-based screening algorithm, assisted by machine learning analysis of cough sounds and lung auscultation data, to identify individuals with a high probability of having Post-TB Lung Disease for referral and confirmatory testing.

Effectiveness of Anti-Fibrotic Therapy for Preventing Pulmonary Impairment in COVID-19

COVID-19 is associated with persistent pulmonary impairment despite successful management of acute disease. Of particular interest is pulmonary fibrosis, with several studies reporting reduced FVC, DLCO and anterior reticulation on chest CT. The overall goal of this project is to conduct a retrospective analysis of medical records to measure the association between receipt of antifibrotic therapy (Pirfenidone and/or Nintedanib) and lung impairment following hospital discharge among adults with COVID-19.

Veterans health

Bridging the care continuum for vulnerable veterans across va and community care (bridgecc) queri program.

Led by investigators at the Bedford VA, this project is implementing three evidence-based practices (EBPs) that aim to improve coordinated care between VA and non-VA providers to improve the health of veterans. The EBPs focus on 1) homeless overdose prevention expansion; 2) maintaining independence and sobriety through systems integration and outreach; and 3) post-incarceration engagement to increase social support. Dr. Sabin is guiding the costing components for each EBP.

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The Fogarty International Center and its NIH partners invest in research on a variety of topics vital to global health. For each of these global health research topics, find an in-depth collection of news, resources and funding from Fogarty, the NIH, other U.S. government agencies, nongovernmental organizations and others.

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• We support students and faculty across the Johns Hopkins community with global health grants, workshops, scholarships, and experiential learning opportunities
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Research Projects

Our award-winning faculty at the School of Global Public Health is tenaciously engaged in groundbreaking research around the world, serving as University-wide resources for large-scale, multi-school, multi-disciplinary and multi-site research projects. Below are just a few of our faculty’s recent scholarly undertakings.

Behavioral Communication Strategies for COVID-19 (BCSE: COVID-19) Course

• Read more about Behavioral Communication Strategies for COVID-19 (BCSE: COVID-19) Course

Evaluation of Intensified Dengue Control Measures with Interrupted Time Series Analysis in the Panadura Medical Officer of Health Division in Sri Lanka: A Case Study and Cost-Effectiveness Analysis

Principal investigator.

• Read more about Evaluation of Intensified Dengue Control Measures with Interrupted Time Series Analysis in the Panadura Medical Officer of Health Division in Sri Lanka: A Case Study and Cost-Effectiveness Analysis

"Effectiveness of the Consult for Addiction Treatment and Care in Hospitals (CATCH)"

A model developed for engaging patients in opiod use disorder treatment: pragmatic trial in a large municipal hospital system.

• Read more about "Effectiveness of the Consult for Addiction Treatment and Care in Hospitals (CATCH)"

Aaye's Table

Aaya's Table intends to bring awareness to the gap between healthcare and home care with evidence-based lifestyle changes. The organization wants society to choose healthier options themselves by increasing their knowledge of healthy options. Students provide resources for better nutrition options to physician's offices.

• Read more about Aaye's Table

Acute Care Hospital COVID-19 Emergency Response Plan

A project to create a guide for a plan of action for the increasing number of COVID cases in communities across New York City.

• Read more about Acute Care Hospital COVID-19 Emergency Response Plan

Amplifying provider impact on patient engagement with an EHR- integrated digital diabetes prevention program

Using innovative technology, the development of aninterface between a leading digital diabetes prevention program app and the EHR by leveraging automated clinician and patient-facing tools to promote patient engagement in the digital program while minimizing clinician burden.

• Read more about Amplifying provider impact on patient engagement with an EHR- integrated digital diabetes prevention program

An Analysis of the HIV Healthcare System

A study examining the challenges and service gaps evident in the Greek HIV continuum of care given the number of possible barriers on the system.

• Read more about An Analysis of the HIV Healthcare System

Anthrologica: NYU Training Courses

A series of training courses in partnership with research-based specialists in anthropology dedicated to learning more about vaccine development. The goal of the courses is for new social scientists to learn how to perform in humanitarian contexts and health emergencies.

Areas of Research and study

• Read more about Anthrologica: NYU Training Courses

Arbo-Prevent Project

• Read more about Arbo-Prevent Project

Baboon Parasitology and Coexistence

The development of conservation research and techniques to better understand baboon parasitology and coexistence. Students work on a project of their choosing exploring any gaps they may find in research.

• Read more about Baboon Parasitology and Coexistence

Barriers to treatment among Puerto Rican Men with HIV

A project focusing on the likeliness of outreach for Puerto Rican men who have been diagnosed with HIV. The study evaluates the barriers to continued engagement throughout treatment in New York City.

• Read more about Barriers to treatment among Puerto Rican Men with HIV

Behavioral Communication Strategies for Global Epidemics (BCSE) Course

• Read more about Behavioral Communication Strategies for Global Epidemics (BCSE) Course

BEST PRACTICE FOR EFFECTIVE ACCOUNTABLE CARE ORGANIZATIONS (Columbia) (Universal American)

The purpose of this project is to complete a study of the organization and performance of Accountable Care Organizations (ACOs). Data from interviews with managers, physicians, and nurses at six ACOs, along with data from records about ACO organization and performance, will be analyzed.

Professional organizations

• Read more about BEST PRACTICE FOR EFFECTIVE ACCOUNTABLE CARE ORGANIZATIONS (Columbia) (Universal American)

BroadStreet Health COVID-19 Data Project

A community-centered software company utilizing local experts and data to create solutions to community health disparities.

• Read more about BroadStreet Health COVID-19 Data Project

Building Community Capacity to Disseminate Pcori Information and Enhance Pcori Initiatives

Using a patient-centered approach, this community engagement project seeks to build the capacity of local Community-based Organizations (CBOs) to help patients and potential patients get more involved in obstructive sleep apnea (OSA) screening and treatment initiatives, and create a guide that researchers can use to successfully partner with local CBOs and enhance patient-centered outcomes research (PCOR) initiatives.

• Read more about Building Community Capacity to Disseminate Pcori Information and Enhance Pcori Initiatives

Canadian Autism Spectrum Disorder Alliance (CASDA)

The goal of CASDA is to create a comprehensive national strategy to address barriers to autism research and resources including gaps in funding and individual rights for families with autistic individuals. CASDA intends to work with governments and experts to make resources more available to communities nationwide.

• Read more about Canadian Autism Spectrum Disorder Alliance (CASDA)

Center for Environment and Humanity, Kodaikanal International School

• Read more about Center for Environment and Humanity, Kodaikanal International School

Central American Healthcare Initiative

The implementation of innovative projects to improve access to healthcare throughout Central America. A webinar series was also developed centered on health innovation in Central America.

• Read more about Central American Healthcare Initiative

Conflict and HIV in Ukraine: The Effect of Displacement on HIV-related Sex and Substance Use Risk Behaviors Among Ukrainian Young Adults

• Read more about Conflict and HIV in Ukraine: The Effect of Displacement on HIV-related Sex and Substance Use Risk Behaviors Among Ukrainian Young Adults

Cross-Continental Master of Public Health Program 2017-2018

• Read more about Cross-Continental Master of Public Health Program 2017-2018

Cross-Continental Master of Public Health Program 2018-2019

• Read more about Cross-Continental Master of Public Health Program 2018-2019

Cross-Continental Master of Public Health Program 2019-2020

• Read more about Cross-Continental Master of Public Health Program 2019-2020

Demographic and Health Disparities in Recovery From Hurricane Katrina: Katrina@10

This is an NIH-funded center grant which capitalizes on joining together three longitudinal cohorts from researchers at Tulane University, Harvard University, and NYU to explore population recovery a decade after Hurricane Katrina.

• Read more about Demographic and Health Disparities in Recovery From Hurricane Katrina: Katrina@10

Evaluating Malaria Camps in Rural India

• Read more about Evaluating Malaria Camps in Rural India

Evaluation of Smoke-Free Housing Policy Impacts on Tobacco Smoke Exposure and Health Outcomes

A natural experiment examining the impact of the HUD policy on reducing ETS exposure and improving health outcomes. Smoking exposure among people living in public housing is significantly higher than those living in detached housing environments.

• Read more about Evaluation of Smoke-Free Housing Policy Impacts on Tobacco Smoke Exposure and Health Outcomes

Feasibility of Vaccine Safety Surveillance and Observational Research

A study focusing primarily on vaccine surveillance in rural communities in Uganda and vaccine and drug utilization during pregnancy. The study also looks at the feasibility of conducting pharmacovigilance in rural Uganda. The study made assessments using the globally standardized Obstetric and Neonatal Health Outcomes.

• Read more about Feasibility of Vaccine Safety Surveillance and Observational Research

Food Tank: The Think Tank For Food

Independent research organization focusing on advancements in sustainable and equitable food systems. Researchers format articles and conduct interviews to further provide research to the public. In addition to producing articles during their internship period, students also assist in the production of podcast episodes.

• Read more about Food Tank: The Think Tank For Food

Full Circle Sports Nutrition LLC

A program working with high school athletes in which students assist in research and working to prepare for the annual teen program. Interns are responsible for researching and completing projects centered around care for athletes as well as planning their annual summer program for teens over the summer.

• Read more about Full Circle Sports Nutrition LLC

Ghana Coalition of NGOs in Health (GCNH) Internship

• Read more about Ghana Coalition of NGOs in Health (GCNH) Internship

Global Focus on Cancer

Global Focus on Cancer is an initiative for evidence-based program development and implementation of cancer awareness and education at the local level.

• Read more about Global Focus on Cancer

Global Institute for Disease Elimination (GLIDE)

GLIDE is a program making advancements in research and treatment for a number of diseases through innovation and awareness. The program is geared toward developing a global approach to fighting diseases like polio, malaria, river blindness, and lymphatic filariasis.

• Read more about Global Institute for Disease Elimination (GLIDE)

GPH Capstone: Assessing Feasibility of Conducting RTS,S Vaccine Safety Surveillance

• Read more about GPH Capstone: Assessing Feasibility of Conducting RTS,S Vaccine Safety Surveillance

GPH Capstone: Ethiopia School-Feeding Capstone Project

• Read more about GPH Capstone: Ethiopia School-Feeding Capstone Project

GPH Capstone: Explore Barriers and Facilitators to Scaling Up PrEP for HIV Among Sexual Minority Men

• Read more about GPH Capstone: Explore Barriers and Facilitators to Scaling Up PrEP for HIV Among Sexual Minority Men

GPH Capstone: Studying Malnutrition and Food Delivery Systems in Eastern Senegal

• Read more about GPH Capstone: Studying Malnutrition and Food Delivery Systems in Eastern Senegal

GPH Captone Project at Opera San Francesco (OSF)

• Read more about GPH Captone Project at Opera San Francesco (OSF)

GPH Course: Behavioral Communication Strategies for Epidemics

• Read more about GPH Course: Behavioral Communication Strategies for Epidemics

GPH Course: Behavioral Communication Strategies for Global Epidemics

• Read more about GPH Course: Behavioral Communication Strategies for Global Epidemics

GPH Course: Disease Elimination and Eradication Strategies for Infectious Diseases in LMICs

• Read more about GPH Course: Disease Elimination and Eradication Strategies for Infectious Diseases in LMICs

GPH Course: Environmental Injustice: From Local to Global

• Read more about GPH Course: Environmental Injustice: From Local to Global

GPH Course: Global Food Policy for Public Health

After a four-week intensive unit online, the class on Global Food Policy for Public Health met for its fifth and final week at NYU Florence. A diverse array of students from global public health, bioethics, and food studies became immersed in experiential learning activities that brought to life a European perspective on the topics they studied.

• Read more about GPH Course: Global Food Policy for Public Health

GPH Course: HIV/AIDS Public Health Promotion

• Read more about GPH Course: HIV/AIDS Public Health Promotion

GPH Course: Public Health Emergency Preparedness & Response: A Global Perspective

• Read more about GPH Course: Public Health Emergency Preparedness & Response: A Global Perspective

GPH Courses: 1) Protecting the World’s Health: Triumphs and Challenges and 2) Tackling Global Health Disparities through Implementation Science Research

Drs. Karen Yeates and Cheryl Healton taught courses on global health challenges, covering epidemics like tuberculosis, HIV/AIDS, HPV, and tobacco use. Students heard from guest speakers addressing tobacco in Abu Dhabi, visited health facilities in Tanzania, which engaged in debates tackling topics such as free AIDS care and mandatory HPV vaccines.

• Read more about GPH Courses: 1) Protecting the World’s Health: Triumphs and Challenges and 2) Tackling Global Health Disparities through Implementation Science Research

GPH Emerging Leaders Program

Emerging Leaders Program Leads Brittany Edghill and Christopher Whitehead took a group of undergraduates from the GPH Emerging Leaders Program (ELP) on an exciting trip to the nation’s capital, Washington, DC. Their goal for the trip was to hone in on how the program's themes of Innovation and Storytelling, impact public health at the domestic and global level.

• Read more about GPH Emerging Leaders Program

Hawai'i Budget and Policy Center

A coalition of class action litigation to improve the health of low income households and increase economic and educational opportunities. Outreach also includes service projects that go beyond the law such as campaigns around the social determinants of health.

• Read more about Hawai'i Budget and Policy Center

HEAL International

Education and training for Community health facilitators when it comes to sexual health in the community. HEAL International also operates in Arizona providing resources for youth who have experienced sex trafficking.

• Read more about HEAL International

Health Right International and Partners for Health & Development in Africa (PHDA)

Addressing mental health issues and adherence to ARV medications among clients at SWOP clinics in Nairobi. The organization also does extensive work in maternal health care for women by constructing maternity waiting rooms and providing more educational resources in the region.

• Read more about Health Right International and Partners for Health & Development in Africa (PHDA)

HealthRight Global Network Retreat

• Read more about HealthRight Global Network Retreat

HealthRight International: Providing Psychological Support to Children through Barnahus Centers

• Read more about HealthRight International: Providing Psychological Support to Children through Barnahus Centers

HealthRight Summer Internship Program Kenya Trip

• Read more about HealthRight Summer Internship Program Kenya Trip

HEART Women & Girls

A program to ensure that Muslim women on college campuses have access to sexual health resources. HEART aims to ensure that muslim students have the language to confront sexual violence and the resources to move forward if it happens.

• Read more about HEART Women & Girls

Heroin Cessation and HIV Risk: A Case-Control Study (NIH)

The purpose of this case-control study is to characterize the prognostic indicators, including HIV infection, for the positive outcome of sustained heroin cessation among persons with a prior history of chronic heroin use within economically disadvantaged, predominantly racial/ethnic minority neighborhoods in New York City (NYC). With drug use as a major risk factor for HIV and a chronic relapsing condition, identifying factors that promote sustained cessation can be key to enhancing HIV prevention and treatment efforts.

• Read more about Heroin Cessation and HIV Risk: A Case-Control Study (NIH)

Hurricane Disaster Management Plan during COVID-19 Pandemic

A disaster plan to prepare the public for emergency procedures in case of natural disaster during hurricane season while also in the midst of a pandemic.

• Read more about Hurricane Disaster Management Plan during COVID-19 Pandemic

Identifying Barriers and Opportunities to Essential Medical and Psychosocial Services Among Women Who Inject Drugs in Ukraine

Research focusing on the barriers to medical and psychosocial services for women. More specifically, looking at sexual and reproductive health services in Ukraine. Students and faculty worked to inform future grant applications and create models to increase access to services for WWID in Ukraine.

• Read more about Identifying Barriers and Opportunities to Essential Medical and Psychosocial Services Among Women Who Inject Drugs in Ukraine

Impact of Health Department Worker Safety Training on Health Impacts After Sandy (Columbia)(CDC)

The objective of the research is to identify data gaps, build on existing approaches and methodologies, and increase knowledge about exposures to hazardous pollutants, chemicals and other related physical and mental health impacts during response and recovery activities following Hurricane Sandy.

• Read more about Impact of Health Department Worker Safety Training on Health Impacts After Sandy (Columbia)(CDC)

Impact of Health Reform on Outpatient Substance Abuse Treatment Programs (Rhode Island Hospital)(NIH)

This study will examine how the Patient Protection and Affordable Care Act (PPACA) of 2010 affected the nation's outpatient substance abuse treatment system - a health services sector with important effects on the public health. It will thus contribute to our understanding of the impact of the PPACA and related policy changes on health service delivery in substance abuse treatment programs. Such information will enable policy makers and stakeholders to determine the effect of the PPACA in improving the accessibility and quality of substance abuse treatment.

• Read more about Impact of Health Reform on Outpatient Substance Abuse Treatment Programs (Rhode Island Hospital)(NIH)

Impact of Neighborhoods and Networks on HIV Risk and Care Behaviors Among Black MSM in the Deep South

• Read more about Impact of Neighborhoods and Networks on HIV Risk and Care Behaviors Among Black MSM in the Deep South

Impact of Occupational Exposure to COVID-19 on the Physical and Mental Health of an Essential Workgroup: New York City Transit Workers

Since early March 2020, Drs. Robyn Gershon, Alexis Merdjanoff, and Rachael Piltch-Loeb met with the leadership of the Transport Workers Union, Local 100 (TWU) to collaborate on research that was a first step toward determining risk factors for COVID-19 exposure in this essential workforce.

• Read more about Impact of Occupational Exposure to COVID-19 on the Physical and Mental Health of an Essential Workgroup: New York City Transit Workers

Implementing tobacco use treatment in HIV clinics in Vietnam

A program of translational, population-based, and policy-relevant research. The goal of the project is to optimize implementation of tobacco use treatment in health care delivery systems aw erll as accelerate implementation of tobacco control policies. Innovation was key to developing an approach to making treatment of nicotine addiction more accessible. 

• Read more about Implementing tobacco use treatment in HIV clinics in Vietnam

Independent Drivers Guild NYC COVID-19 Driver Safety Training

• Read more about Independent Drivers Guild NYC COVID-19 Driver Safety Training

Integrated Community-Clinical linkage model to promote weight loss among South Asians with pre-diabetes

This project includes a series of tests intended to test the efficacy of an integrated EHR-CHW intervention among South Asians at risk for diabetes. The project took place over a five month time period documenting group sessions, action plans, and follow-up phone calls.

• Read more about Integrated Community-Clinical linkage model to promote weight loss among South Asians with pre-diabetes

Ivory Coast Mothers and Children

GPH worked with Ivory Coast mothers and Children on their vaccine initiative in Braffoueby. The effort included vaccinating children, distributing prenatal vitamins and vitamin A to the community.

• Read more about Ivory Coast Mothers and Children

Keeping Pace: Dynamic Assessment of Environment and Exercise Using Personal Health Data

An agile research proposal from the Health Data Exploration Project, this project will use data from RunKeeper to understand how relationships between the built environment and exercise change over time.

• Read more about Keeping Pace: Dynamic Assessment of Environment and Exercise Using Personal Health Data

LABOR MANAGEMENT PROJECT WORKSITE WELLNESS PROGRAM (United Healthcare Workers East)

The 1199SEIU United Healthcare Workers East and the League of Voluntary Hospitals and Homes are working together to strengthen worksite wellness activities to improve health outcomes for 1199SEIU members. 1) Two key activities are proposed to support the LMP Worksite Wellness Program: Technical assistance will be provided to support worksite wellness projects funded by the LMP. 2) A strategic plan will be developed to maximize the effectiveness of the LMP Worksite Wellness Program. Key questions and issues to be addressed include Dr.

• Read more about LABOR MANAGEMENT PROJECT WORKSITE WELLNESS PROGRAM (United Healthcare Workers East)

Li Ka Shing Foundation Initiative for Global Mental Health and Wellness

• Read more about Li Ka Shing Foundation Initiative for Global Mental Health and Wellness

Management of Flooding in Karachi, Pakistan

A team effort to create a disaster plan to aid in the creation of a cost effective sewage system and an evacuation plan for flooding and future natural disasters by collaborating with the NDMA. The plan was also created to work with the Orangi Pilot Project to address the threat to low income families during disasters.

• Read more about Management of Flooding in Karachi, Pakistan

Measuring Playground Utilization in New York City (New Yorkers for Parks)

Playgrounds are assumed to be an important resource for physical activity. This study investigates seasonal utilization, user preferences, and perceptions of safety and upkeep of public playgrounds in New York City. A cross-sectional survey was conducted from May 2010 to January 2011 across 10 playgrounds in low/middle income neighborhoods in each of the five boroughs in New York City. A total of 1,396 adults accompanying children were surveyed. Outcomes included playground as main place of outdoor play, and perceptions of playground upkeep and safety.

• Read more about Measuring Playground Utilization in New York City (New Yorkers for Parks)

MOLECULAR MECHANISMS OF FILARIAL ENDOSYMBIOSIS (New York Blood Center) (NIH)

Nematodes cause the most common parasitic infections of humans, and the tissue-dwelling filarial worms produce the most severe pathology associated with these infections. Current control programs, however, which are universally based upon the mass distribution of a small arsenal of drugs are exceptionally vulnerable to failure in the event resistance develops. What is lacking is a method to kill or permanently sterilize the adult female parasites, making it critically important to support additional research leading to the discovery of novel drug targets.

• Read more about MOLECULAR MECHANISMS OF FILARIAL ENDOSYMBIOSIS (New York Blood Center) (NIH)

MPH Students' Internship at UNICEF Working with Rohingya Refugees

• Read more about MPH Students' Internship at UNICEF Working with Rohingya Refugees

Mycetoma Reduction and Prevention in Sudan

A student project designing a patient support system for mycetoma patients. The project is supported by the SAMU-MSF and Mediforum Mediclinic Hospital, Drugs for Neglected Diseases Initiative, Mycetoma Research Center.

• Read more about Mycetoma Reduction and Prevention in Sudan

NATIONAL EVALUATION OF THE ROBERT WOOD JONHSON FOUNDATION'S URBAN HEALTH INITIATIVE

Diana served as the project director for the evaluation, a twelve-year study of multi-million dollar study.

• Read more about NATIONAL EVALUATION OF THE ROBERT WOOD JONHSON FOUNDATION'S URBAN HEALTH INITIATIVE

National Nutrition Policy and World Food Programme Interventions

The United Nations World Food Program led this initiative to find cost-effective options for better nutritional habits in Madagascar. The project included a bottleneck analysis of national nutrition policy and WFP nutrition programming.

• Read more about National Nutrition Policy and World Food Programme Interventions

Neighbourhood Old Age Homes (NOAH)

An effort to provide a better quality of life for social pensioners in South Africa. NOAH provides assistant living communities, health care and community facilities. Their initiative also addresses the mental stresses of the community by working to provide counseling and support services.

• Read more about Neighbourhood Old Age Homes (NOAH)

Neurology Mission

A neurology mission to evaluate neurological concerns of patients in the Napo Province. During the mission, physicians provide free medical resources alongside 500 volunteers.

• Read more about Neurology Mission

NEW JERSEY SANDY CHILD AND FAMILY STUDY (Rutgers) (NJ-S-CAFH)

The Program on Population Recovery and Resiliency at NYU GPH will provide Rutgers University with research services related to their proposed contract with the State of New Jersey to conduct an assessment of populations affected by the October 2012 Superstorm Sandy.

• Read more about NEW JERSEY SANDY CHILD AND FAMILY STUDY (Rutgers) (NJ-S-CAFH)

Observing Individual Behaviors Outside of COVID-19 Hotspots

• Read more about Observing Individual Behaviors Outside of COVID-19 Hotspots

Omics-Based Predictive Modeling of Age-Dependent Outcome to Influenza Infection (NIH)

The focus of this project is to integrate multi-scale data collected over the course of influenza infections-including system-wide transcriptomics and meta- transcriptomics, immunological response and physiological markers, along with viral diversity-in order to perform network analyses and develop computational models that predict severe disease outcome.

• Read more about Omics-Based Predictive Modeling of Age-Dependent Outcome to Influenza Infection (NIH)

One World Health

A series of sustainable efforts to provide more affordable healthcare services and facilities to improve the quality of life in those communities. The ultimate goal of One World Health is for those facilities to become self-sufficient within 18 to 24 months.

• Read more about One World Health

OneWorld Health Internship

• Read more about OneWorld Health Internship

Optimizing the implementation of tobacco use treatment in the context of lung cancer screening

Working with the Lung Cancer Alliance, 18 heterogeneous lung cancer screening sites were observed to To estimate the cost and incremental cost-effectiveness of evidence based tobacco treatment components and creating effective models for smoking cessation treatment in lung cancer screening settings.

• Read more about Optimizing the implementation of tobacco use treatment in the context of lung cancer screening

PAN Foundation

PAN Foundation works with federally and commercially insured people living with life-threatening chronic and rare diseases with out-of-pocket costs for prescribed medicines to come up with initiatives to improve the quality of life for patients.

• Read more about PAN Foundation

PATHOGENESIS OF OBSTRUCTION/EMPHYSEMA AND THE MICROBIOME (POEM) IN HIV (U of Pittsburgh)(NIH)

Application of metagenomic techniques will allow us to determine patterns and changes in the population of microbes that play a key role in the pathogenesis and progression of emphysema in this population. The overall goals of this proposal are to determine the respiratory microbial flora (or microbiota) in HIV-I- and HIV- subjects and to establish its role in pathogenesis and progression of HIV-associated COPD using our ongoing cohorts. Specific aims of the proposal are: 1. To compare the microbial community structure in the respiratory tract in subjects with and without HIV infection. 2.

• Read more about PATHOGENESIS OF OBSTRUCTION/EMPHYSEMA AND THE MICROBIOME (POEM) IN HIV (U of Pittsburgh)(NIH)

PCOS Challenge

A non-profit organization focused on improving the lives of women with PCOS by improving communication tools used with patients to learn about their treatment options and increase patient education in evidence based treatment options.

• Read more about PCOS Challenge

PRE-EXPOSURE PROPHYLAXIS UPTAKE AND ADHERENCE AMONG MALE SEX WORKERS IN MOMBASSAM, KENYA

HealthRight International and the Center for Health, Identity, Behavior and Prevention Studies (CHIBPS) will evaluate the efficacy and feasibility of pre-exposure prophylaxis (PrEP) to prevent HIV infections in a population of male sex workers (MSW) in eastern Kenya. This project aims to be among the first to evaluate the feasibility, acceptability and impact of pre-exposure prophylaxis (PrEP) on HIV risk among male sex workers (MSW) in Malindi, Kenya.

• Read more about PRE-EXPOSURE PROPHYLAXIS UPTAKE AND ADHERENCE AMONG MALE SEX WORKERS IN MOMBASSAM, KENYA

Project 18 (P18) Neighborhood Study

• Read more about Project 18 (P18) Neighborhood Study

Project HEED (Help Educate to Eliminate Diabetes)

Project HEED provides workshops to help those looking for lifestyle changes to reduce the impact of diabetes in adults who are of Caribbean descent. The program utilizes community-based research methods in a peer-led environment.

• Read more about Project HEED (Help Educate to Eliminate Diabetes)

A project focused on continuous quality improvement and scale-up methods to reduce heterosexual acquisition of HIV through volunteer medical male circumcision programming in East and South Africa. Another aim of this project is to optimize existing voluntary male medical circumcision clinics and scaling up sustainable models for maintaining early infant male circumcision coverage.

• Read more about Project IQ

Project P-18 Viral

This ancillary study of HPV and HSV-1 and -2 infection as part of the P18 Cohort Study of racially/ethnically and socioeconomically diverse YMSM seek to (1) to detect cases of oral and anal HPV infection through site-specific PCR testing and clinically significant HPV subtype through serotyping and to estimate HPV persistence and clearance rates; (2) to identify uptake and completion of HPV vaccination via a combination of self-reported vaccination history in addition to New York State HPV vaccine registry verification; (3) to determine the prevalence and

• Read more about Project P-18 Viral

Project UPLIFT (Using Practice and Learning to Increase Favorable Thoughts)

A program that teaches skills to treat and prevent depression in English-speaking PWE via telephone. Activities included in the program were focus groups for Spanish-speaking adults with epilepsy. 

• Read more about Project UPLIFT (Using Practice and Learning to Increase Favorable Thoughts)

Prospective Urban and Rural Epidemiology (PURE) Study

• Read more about Prospective Urban and Rural Epidemiology (PURE) Study

Reducing Stigma and Improve Adherence in HIV+ Pregnant Women in Botswana

• Read more about Reducing Stigma and Improve Adherence in HIV+ Pregnant Women in Botswana

Researching Short- and Long-Term Dangers of Chemical Contaminants to Early Childhood Development

• Read more about Researching Short- and Long-Term Dangers of Chemical Contaminants to Early Childhood Development

Roots of Health

An organization working to provide reproductive health services in the Philippines such as reproductive health classes and clinical services that focus on educating the next generation of women and girls on their bodies and resources to get help and stay protected.

• Read more about Roots of Health

SHOREline (Columbia) (Baton Rouge Area Foundation)

The project has the following objectives:

1. Analyze the GCPI survey data and develop a journal article in collaboration with NCDP;

2. Provide overall strategic direction for the SHOREline youth development program, which includes the development of foundational documents, provision of guidance to the chapters and field coordinators, and development of a long-term sustainability plan;

3. Development and dissemination of a standardized didactic and project-based learning curriculum to participating SHOREline high schools;   

• Read more about SHOREline (Columbia) (Baton Rouge Area Foundation)

T.E.A.L (Tell Every Amazing Lady) about Ovarian Cancer is a national movement dedicated to informing more women about the signs to look for and treatment options for ovarian cancer.

• Read more about T.E.A.L

TAILOR PEER-BASED SLEEP HEALTH EDUCATION AND SOCIAL SUPPORT IN BLACKS WITH OSA (NYU SoM)(NIH)

This collaborative research project will build capacity to support evaluation and referral of black men and women at risk for sleep apnea at the community level. It will examine whether a culturally and linguistically tailored peer-based sleep health intervention will increase adherence to recommended sleep apnea screening and treatment among blacks in barbershops, beauty salons and churches. Three hundred and ninety eight blacks will be enrolled in the study and followed for a year to evaluate intervention responses and examine environmental drivers of health disparities.

• Read more about TAILOR PEER-BASED SLEEP HEALTH EDUCATION AND SOCIAL SUPPORT IN BLACKS WITH OSA (NYU SoM)(NIH)

The Alliance for Eating Disorder Awareness Postdoctoral Fellowship

The Alliance for Eating Disorder Awareness provides community through safe spaces and support groups for individuals working through illness. Their postdoctoral fellowship puts students alongside a clinical team that treats uninsured patients.

• Read more about The Alliance for Eating Disorder Awareness Postdoctoral Fellowship

The Interfaith Public Health Network

IPHN partners with other organizations to draw attention to the issues surrounding the social determinants of health and mobilize faith communities to take action with barriers to health as a result of racism, income, employment and poverty to name a few.

• Read more about The Interfaith Public Health Network

The Restore Cup: Developing a Theory of Change

The study of an inexpensive medical device for women with obstetric fibula in Sub-Saharan South Africa. The NYU Global Health team is apart of the group conducting clinical trials for women who may be preparing for surgery or cannot access a successful surgery.

• Read more about The Restore Cup: Developing a Theory of Change

THE ZIKA WOMEN'S PANEL STUDY

The study is funded by the Robert Wood Johnson Foundation, examines intra-individual change in risk perception of the Zika virus among a panel of 200 women of child-bearing age as the science and the epidemiology evolve.

• Read more about THE ZIKA WOMEN'S PANEL STUDY

Themes of Residual Colonization in Migration and Health Research in Post-Apartheid South Africa

Fieldwork focusing on how residual colonization impacts migration and health research in South Africa today. A team asks questions that gets to the core of how migration impacts economic policy and institutions.

• Read more about Themes of Residual Colonization in Migration and Health Research in Post-Apartheid South Africa

Thrive London

An initiative from the Mayor of London in collaboration with Greater London Authority to improve mental health in the city. The initiative includes funding for youth organizations and student societies to improve the awareness and well-being of young people when it comes to their mental health.

• Read more about Thrive London

Uganda Tuberculosis Implementation Research Consortium

A program focusing on the predictors of evaluation in child contacts of TB patients.

• Read more about Uganda Tuberculosis Implementation Research Consortium

Ukraine PrEP Use

Ukraine has the second highest HIV epidemic in Europe. Researchers are looking to assess the the use of PrEP in a pilot program led by The Alliance for Public Health in Ukraine. The project also aims to study the feasibility and costs of two PrEP program models for MSM in Ukraine.

• Read more about Ukraine PrEP Use

UNDERSTANDING THE DIFFUSION AND IMPACT OF STATE ALCOHOL AND TRAFFIC POLICIES (NIH)

Traffic fatalities are the second largest contributor to years of life lost before age 75 and are the leading cause of death among youth aged 15-24 years. Alcohol involvement in these crashes has remained relatively steady despite overall declines in traffic fatality rates. Public policies (laws, regulations, penalties) concerning alcohol and car safety have contributed to these declines, but there is enormous variation in policies among states. To date, little scholarship has systematically investigated the impact of such a diverse regulatory environment on health outcomes.

• Read more about UNDERSTANDING THE DIFFUSION AND IMPACT OF STATE ALCOHOL AND TRAFFIC POLICIES (NIH)

Using SMS Data To Improve Ebola Models and Estimate the Impact of Ebola on Healthcare Seeking Behavior in Liberia

Awarded to Dr. Chunara (GIPH) and Dr. Karen Grepin (Wagner), in this project, this study will crowdsource information about Ebola incidence and related-health behaviors in Liberia using SMS.

• Read more about Using SMS Data To Improve Ebola Models and Estimate the Impact of Ebola on Healthcare Seeking Behavior in Liberia

Voices and Perspectives on Migrant Health in Milan, Italy

This qualitative research project focuses on migrant health in the Lombardi region of Italy. The project documented the perceptions of migrant patients and healthcare providers.

• Read more about Voices and Perspectives on Migrant Health in Milan, Italy

WATCH (LSU)(NIH)

Employing a multi-disciplinary team, this project will analyze data provided by the LSU WaTCH investigators using an ecological bio-behavioral stress model that explores the complex paths from exposure to dysfunction among Gulf Coast children exposed to the Deepwater Horizon oil spill.

The overall goals of this project are to: (1) understand the short- and longer-term impacts of the oil spill on children’s development and well-being; and (2) examine how parental and social forces, and alternative treatment models can mediate or modify the spill’s effects on children.

• Read more about WATCH (LSU)(NIH)

Wellness Tips for Alaskan Parents: Applying the CDC Clear Communication Index

Hosted by the Rede Group, a joint effort between the Alaska Public Health Division Obesity Prevention and Control Program to assess changes needed to make to marketing materials for parents of young children using the CDC Clear Communication Index.

• Read more about Wellness Tips for Alaskan Parents: Applying the CDC Clear Communication Index

WIC's Farmer's Market Initiative

This project aimed to develop a strategic approach to provide education around the utilization of WIC checks at farmers’ markets, with the goal of improving redemption rates throughout the season.

• Read more about WIC's Farmer's Market Initiative

William N. Rom Climate Fellowship

• Read more about William N. Rom Climate Fellowship

Women in Leadership

Students focus on the state of sexual reproductive health for women in Uganda. This includes creating educational sessions for women and girls at health centers and within education facilities. Students complete their own research and fieldwork as well on reproductive health and family planning.

• Read more about Women in Leadership

Zika Contraception Access Network

A program dedicated to providing contraception for women who want to delay pregnancy during Zika outbreak in Puerto Rico by increasing provider and staff education regarding contraceptive counseling by designing new educational tools.

• Read more about Zika Contraception Access Network

ZIKA RISK SALIENCE AND EVOLVING RISK COMMUNICATION CHALLENGE

This study is funded by the Decision, Risk and Management Sciences/National Science Foundation. This research involves a series of representative national panel surveys to examine how various social, scientific, and policy cues influence the US public’s appreciation of the risk of the Zika virus over time, as well as the public’s receptivity to various clinical, environmental, and behavioral interventions.

• Read more about ZIKA RISK SALIENCE AND EVOLVING RISK COMMUNICATION CHALLENGE

Research Projects

Our faculty are involved in research projects in in Infectious Disease, Maternal & Child Health, Adolescent Health and Food Systems & Planetary Health. Click on the boxes below to read about their individual research projects!

News from the School

From public servant to public health student

Exploring the intersection of health, mindfulness, and climate change

Conference aims to help experts foster health equity

Building solidarity to face global injustice

colorado school of public health

Colorado sph, center for global health, research & projects.

Affiliates and associated partners with the Center for Global Health conduct research in countries around the world, with new projects added to our database every day.  See a complete list of publications highlighting our faculty's research from 2022-2023.

Featured Project: ​Guatemala Signature Site

Collaborations Building Global Health in Rural Guatemala

With a million dollar gift from the Jose Fernando Bolaños Foundation, University of Colorado and Children's Hospital Colorado health professionals are building new collaborations to develop and improve the community health of El Pomal, Guatemala. Learn more about their community collaborations and inspiring work.

Project map

To learn more about our efforts around the world, click on the pinpoints on the map (blue indicates active projects, red indicates completed projects). Then, scroll down below for information about individual projects by topic. To navigate around the map, click the zoom-in (-) and zoom-out (+) icons, as well as the directional symbols (arrows)​, in the upper left hand corner. After clicking on a blue pinpoint you will want to scroll to read the entire project description. Click the left or right of the description; a hand will appear, hold mouse and move it up and down to scroll.

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CDC Global Health Strategy

At a time when the COVID-19 pandemic substantially affects all Americans, CDC’s commitment to our vision to create a world where all people – in the United States and around the globe – live healthier, safer and longer lives is more essential than ever. CDC’s mission to protect the American people from health threats, through direct response and partnering with countries around the world to strengthen their ability to respond to infectious disease threats, is unwavering.  As the lead U.S. Government (USG) agency dedicated to the health and safety of the American people, and the lead technical global public health agency for the US, CDC works 24/7 worldwide to reduce morbidity and mortality and safeguard communities by addressing global health threats.  Achieving this vision requires that CDC draw upon its superior scientific and technical expertise, innovation, and research to address known infectious disease threats, new and emerging threats such as SARS-CoV-2, and prepare for the inevitable next  global public health threat, whether naturally occurring or man-made.

CDC understands the importance of the trust placed in the science and technical leadership of the agency to keep Americans safe from public health threats both domestically and abroad. The COVID-19 pandemic has far-reaching social and economic impacts, including disruption of essential healthcare services and interruption of life-saving public health programs such as those focused on preventing death and disability from measles, polio, malaria, HIV, TB, and other high burden diseases.  CDC recognizes the need to remain focused on the response to the COVID-19 pandemic, as a critical partner in a whole of government approach, while mitigating the long-term impacts on public health systems by planning for recovery and resiliency now.  CDC has a critical leadership role as the global public health enterprise focuses on transformational shifts in how we protect the population from public health threats.  This effort requires innovation, expansion of strong partnerships, and the timely application of lessons learned from our response to the COVID-19 pandemic.

(See appendix for CDC’s Strategy for Global Response to COVID-19 .)

CDC’s global health strategy is built around the agency’s core strengths:  scientific leadership and expertise, development of a public health workforce, laboratory capacity and innovation, and data analytics to drive impact.  CDC’s unique expertise in using public health data to inform decisions and establishing systems for emergency operations and response provides collaborations that strengthen global health security.  In addition, CDC has deep technical expertise in disease-specific areas, operational research, implementation and evaluation of public health programs, building public health infrastructure, and provision of technical assistance through partnerships with Ministries of Health (MOHs), other public health institutions, non-governmental organizations (NGOs), and private sector industries. As the lead agency for domestic public health, CDC is uniquely positioned to facilitate and leverage scientific knowledge and expertise across domestic and global public health programs and emergency responses.  CDC experts and international CDC-trained public health specialists provide the critical, well-trained workforce needed to respond to existing disease outbreaks and to prepare for future threats. CDC’s forward-deployed staff are America’s first line of defense to protect Americans’ health when infectious disease outbreaks erupt around the world and respond to disease threats wherever they occur.

CDC Global Health Strategy 2019 - 2021 (For Print) [PDF - 2 MB]

The CDC aspires to create a world where people – in the United States and around the globe – live healthier, safer, and longer lives.

CDC’s global health mission is to improve and protect the health, safety, and security of Americans while reducing morbidity and mortality worldwide.

Goals and Objectives

Objective 1.1: Strengthen the capacity to prevent and detect disease outbreaks and other public health threats

Objective 1.2: Strengthen the capacity for timely and effective response to disease outbreaks and other public health threats

Objective 1.3: Strengthen the capacity to build resilient public health systems to protect and secure essential healthcare services

Objective 2.1: Reduce the morbidity and mortality of high burden diseases and conditions

Objective 2.2: Eliminate and eradicate priority diseases and other public health threats

Objective 3.1: Develop and apply global public health scientific, laboratory, and programmatic expertise

Objective 3.2: Translate and disseminate evidence-based research and data into global health guidance, policy, and programs

Objective 3.3: Drive innovation to accelerate new, more effective tools, products, strategies, and technologies

Objective 3.4 Promote and ensure health equity as a central tenet across public health science, program and policy

Pillars of CDC’s Global Health Strategy

CDC serves as a leading source of credible scientific information, demonstrated record of trailblazing science, evidence-based decision-making and action, global reference laboratories for emerging and diseases of pandemic potential, and an experienced workforce that is comprised of experts in their fields. Our workforce is available to address the most urgent global public health threats.

CDC fosters health diplomacy in coordination with other U.S. Government agencies through its longstanding bilateral and multilateral partnerships, engagement with the private sector, and ongoing collaborations with academic institutions and foundations. CDC maximizes the agency’s unique role while leveraging these diverse partnerships to achieve measurable health impact around the world.

CDC takes seriously its responsibility to be a good steward of resources by demonstrating impact on leading public health priorities, establishing and strengthening sustainable country, regional and international public health systems, reducing the economic impact of disease outbreaks globally, and building lasting capacity for countries to address current and future health needs.

CDC leverages the latest technologies and advanced analytics to accelerate public health impact. CDC develops new medical countermeasures, diagnostics, laboratory and data platforms, and explores new ways to innovate across its global health portfolio by identifying unique models of collaboration and partnerships.

CDC helps to eliminate health disparities and achieve optimal health for all. CDC addresses health equity and reaches those in greatest need through its global programs, research, tools and resources, and leadership.

INTRODUCTION

Background and Context Since the establishment of the U.S. Centers for Disease Control and Prevention (CDC) in 1946, the agency’s global health work has grown in scale, scope, and complexity to address evolving public health challenges and emerging threats around the world. With an initial focus on malaria elimination in the United States, CDC’s leadership and engagement expanded over time to address a range of diseases and conditions, improve global health preparedness and security, and enhance science-based knowledge and practice.

In today’s interconnected world, a disease threat anywhere is a disease threat everywhere. From a global health perspective, domestic and international health are inseparable; no one country can safeguard the health of its citizens in isolation from the rest of the world. In order to protect our communities at home, traveling, living, and working abroad – including armed services personnel deployed overseas – CDC works with international partners to stop public health threats at their source. CDC drives change to make a lasting public health impact, mitigate health threats and help ensure stability to protect Americans and foster safe, secure, and healthy societies worldwide.

Future of Global Health A health threat anywhere is a health threat everywhere in this increasingly globalized world; therefore, public health is at a crossroads and CDC is adapting and innovating to meet the new challenges.  These new range of health challenges are tied to global production of food and medicine, an increase in global travel, more frequent and severe weather events, and a steady rise in the world’s population. Outbreaks from Ebola to novel Influenza are increasingly identified in places not seen before. An aging population means people are living longer with chronic diseases, which are more costly and complicated to treat. The growing proportion of young people in sub-Saharan Africa, who will be at risk of exposure to HIV, threatens gains made in hard-won declines in new HIV infections.

Additionally, with innovations from the private sector and an increase in academic institutions and non-profit organizations implementing global health programs, CDC must not only collaborate with these organizations but also continuously bring new approaches and efficiencies to CDC’s work around the world to deliver its public health mission in the most effective way.

The purpose of this strategy is to articulate CDC’s unique global role in public health. As the lead public health agency for the United States and a renowned global organization, CDC continues to make measurable, sustained progress in the highest impact areas, based on burden of disease evaluations, the likelihood of producing positive effects, and an awareness of the economic implications of public health action, for a range of future and ongoing public health threats.

CDC Global Health Vision, Mission, and Principles The CDC aspires to create a world where people – in the United States and around the globe – live healthier, safer, and longer lives. As the lead U.S. Government (USG) agency dedicated to the health and safety of the American people, CDC works 24/7 worldwide to reduce morbidity and mortality and safeguard communities by addressing global health threats before they affect the United States. Achieving this vision requires that CDC draws upon its scientific and technical expertise, innovation, and research to address known and emerging public health threats globally, whether naturally occurring or man-made.

CDC’s global health mission is to improve the health, safety, and security of Americans while reducing morbidity and mortality worldwide. The agency does this through its expertise, unique technical skills, scientific knowledge and research, collaborative partnerships, and evidence-based, global public health action. CDC executes its global health vision and mission by focusing on three goal areas: 1) achieving measurable global health impact, 2) assuring global health security, and 3) providing world-renowned public health science leadership and expertise.

Furthermore, the following principles(referred to as “pillars” previously) guide CDC’s global public health work across the agency:

• Scientific Expertise –CDC has a demonstrated record of trailblazing science, evidence-based decision-making and action, and an experienced workforce that are experts in their field. Our workforce is available to address the most urgent global public health issues.
• Diverse Partnerships – CDC fosters health diplomacy through its longstanding inter-agency partnerships, bilateral and multilateral partnerships, engagement with the private sector and ongoing collaborations with academic institutions and foundations. CDC is able to maximize the agency’s unique role while leveraging these diverse partnerships to achieve measurable health impact around the world.
• Innovation – CDC leverages the latest technologies and advanced analytics to accelerate public health impact. CDC develops new medical countermeasures, diagnostics, laboratory and data platforms and explores new ways to innovate across its global health portfolio by identifying unique models of collaboration and partnership.
• Sustainability – CDC takes seriously its responsibility to be a good steward of resources by demonstrating impact on leading public health priorities, fostering technical sustainability, reducing the economic impact of disease outbreaks globally, and building lasting capacity for countries to address current and future health needs.
• Health Equity – CDC works to eliminate health disparities and achieve optimal health for all. CDC addresses health equity and reaches those in greatest need through its global programs, research, tools and resources, and leadership.

CDC Global Health Goals, Objectives, and Strategies CDC global health objectives align with a number of national strategies and plans including the Department of Health and Human Services (HHS) Strategic Plan, the CDC Strategic Framework, the U.S. National Security Strategy, the National Biodefense Strategy, and the U.S. Global Health Security Strategy. CDC’s work supports a number of global and presidential initiatives across several health priorities, including the Global Health Security Agenda, the Global Polio Eradication Initiative, the Measles and Rubella Initiative, the National Action Plan for Combatting Antibiotic Resistant Bacteria (CARB), the Neglected Tropical Disease Initiative, the President’s Emergency Plan for AIDS Relief (PEPFAR), and the President’s Malaria Initiative (PMI). CDC works with multilateral partners like the World Health Organization (WHO), World Organization for Animal Health (OIE), Food and Agriculture Organization (FAO), and USG agencies like the U.S. Agency for International Development (USAID), Department of State (DoS), and Department of Defense (DoD). These diverse, multi-sectoral partnerships best position the agency to affect  change, maximize impact, and prevent disease among people in the United States and around the world.

As the U.S. public health agency, CDC plays a prominent role in identifying and addressing leading causes of morbidity and mortality worldwide. Through cutting-edge science, real-time surveillance, laboratory diagnostics, and collaborative partnerships, CDC develops evidence-based programs and interventions to target effectively diseases, populations, and regions. CDC leverages the expertise of its workforce — both at headquarters and in the field — to improve health and well-being around the world, continuously building the evidence base, scaling up what works, and applying lessons learned to reducing and eliminating future health threats.  CDC works diligently to enhance the capacity of other countries to prevent, detect, and respond to diseases and other public health threats at their source, helping to save lives, improve health, and eliminate disease in regions across the globe.

• Collect data, analyze the information, and report on key findings to build the evidence base, target specific populations, and tailor preventive interventions
• Develop data-driven strategies and programs to prevent disease, promote optimal health, and improve health outcomes
• Implement, optimize, evaluate and scale interventions to maximize health impact and sustain improved health and well-being

A. Achieving an AIDS-Free generation CDC supports the design and implementation of HIV-focused population surveys, sometimes referred to as “PHIAs” – Population-based HIV Impact Assessments, which provide the clearest picture to-date of the HIV epidemic in some of the world’s most affected countries. These national surveys – implemented under the leadership of Ministries of Health and by PEPFAR, CDC, and partners such as ICAP at Columbia University and the University of Maryland– directly measure progress toward global targets to control the HIV epidemic.

Recent data show that up to 13 high-HIV-burden countries are poised to achieve epidemic control by 2020.  For example, Ethiopia has reached HIV/AIDS epidemic control and data from Uganda indicate that its previously expanding epidemic has stabilized. CDC also uses data from these assessments to inform planning and the decisions surrounding real-world, real-time public health solutions. CDC plays a critical role in their implementation, lending expertise in epidemiology, laboratory science, and data analysis to help partners design and implement the surveys, and rapidly harness the results for program improvement.

B. Innovating TB and Malaria prevention and treatment The Malaria Frontline project in Nigeria, building on  infrastructure established for polio eradication, is providing early lessons about how systematic collection and review of malaria case data can be used to inform local decisions about distribution of malaria commodities and timing of community-level prevention activities.

Tuberculosis (TB) is the leading infectious cause of death and the leading cause of death for people living with HIV (PLHIV).  Worldwide, an estimated 40% of deaths in PLHIV are due to TB.  TB preventive therapy (TPT) reduces 5-year mortality among PLHIV by 37%, independent of HIV treatment. Although the use of preventive therapy has been a World Health Organization (WHO) recommendation for PLHIV and children <5 years exposed to persons with TB since 1993, global uptake has been extremely slow.  Of the 34.5 million adults living with HIV, only 4.8 million (14%) were ever reported to have been started on preventive therapy since 1993. To address this gap, CDC, through PEPFAR programs, has prioritized TPT with guidance to countries, as well as requiring reporting for TPT initiation and completion. CDC is working closely with its country offices providing technical assistance to improve and expand scale-up of TPT.

C. Optimizing impact of pneumococcal conjugate vaccines To date, 142 countries have introduced pneumococcal conjugate vaccines (PCV) into their routine immunization programs; CDC has worked with over 35 of these countries to monitor PCV impact. For example, CDC worked with Haiti to strengthen their capacity for bacterial meningitis surveillance in anticipation of measuring PCV impact upon introduction in late 2018. Additionally, data from effectiveness studies conducted in South Africa with CDC and in-country partners resulted in a change in the PCV schedule. CDC is evaluating the impact of PCV by building epidemiological and laboratory capacity to help countries generate evidence regarding PCV introduction and sustained use. Through partnerships – with Ministries of Health, academic institutions, the World Health Organization, and other public health stakeholders,CDC has strengthened surveillance to monitor disease burden for pneumonia and meningitis and conduct studies to measure the effectiveness of PCV against disease and carriage.

• Provide pathogen-specific expertise, laboratory diagnostics, and decision analysis for targeted disease elimination, eradication, and control efforts
• Apply expertise and lessons learned from elimination and eradication efforts to inform future control strategies and prevent resurgence

A. Eradicating polio and combating vaccine-preventable diseases (VPD) CDC houses the global reference laboratories for measles, rubella, congenital rubella syndrome, and polio, providing support to global laboratory networks through training, reference testing, and research.   Advanced molecular analysis allows programs to track transmission of measles, rubella, and polioviruses, to guide programmatic efforts to interrupt circulation.  Environmental surveillance for poliovirus provides early warning of virus circulation before paralysis cases arise and additional evidence of interruption where paralysis cases are absent.  These laboratory tools contribute to programs that  are driving polio to the brink of extinction and reducing the number of annual global measles-related deaths to under 100,000 for the first time in 2016.

B. Developing advanced tools and techniques for detecting new microbes, biomarkers, and cases CDC researchers have developed a novel, integrated serosurveillance platform for public health use across vaccine preventable diseases, malaria, neglected tropical diseases, water-borne diseases, and maternal-child health programs,  that can simultaneously measure up to 100 different disease-specific antibodies from a single, dried blood spot, an easy-to-collect sample type.

C. Eliminating epidemic meningitis in Africa MenAfriVac, a novel vaccine against serogroup A meningococcal disease, was the first vaccine developed specifically for Africa and 21 countries have introduced the vaccine since 2018.

Developed by the Meningitis Vaccine Project, a partnership between PATH and the WHO with CDC support, MenAfriVac demonstrated dramatic success, largely eliminating epidemics of serogroup A. Likewise; the CDC-led MenAfriNet Consortium created an innovative partnership to enhance collaboration for strengthening regional surveillance and generating high-quality data to inform global immunization policy.

Disease knows no border; as a result, Americans’ health is connected integrally to the health of the rest of the world. National and economic security is a requisite for global health security, and CDC must protect Americans by working with countries to stop health threats at their origin. The agency works collaboratively with a variety of partners, with special emphasis on counterparts in Ministries of Health (MOHs) as well as regional health organizations, to improve global health preparedness by enhancing local capacity, systems, and infrastructure to prevent, detect, and respond to epidemics, outbreaks, humanitarian crises, and other public health threats whenever and wherever they occur. This increased capacity not only protects Americans from the global spread of disease, saving lives and livelihoods, but also helps drive and sustain improvement in local health outcomes.

A 2016 Report from the National Academies of Science, Engineering and Medicine  estimated that the cost of pandemics in the 21st century could cost U.S. $6 trillion, with an estimated annual loss of U.S. $60 billion from potential pandemics. However, the same report emphasized the role investments in preparedness and response can play in minimizing the impacts of pandemic threats.

• Apply laboratory diagnostic tools, emerging technologies, modeling, and data visualization to better predict outbreaks, identify them early, and improve monitoring and reporting
• Define and implement effective mitigation strategies to reduce the likelihood of outbreaks and limit the impact of public health threats
• Work with partners and countries to enhance networks, systems, and infrastructure to prepare for responses
• Provide technical expertise and external funding to build in-country capacity for real-time surveillance and detection

A. Improve country capacity to detect and respond to outbreaks and prevent future ones In 2010, CDC began a collaboration with the Uganda Virus Research Institute (UVRI) and the Ugandan Ministry of Health to establish a national surveillance and laboratory network to detect, confirm, and respond rapidly to viral hemorrhagic fever (VHF) outbreaks. Over the last 8 years, the program expanded lab diagnostic testing for VHFs and other zoonotic diseases, improved clinical recognition of cases, and used data collected from surveillance to inform disease-control decision making. The program now has over 20 sentinel surveillance sites throughout the country, which report to UVRI and the Ministry of Health when suspect VHF cases are identified. Together with the enhanced capability of VHF diagnostic testing and the ability also to screen suspect cases for wide spectrum of VHF and other pathogens, the time between clinical identification of a suspect VHF case and lab confirmation has been shortened from an average of 2 weeks to 2.5 days. This reduced the chance for additional person-to-person transmission of VHFs and has in turn reduced the size and scope of outbreaks. Perhaps most importantly, the Uganda surveillance program serves as a continent-wide resource for laboratory confirmation and outbreak response support. It also provides expert technical assistance to support Ministry of Health capacity building and training.

B. Develop and apply non-traditional surveillance tools and methods for real-time detection of emerging public health threats The recent Zika outbreak reminded the world how vulnerable mothers and babies are to emerging diseases. It also reminded the world that strong pregnancy and birth defects surveillance systems play a vital role in detecting threats. CDC’s expertise in and efforts to strengthen birth defects surveillance and infant follow-up systems domestically and globally have been critical to answering key questions about the impact of Zika virus infection during pregnancy. During the 2016 Zika Emergency Response, CDC developed an innovative pregnancy and birth defects surveillance system to monitor rapidly the impact of Zika virus on these populations. This system helped drive public health action, quickly arming healthcare providers with information to identify health problems and provide care for pregnant women and their babies.

As future threats emerge, CDC is better prepared to assist global partners by providing tools, support, and technical expertise. Surveillance activities for emerging threats may also involve expanded referral to services, improved health outcomes, and enhanced data reporting across local programs and organizations.

C. Training a multidisciplinary, global workforce Since its inception in 1980, CDC’s Field Epidemiology Training Program (FETP) has trained over 11,000 disease detectives worldwide. With program engagement in over 70 countries, CDC supports the development of a skilled public health workforce around the world who can find and stop outbreaks at their source, before they spread globally. These multidisciplinary “boots on the ground” responders (clinicians, veterinarians, scientists, etc.) have actively participated in responses to thousands of outbreaks of cholera, measles, yellow fever, and other diseases, by identifying suspected outbreaks early and raising standards for quality investigations.

More recently, CDC’s Public Health Emergency Management (PHEM) Fellowship provides critical training for professionals who work in public health preparedness and response across the globe. Conducted at CDC headquarters in Atlanta, the four-month program strengthens the ability of the international community to respond to public health threats efficiently and effectively.

Through specialized classes, mentorship, and technical assistance, PHEM Fellows learn the principles behind public health emergency management and the functions of an emergency operations center. Since the 2013 inaugural class, CDC has graduated 69 Emergency Management Specialists from 28 different countries.

PHEM Fellows return to their home countries to lead emergency responses,  decreasing response times to deadly threats like avian influenza, dengue, measles, and meningitis, increasing the world’s health security by containing these outbreaks at the source.

• Use training, mentorship, and simulations to improve global response capabilities of partner organizations and countries
• Roster, train, and deploy highly skilled public health professionals across multiple disciplines to support effective and rapid responses
• Collaborate with international stakeholders to promote adoption of international standards and strengthen surge capacity during global responses

A. Improving in-country emergency response capacity In August 2017, CDC spearheaded a 5-day Public Health Emergency Management (PHEM) workshop in partnership with the World Health Organization, the United States Defense Threat Reduction Agency, and Public Health England. The workshop brought together 55 emergency management staff members from across Africa to learn from experts in the field about how to enhance the coordination and response capabilities of their country’s PHEM programs.

B. Maintaining a rapid response capacity at CDC to respond to international public health emergencies The Global Emergency Alert and Response System (GEARS) serves as CDC’s one-stop shop for response needs, combining global detection, alert, and response support activities.  GEARS is integral to CDC’s rapid response activities and works across the agency to coordinate emergency activities. Through its standard operating procedures, GEARS helps to reduce uncertainty in emergency response support. GEARS brings together the long-standing Global Disease Detection Operations Center (GDDOPs), CDC’s electronic surveillance and analysis system for global threats, and the Global Rapid Response Team (GRRT), CDC’s deployment-ready and rostered experts. As a proven, critical agency asset, GEARS event detection efforts detected over 340 public health events in more than 100 countries in 2017. GEARS has rostered over 400 CDC deployers that have provided over 17,000 person-days of response support since 2015. A cross-agency effort, GEARS ensures experts are properly credentialed and trained to avoid delays in deployment – a lesson learned from the West Africa Ebola epidemic.

C. Expanding and establishing global influenza surveillance, detection and response CDC works with international partners to prevent, control, and respond to both seasonal and novel influenza threats.  Since 2004, CDC supports  more than 50 countries, all World Health Organization (WHO) regional offices, and WHO Headquarters via direct bilateral support to build a network to better detect and respond to influenza globally. CDC has increased virologic and epidemiologic influenza surveillance capacity to report and characterize influenza viruses, and has contributed to a large increase in the number of countries participating in WHO’s Global Influenza Surveillance and Response System (GISRS) from 57 in 2004 to 146 in 2017.   CDC’s international influenza work also includes assessing the economic burden of disease, quantifying vaccine effectiveness, and supporting introduction of vaccines among populations at high risk of influenza illness complications.

CDC’s greatest asset is its public health experts, including its epidemiologists, scientists, laboratory specialists, health economists, public health advisors, communicators, and behavioral scientists. The agency draws on its unparalleled scientific knowledge and technical capacity to  address known, new, emerging, and unknown threats globally. Leveraging the collective strengths of its multidisciplinary staff and partners, CDC sets priorities and drives innovation for global public health science, laboratories, and programs. Serving as a model for and working collaboratively with partners and countries across the world, CDC accelerates the implementation, evaluation, and scaling of impactful, cost-effective programs, and provides the guidance needed to improve health worldwide.

• Conduct and support science that increases the understanding of the epidemiology, pathogenesis, and ecology of emerging public health threats
• Develop and enhance the surveillance, laboratory, research, and programmatic capabilities of public health institutes and partner organizations to better prevent and respond to public health threats
• Invest in career development programs that further build the expertise of the CDC workforce and sustain relationships with CDC-trained experts and public health practitioners
• Apply CDC expertise globally through strategic collaboration with international stakeholders

A. Using CDC experts across the global to domestic continuum to save lives and protect Americans Using advanced molecular detection (AMD) technologies, CDC disrupts how pathogens are detected and characterized.  The agency is adapting AMD technologies, for example, to detect malaria resistance earlier and more reliably, replacing decades-old parasitic disease diagnostics with state-of-art methods, characterizing pathogens such as Mycobacterium tuberculosis, influenza virus, or hospital-acquiredantimicrobial resistant organisms.  AMD technologies are evolving rapidly, becoming less expensive and more automated.  This rapid progress may allow Low- and Middle-Income Countries (LMICs) to “leapfrog” to advanced technologies.

B. Serving as a model for other countries to build up public health science, laboratories, and programs After decades of support from CDC, in October 2010, the World Health Organization (WHO) designated the Chinese National Influenza Center (CNIC) as one of six WHO Collaborating Centers for Reference and Research on Influenza. CDC’s support for China CDC’s influenza surveillance capacity contributed to the detection of Asian H7N9 virus when it first emerged in China in 2013.

In 2013, virus sharing of H7N9 with the United States and other WHO collaborating centers led to the development of the first candidate vaccine virus for manufacturing pandemic vaccine to help protect the world in the event the spread of H7N9 virus led to a pandemic. The bilateral support also created capacity for China to mount a rapid and robust response to novel influenza viruses that continues to this day. China’s comprehensive influenza surveillance network is now self-sustaining.

C. Strategically using technology for workforce development High-quality standards, safe laboratory testing, and a well-equipped competent laboratory workforce are essential for producing reliable laboratory data. Innovative technologies provide the laboratory workforce with additional resources to improve their efficiency.

Examples of these technologies include:

• Broadcasting platforms used to deliver webinars on preparedness topics
• Robust programming software used to develop computer-based eLearning courses that are available 24/7 targeted to clinical and public health laboratory staff
• Creation of 3-dimensional laboratory environments to support learner interaction during eLearning
• Acquisition of virtual reality equipment and software to support the development of virtual laboratory environments to assess practical laboratory skill competency.
• Inform global public health priority setting by engaging with key international players across sectors and within high, middle, and low income countries
• Improve accessibility, usability, and translation of CDC and partner data to improve real-time surveillance, analysis, and evaluation
• Conduct and support implementation research that informs culturally appropriate intervention design, implementation, and evaluation
• Disseminate findings in peer reviewed literature, international guidance documents, and through other visible communication channels

A. Data analysis to best inform programming in limited resource settings CDC’s One Health experts have worked with 20 countries to implement a One Health Zoonotic Disease Prioritization process that builds collaboration across disciplines and sectors to focus limited resources on preventing, detecting, and responding to those zoonotic diseases of greatest national concern.  Countries with limited resources can focus on the top priority zoonotic diseases (for example, rabies and Ebola) of greatest national concern.  Participants include a wide-ranging group of people who protect health–of people, animals, or the environment–and they identify the country’s top 5 diseases to target.  Prioritizing diseases means countries can more efficiently build lab capacity, conduct disease surveillance, plan outbreak response and preparedness activities, and create disease prevention strategies to reduce illness and death in people and animals.  During the prioritization, participants discuss action plans, roles, and responsibilities for how each sector

will collaboratively engage in developing control and prevention strategies using a One Health approach for the newly prioritized zoonotic diseases. After the prioritization, scientists continue to collaborate with countries on their priorities and strategies to help mitigate their greatest zoonotic disease threats, implement and strengthen One Health approaches, and further the goal of a world safe and secure from infectious disease threats.

B. Rapid translation of data to improve public health outcomes In December 2015, a yellow fever epidemic began in Angola and subsequently spread to the Democratic Republic of Congo (DRC).  Soon after cases began to increase dramatically in Brazil.  More than 30 million doses of vaccine were distributed quickly, depleting the global vaccine stockpile.  CDC experts  led an emergency consortium of the World Health Organization, pharmaceutical companies, and ministries of health to devise a bold proposal, based on limited but solid evidence, to vaccinate using 20% fractional doses.

During a 10-day period, the DRC, under WHO guidance, vaccinated a record 7.6 million people at risk while CDC experts monitored for efficacy and side effects.  The campaign was a success, the epidemic stopped, and lives were saved.  The CDC study showing safety and efficacy of the fractional doses  established a critical option for future yellow fever epidemic responses.

C. Supporting partners in using and translating Joint External Evaluations as standard of practice Since 2016, CDC has been involved in the standardized Joint External Evaluation (JEE) assessments to evaluate a country’s capacity to prevent, detect, and rapidly respond to public health risks. As of May 2018, over 75 countries have completed JEEs, and CDC experts have participated in more than 60% of the evaluations.  Importantly, JEEs help countries develop costed action plans, which can open the door for partnership by matching needs with resources. As one of many examples, the Private Sector Roundtable (PSRT) and Uganda  collaborated to identify areas of cooperation based on the JEE. Workforce development was one of the areas identified, and because of this cooperation, Johnson and Johnson  agreed to provide $250,000 to Uganda to strengthen their workforce. By measuring progress on specific targets, JEE results help us understand where and how countries are making improvements towards meeting the International Health Regulations.

• Systematically identify and invest in innovative tools, research, and programs internally, domestically, and globally
• Fund, evaluate, and support the innovative work of partners
• Rapidly disseminate emerging and innovative findings to be tested and scaled elsewhere
• Integrate and share data to accelerate discovery, generate insights, and improve programs

A. Developing technologies to detect disease faster CDC developed two new tests to detect Zika virus in human tissue. CDC scientists used these tests to confirm the tissues were positive for Zika virus. This evidence led CDC to conclude that Zika virus causes microcephaly and embarked on a critical research to protect pregnant women in the U.S. and around the world.

B. Applying laboratory leadership through networks CDC’s Polio and Picornavirus Laboratory serves as a WHO Global Specialized Laboratory and provides technical and programmatic assistance to the Global Polio Laboratory Network. The Network consists of 146 WHO-accredited poliovirus laboratories in all World Health Organization (WHO) regions. The accuracy and quality of testing at Global Polio Laboratory Network member laboratories is monitored through an annual accreditation program that includes onsite reviews and proficiency testing.

CDC’s laboratories provide critical diagnostic services and genomic sequencing of polioviruses to help guide disease control efforts in many countries. This includes implementation of improved laboratory procedures that have increased sensitivity to detect and confirm new polio infection. Other new laboratory procedures are helping countries overcome specific operational challenges, enable more rapid detection of wild poliovirus (WPV), and allow for faster response to importations or spread of virus. Additional efforts include technical assistance to laboratories implementing environmental surveillance for polio detection.

C. Bringing innovative findings to scale CDC has worked with university researchers to develop and test microneedle patches to deliver vaccines like measles, rubella, polio, influenza, and rabies.  The microneedle patch should improve the ability of CDC and partners to get the measles-rubella vaccine to remote areas because the patch is more stable at varying temperatures than the currently available vaccines and takes up less space than the standard vaccine. Because microneedles dissolve in the skin, there is no disposal of needles, reducing the risk of accidental needle sticks. The measles patch is expected to be manufactured at a cost comparable to the currently available needle and syringe vaccine. The patches also do not require highly skilled health workers to administer.

In 2017, CDC experts collaborated with partners to evaluate the feasibility and acceptability of using a novel Digital Microfluidics (DMF-ELISA) to detect antibodies to measles and rubella.  This  new rapid diagnostic system could be a useful tool to identify people at risk of contracting measles and rubella living in remote settings without access to laboratories.  Findings could help better target areas for vaccination campaigns and limit the spread of vaccine preventable diseases.  CDC works closely with partners to strengthen immunization systems in order to advance global health security, protecting vulnerable populations from life-threatening vaccine preventable diseases.

CDC is working to implement point-of-care testing for measles infections in collaboration with the WHO Global Measles and Rubella Laboratory Network.

ACHIEVING MORE THROUGH PARTNERSHIP

CDC has a long-standing commitment to working closely with domestic and international partners to set common objectives, implement comprehensive public health prevention and response programs, and ensure that the resources entrusted to CDC achieve the maximum impact by leveraging the unique roles and mission of other organizations. In order to achieve its global health priorities, CDC deploys innovative and proven models for multi-sectoral engagement.  This includes working closely with international organizations like the World Health Organization, the United Nations and the World Bank; engaging counterparts in the Ministries of Health around the world to achieve a range of health objectives; and collaborating with foundations, the private sector and academic institutions to define, implement and evaluate a variety of health programs.  CDC is strengthened by the diversity of its partners and will continue to bring new partners together to innovate and accelerate the work that the agency does around the world to protect the health of all people.

CDC ’s Global Health Partners

Through its work with partners, CDC maintains a strong, effective global health presence to protect Americans from major health threats wherever they arise. Global partners expand the reach of the work CDC experts do to strengthen critical public health services around the world—which helps protect the health of Americans both at home and abroad. Our partners in global health include a variety of valuable stakeholders and partners, such as:

• Foreign governments including ministries of health
• Other U.S. government agencies
• The World Health Organization and other international organizations
• Academic institutions
• Foundations
• Nongovernmental organizations
• Faith-based and community-based organizations
• Businesses and other private organizations

Our agency’s mission to protect the health of persons in the United States is based on a strong domestic public health system that is prepared to respond to all threats, and a global footprint that supports our global health commitments.  To succeed, we must work globally both to ensure the health and safety of our own citizens and to help countries develop the health systems and public health capacities they need to protect their  populations.  CDC’s Global Health Strategy outlines the agency’s approach to achieving its global health vision of a world where people – in the United States and around the globe – live healthier, safer, and longer lives. To achieve the goals and objectives outlined above most effectively, we must continue to implement the strategies, prioritize activities and partnerships, and leverage resources, investments and the work of other U.S. government agencies and global entities.

We must adapt the way we work so that we as an agency are nimble and agile enough to respond to disease threats no matter where they occur.  To help ensure our global reach, CDC is establishing platforms with regional offices to advance global health security and maintain a sustainable global presence, allowing CDC to strengthen its ability to accomplish  its mission of protecting Americans by responding more rapidly, efficiently, and effectively to health threats wherever they occur.  We must strengthen and nurture our relationships with existing partners like USAID, Department of State, and World Health Organization, as we look to expand our partnerships with the U.S. Department of Defense, Commerce, and the private sector so we truly work in a multi-sectoral fashion.

The global health challenges we face – which threaten both our nation’s health and well-being and the global community – are significant.  The sheer numbers of people who struggle against deadly diseases like HIV and TB; the always-present threat of a pandemic influenza and emerging vector-borne viruses; the growing resistance to front-line antibiotics; these are not easy problems to solve.  However, the time to address these challenges is now.  As CDC Director Dr. Robert Redfield has said, “Embracing the possible, we will do it together.”  We look forward to working with our partners to meet these challenges and make a lasting impact in global health.

ANNEX – EVIDENCE OF CDC’S IMPACT IN GLOBAL HEALTH

CDC’s success as a world premiere scientific and data driven agency is dependent on our core capabilities. This includes the development and deployment of a world-class surveillance and data analytics system to tell us what has happened, what is happening, and what may happen.  It requires CDC to maintain our state-of-the-art laboratories, which serve as the reference laboratories for the world.  CDC must recruit and retain our elite public health workforce who stand ready to collaborate strategically with others to solve the public health challenges of today and tomorrow.  Finally, the agency needs to maintain the ability to respond quickly to outbreaks when they occur. CDC’s global health programs leverage these capabilities for meaningful results.

Early Detection and Effective Responses to Outbreaks

Liberia Builds Health Security Capacity During and following the 2014 Ebola response, CDC worked closely with Liberia to develop public health capacity. This investment paid off in May 2017, when Liberia reported 14 cases and 8 deaths from an unknown illness. Within 24 hours of learning of the outbreak, Liberia’s Ministry of Health mobilized CDC-trained disease detectives to investigate the report; this team was able to quickly investigate the cases, and work with the CDC-supported national laboratory to rule out Ebola. Through the close collaboration with CDC, the government of Liberia sent samples to CDC where its premiere laboratories identified the cause as meningococcal disease. The outbreak was controlled within a matter of weeks. Through the CDC-supported disease detectives and laboratory capacity, Liberia limited the outbreak to 31 cases and 13 deaths due to the improved ability to prevent, detect, and respond to disease threats.

Providing Customized Solutions for Outbreak and Other Urgent Investigations CDC’s Epi Info is a public domain suite of interoperable software tools designed for the global community of public health practitioners and researchers. It provides for easy data entry form and database construction, a customized data entry experience, and data analyses with epidemiologic statistics, maps, and graphs for public health professionals who may lack an information technology background. Epi Info is used for outbreak investigations; for developing small to mid-sized disease surveillance systems; as analysis, visualization, and reporting (AVR) components of larger systems; and in the continuing education in the science of epidemiology and public health analytic methods at schools of public health around the world.  In support of recent regional outbreaks:

CDC developed a customized version of the Epi Info desktop application with a focus on viral hemorrhagic fevers. Although not fully operational prior to the 2014-2016 Ebola outbreak in West Africa, the customized application was still used in all three affected countries to track cases and contacts. CDC is currently using the application in laboratories for the 2018 Ebola outbreak in the Democratic Republic of the Congo.

In response to the potential safety signal of the antiretroviral drug dolutegravir and a possible link to neural tube defects, CDC collaborated with the Kenya Ministry of Health rapidly leveraging existing birth defects surveillance capacity. This work includes the development of a tablet version of Epi-Info that tracks structural birth defects in real time.  Electronic reporting has the potential to identify cases more quickly and reduce delays in accurate diagnosis and reporting over the standard paper-based system.  These improvements will help inform the urgent discussion of the safety of certain antiretroviral drugs for women living with HIV and their children.

Vietnam Adopts Event-Based Surveillance as National Surveillance Standard In Vietnam, CDC supported an event-based surveillance (EBS) pilot project in six provinces from 2016-2017. The EBS pilot program is the first of its kind in the country, actively engaging local community members, leaders, and health care staff in the detection and reporting of outbreaks or unusual health events. As of December 2017, the CDC project had trained approximately 9,000 heath workers in outbreak detection and reporting, resulting in more than 5,900 early warning signals of potential outbreaks reported. Each report was screened and verified, resulting in confirmation of more than

420 infectious disease outbreaks, including foodborne outbreaks; hand, foot, and mouth disease; mumps; diphtheria; and chickenpox. More than 400 of the confirmed outbreaks were responded to in less than 48 hours. Due to the pilot’s success, the Ministry of Health has adopted the EBS framework as their standard detection strategy.

Indonesia Builds Laboratory Capacity to Detect Priority Pathogens Indonesia, a GHS priority country, considered by many, to be a hotspot for emerging pathogens did not have the capacity to diagnose or characterize vector-borne viruses.  Beginning in 2012, CDC in partnership with the Ministries of Science and Technology and of Health, established a state of art molecular diagnostic laboratory for the identification and sequencing of emerging viruses.  The lab, which is largely funded by GHSA, has confirmed the first transmission of West Nile and Zika viruses in Indonesia and demonstrated a high natural prevalence of Zika in children throughout the country.  Equally important, the lab has trained more than 400 local staff in virus diagnostics and biosafety, and has conducted continuing medical education courses for more than 1,000 Indonesian health professionals.  Based on this success, in 2018 the Government of Indonesia spent more than US $1 million to expand the lab’s capacity.

CDC Rapid Response Teams Surge to Address Yellow Fever Outbreaks Global Health Security Agenda (GHSA) investments allowed CDC’s Global Rapid Response Team (GRRT) to surge in response to a significant yellow fever outbreak in Angola and the Democratic Republic of Congo (DRC) in 2016. The GRRT is a trained and ready multidisciplinary workforce with 50+ CDC staff on call each month. In DRC, 2,000 samples were tested for yellow fever to help target a vaccination campaign to contain the 2016 outbreak.

HIV Laboratory Capacity Serves as Platform for Other Disease Detection Laboratories play a crucial role at every step in responding to the HIV and TB epidemic: from accurate diagnosis and testing, to effective treatment, care and monitoring of the disease, to preventing new HIV infections. Strong laboratory systems are critical to both controlling today’s epidemics and getting ahead of the curve for an effective response tomorrow. With partners’ support, CDC experts are implementing efforts on a number of fronts to help bring laboratories around the world to international standards and enhance lab capacity. These include:

• Establishing public-private partnerships to improve lab quality and strengthen the skills of lab personnel in communities severely affected by HIV and TB.
• Helping partner governments launch accreditation programs for labs including the creation of the first lab accreditation program in 2009.
• Helping labs along the path to accreditation, by implementing the CDC-developed Strengthening Laboratory Management Toward Accreditation (SLMTA) program, which has supported more than 1100 labs in 52 countries worldwide.
• Working with countries to develop national strategic plans for laboratories to better support their response to HIV, TB and other diseases.

These efforts to improve lab capacity and enhance lab quality to fight HIV and TB are laying the groundwork for countries to respond to other diseases and emerging global health threats.

STRATEGIC PARTNERSHIPS

Global Polio Eradication Initiative (GPEI) Since the Global Polio Eradication Initiative (GPEI) was started in 1988, (with CDC as one of the five  spearheading partners along with WHO, UNICEF, Rotary International, and the Bill & Melinda Gates Foundation ), the number of countries with endemic poliovirus transmission has decreased from 125 to 3, and reported polio cases have decreased from 350,000 in 1988 to 22 in 2017. Through the transition planning process, CDC and its partners are working systematically to merge best practices learned from years of fighting polio, measles, rubella, and other vaccine-preventable diseases with lessons learned from strengthening immunization systems and programs.

Saving Mothers, Giving Life (SMGL) Reductions in maternal and perinatal mortality are global development priorities yet still present major challenges in sub-Saharan Africa. CDC provided scientific leadership for the Saving Mothers, Giving Life (SMGL) public-private initiative implemented from 2012–2016 in selected districts of Uganda and Zambia with the goal of improving maternal and perinatal health in high mortality settings. Through community and facility evidence-based interventions and district-wide health systems strengthening, SMGL reduced delays to timely and appropriate obstetric care.

Over the course of the 5-year SMGL initiative, population-based estimates documented a 44% reduction in the SMGL district-wide maternal mortality ratio (MMR) in Uganda (from 452 to 255 per 100,000 live births) and a 41% reduction in Zambia (from 480 to 284 per 100,000 live births). The MMR in SMGL-supported health facilities declined by 44% in Uganda and by 38% in Zambia. The institutional delivery rate increased by 47% and 44% in Uganda and Zambia SMGL-supported districts. The number of facilities providing emergency obstetric and newborn care (EmONC) rose from 10 to 26 in Uganda, and from 7 to 13 in Zambia. SMGL’s comprehensive district systems-strengthening approach successfully improved coverage and quality of care for mothers and newborns.

The lessons learned from SMGL can inform policymakers and program managers in other low- and middle-income settings where similar approaches could be utilized to rapidly reduce preventable maternal and newborn deaths.

CDC and WHO Collaborating Centers CDC and WHO work collaboratively within the WHO Network of 55 Collaborating Centers for Occupational Health to develop practical guidance and tools and to provide technical assistance to upgrade international capacity to prevent work-related diseases, injuries, and fatalities. CDC and WHO collaborate to: 1) strengthen the performance of health systems in occupational health; 2) assess the effectiveness of a global database platform for monitoring worker health globally; and 3) evaluate and improve the ability to identify workplace hazards and apply controls globally and domestically. CDC contributes from its research base to reduce occupational diseases, injuries and deaths in the United States and globally, and benefits from achievements in other nations.

Viral hepatitis is a global health problem and CDC is a long-standing supporter of the viral hepatitis prevention activities of the World Health Organization . As a WHO Collaborating Center for Reference and Research on Viral Hepatitis, CDC serves as a national reference laboratory for viral hepatitis, an evaluator of new vaccination and test technologies, and a convener of conferences on topics ranging from viral hepatitis prevention priorities for persons who inject drugs to strategies for improving the quality of hepatitis laboratory testing. This support has helped WHO develop a Global Hepatitis Program; guidance for viral hepatitis immunization, surveillance, testing, and treatment; and the first Global Health Sector Strategy on Viral Hepatitis 2016-2021. Endorsed by the 2016 World Health Assembly, the strategy targets the elimination of hepatitis B and hepatitis C as public health threats by 2030.

CDC serves as a WHO Collaborating Centre for Sexually Transmitted Infections Prevention (STI) providing epidemiologic, economic, and laboratory expertise. As part of this work, CDC provides STI global burden estimates and economic costs, training, and proficiency testing related to antimicrobial resistant gonorrhea work and syphilis point of care test technology. CDC is collaborating with WHO on global congenital syphilis elimination providing technical assistance in validation and certification of this goal and working with countries on progress towards this milestone. On December 1, 2017, PAHO celebrated the validation of elimination of mother-to-child transmission of HIV and syphilis in six Caribbean countries and territories. Since 2015, 11 countries have validated elimination of congenital syphilis of which nine are in the Americas Region. In addition, CDC is working with WHO and the World Bank on triple elimination of mother-to-child transmission of HIV, syphilis, and hepatitis B in Africa.

CDC One Health Program and Zoonotic Diseases CDC’s One Health experts have worked with 20 countries to implement a One Health Zoonotic Disease Prioritization process that builds collaboration across disciplines and sectors to focus limited resources on preventing, detecting, and responding to those zoonotic diseases of greatest national concern.  Countries with limited resources can focus on the top priority zoonotic diseases of greatest national concern (for example, rabies and Ebola).  Participants include a wide-ranging group of people who protect health–of people, animals, or the environment–and they identify the country’s top five diseases to target.  Prioritizing diseases means countries can more efficiently build lab capacity, conduct disease surveillance, plan outbreak response and preparedness activities, and create disease prevention strategies to reduce illness and death in people and animals.  After the prioritization, scientists continue to collaborate with countries on their priorities and strategies to help mitigate their greatest zoonotic disease threats, implement and strengthen One Health approaches, and further the goal of a world safe and secure from infectious disease threats.

In 2015, Ethiopian human and animal health professionals identified anthrax, brucellosis, and rabies as three of the top five zoonotic diseases of concern during a One Health Zoonotic Disease Prioritization Workshop.  Canine rabies is also a concern, with 2,700 human deaths each year due to the disease. Along with selected regional labs, Ethiopian Public Health Institute (PHI) and the National Animal Health Diagnostic and Investigation Center (NAHDIC) underwent a 4-month assessment of laboratory bacteriological and serological sections and brucellosis diagnostic capacity. CDC provided both public health veterinary labs with necessary equipment, supplies, and training to enhance their ability to conduct serologic and molecular testing. CDC staff are working with the Ethiopian government to establish practical country-based brucellosis guidelines for laboratories and clinicians.  CDC is working with regional partners to conduct laboratory assessments that focus on bio-safety and bio-security measures for anthrax at EPHI, NAHDIC, and regional labs. CDC procured the necessary equipment and supplies and is training laboratorians, establishing rabies testing capacity in three regions (Addis Ababa, Amhara, and Tigray). Experts have coordinated with the Ministry of Health and Ministry of Livestock and Fisheries to implement an integrated bite-case management program for rabies surveillance and response. CDC is also helping the helping the National Vaccine Institute to conduct potency testing of canine rabies vaccine and increase animal vaccine potency to meet international standards.

Developing a Public Health Workforce at Points of Entry to Control the Spread of Disease Ensuring that a country’s air, sea, and land points of entry (POE) are protected from health threats is a vital health security consideration, both for the country itself, as well as for the protection of the international community. In many countries, Ministry of Health staff stationed at POE (i.e., Port Health) who help detect and respond to ill travelers are in short supply. To enhance a POE’s ability to detect ill travelers, CDC trains non-traditional public health partners, such as immigration, customs, security, airline, and other staff who have direct contact with the traveling public to know what signs and symptoms of illness of public health concern to look for and to know how to notify medical authorities for further evaluation. This extension of the public health workforce at a POE can help to prevent ill travelers from boarding a conveyance or entering a country, thereby mitigating the risk of a disease being imported or exported beyond a country’s borders.

Influenza Vaccine Program Development CDC works with more than 120 partners both public and private to develop and advance influenza vaccine program development. Using the broad surveillance capacity built since 2004, foreign governments are able to provide evidence of influenza circulation, seasonality, and population burden to establish the need for strategic and evidence-based seasonal influenza vaccine programs and policies.

Global Water, Sanitation and Hygiene (WASH) In Sierra Leone, a country where 60 percent of the population does not have access to potable water and where flooding and waterborne disease outbreaks, such as cholera, can occur during the rainy season, CDC provided vital training for waterborne disease outbreak detection and response. CDC trained multisector partners, including those from the Sierra Leone Ministry of Health and Sanitation (MoHS) and the Ministry of Water Resources (MoWR) as well as community health centers using the Global Enteric Disease Outbreak Response Capacity Building Toolkit developed by DFWED. The toolkit builds needed capacity in epidemiology, environmental health, and clinical and environmental microbiology. CDC will continue to deploy the toolkit, to strengthen workforce capacity in GHSA countries. The toolkit offers a sustainable platform for training by utilizing modules and an eLearning platform to prevent, detect, and respond to waterborne outbreaks such as cholera.

Leveraging Surveillance and Data

Birth Defects Surveillance Improves Health Outcomes Globally The Birth Defects Countries and Organizations United for Neural Tube Defects Prevention (Birth Defects COUNT) is CDC’s global initiative to reduce mortality and morbidity caused by folic acid-preventable neural tube defects. Neural tube defects are serious birth defects of the brain or spine and are a major cause of death and lifelong disability worldwide. Birth Defects COUNT focuses on increasing the availability of birth defects surveillance and blood folate data to drive and monitor the effectiveness of prevention policies. Through Birth Defects COUNT, CDC provides technical expertise and assistance, convenes partners, and disseminates best practices to enable countries to realize positive public health outcomes.

Acute-Febrile Illness Typically, healthcare workers in Uganda would presumptively treat a child suffering from acute fever for malaria.  Beginning in 2016 at six regional hospitals that are part of a GHSA-funded CDC partnership with the Ministry of Health and the President’s Malaria Initiative, doctors can order blood and antibiotic susceptibility tests never before available to them on site.  During the first 18 months of this pilot initiative, more than 30,000 pediatric admissions were tested.  Only half had malaria but as many as 8% yielded pathogenic bacteria, some of which were found to be drug resistant, allowing the children to be successfully treated.  Other children were found to be infected with mosquito-borne viruses and animal transmitted bacteria.  This GHSA project leverages prior surveillance investments to better track causes of illness, generate antimicrobial susceptibility results, and improve clinical care and policy planning.  The results build a foundation to enhance capacity to detect, report, and rapidly respond to public health concerns in Uganda.

Community-Level Data to Predict Risk In an increasingly globalized world, diseases whose geographic spread used to be limited to well-defined areas can now spread to every part of the world within 24 hours—often before disease surveillance systems can detect them. There is thus increasing need to integrate population movement into traditional epidemiologic methods, especially when the travel crosses an international boundary. Human population movement is influenced by a number of factors, including travel purpose, duration, season, and familial and community connections. CDC subject matter experts have designed novel methods, such as community level mapping to illustrate population movement patterns into, through, and out of their borders. Ministries of health can use this information to identify geographic areas with greater public health risk to target their surveillance and response interventions and thus limit a disease’s potential to spread.

South-East Asia New Born Birth Defects system In South-East Asia, strong collaborations with the World Health Organization South-East Asia Regional Office, has led to the development of a sophisticated surveillance database for tracking newborn health, birth defects, and stillbirths. In collaboration with ministries of health, CDC and WHO have trained and built capacity among health care providers in 145+ hospitals from seven countries that now contribute data to the South-East Asia New Born Birth Defects system.  This system has the flexibility and the adaptability integrate into country health information systems and has been expanded to respond to emerging threats such as Zika Virus.

Developing Surveillance Capacity to Improve Outcomes in Pregnancy The capacity to conduct rigorous biomarkers surveillance is a critical component of global public health infrastructure. One biomarker, red blood cell (RBC) folate, can be used to identify groups of women at increased risk for having a neural tube defect-affected pregnancy and to identify women with folate deficiency associated anemia, both of which are significant causes of morbidity and mortality worldwide. To improve monitoring of RBC folate in populations and to estimate NTD risk, CDC has worked to establish harmonized regional laboratories that use the microbiologic assay, the most reliable method for assessing RBC folate. By training and equipping scientists from low- and middle-income countries, CDC has developed regional expertise and capacity in three continents.

Violence against Children Surveys (VACS) Violence underpins many public health problems and increases vulnerability to other health problems. Violence against children leads to higher risks of health and social problems, such as chronic disease, HIV, mental health issues, substance abuse, and violence perpetration later in life. The economic impact of violence against children is estimated at hundreds of billions of dollars per year.

Many inter-related factors contribute to violence against children.  A variety of institutions and sectors can play a role in preventing and responding to it. Country-specific data and evidence-based approaches can inform how best address violence against children at individual, family, community, and society levels.

A first step in preventing violence is better understanding its magnitude, nature, and consequences. Violence against Children Surveys (VACS) measure physical, emotional, and sexual violence against girls and boys. CDC conducts these surveys to guide programs and policies to prevent violence before it starts. Findings from VACS provide reliable evidence to enable countries to make better decisions using limited resources to develop, launch and evaluate violence prevention programs and child protection systems.

VACS are nationally representative household surveys of children and young adults aged 13-24 years. The data collected can inform steps already taken to address violence against children and give insight into where these can be strengthened or expanded. In addition, findings can help raise awareness of the scope of the problem, support outreach and advocacy, and bring in new and diverse stakeholders.

Research, Innovation and Technology

CDC Laboratories Play a Critical Role in Successful Global HIV Response A core area of strength for CDC is the agency’s laboratory expertise, particularly around the development of diagnostics and testing quality assurance.  For example, CDC is the only agency to independently evaluate and certify the quality of rapid HIV test kits for use in PEPFAR-supported countries.  To date, only 50% of rapid tests presented for evaluation have passed CDC’s rigorous testing. CDC also worked closely with commercial partners to transfer the technology and development of a HIV rapid recency  testing kit for global use and implementation in PEPFAR-supported programs for enhanced surveillance and prevention efforts. As a point-of-care device, the rapid recency assay can diagnose HIV infection and distinguish recent from long-term infection, all in one test.  This allows for urgent intervention including counseling, contact tracing, and partner testing to prevent further transmission. The rapid recency assay is commercialized by two companies and is now widely used and implemented in more than 50 countries.  This assay also plays an integral role in the implementation of population-based HIV surveys that are utilized to measure the status of the national HIV response. Use of this assay has shown significant decline of HIV-1 incidence in several countries. Swaziland in particular has demonstrated a nearly 50% decline in incidence in 5 years (from 2011 to 2016).

Developing Novel Laboratory Assays CDC developed two new tests that could detect Zika virus in tissues. CDC scientists used these two new tests to confirm the tissues were positive for Zika virus. This evidence led CDC to conclude that Zika virus causes microcephaly and embarked on a critical research to protect pregnant women in the U.S. and around the world.

Research to improve domestic and global hiv prevention and treatment CDC platforms in Kenya and Thailand collaborate through public-private and U.S. government partnerships to conduct clinical trials of innovative biomedical and integrated interventions to prevent new HIV infections, improve sustained HIV viral suppression, and reduce HIV morbidity. Innovations along the continuum from prevention to treatment are critical components of strategies to achieve an AIDS free generation and eliminate HIV in the United States, the host countries, and around the world. Research at the sites focuses on evaluating alternative, novel HIV pre-exposure prophylaxis (PrEP) agents and delivery systems to optimize PrEP efficacy. Previous research evaluated HIV vaccine candidates and novel diagnostics. Additional clinical trials are focused on biomedical innovations to achieve long-term HIV viral suppression among people living with HIV (PLHIV), towards a functional HIV cure, and to reduce chronic morbidity and co-morbid infections among PLHIV. Research currently focuses on men who have sex with men (MSM) and young MSM (Thailand) and women, adolescent girls and PLHIV (Kenya); representing key at-risk population in the United States, the host countries, and globally. The research evaluates new interventions that can translate to improved domestic and global HIV prevention and treatment. The sites also represent platforms of skilled local staff capacity and response units that can quickly implement new clinical trials in areas other than HIV, such as urgent and planned clinical trials of vaccine candidates, novel antimicrobials for resistant agents, and new diagnostics.

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Call for proposals: 2024 stanford global health seed grants.

Published: 02/11/2024

• Call for Proposals Opens: February 12, 2024
• Deadline for Submissions: March 29, 2024
• Notification of Selections: May 13, 2024
• Funding Period: June 15, 2024 – December 15, 2025

The Stanford Global Health Seed Grant program encourages the development of innovative solutions to global health and planetary health challenges. It supports scientific and clinical research, implementation science, and development of new innovations in health care implementation or delivery. The program seeks to enable Stanford’s vibrant global health community, support global health training opportunities for Stanford trainees and students, and build capacity with international partners. Research projects that have strong potential to generate solutions and impact, and/or scale-up into larger initiatives are encouraged to apply.

The Center for Innovation in Global Health believes that local is global. We are committed to improving health equity among all populations, including in the United States.

Program Priority Areas

Preference will be given to research teams that include more than one discipline and reflect the Center for Innovation in Global Health’s major initiatives and funders’ priorities:

• Global Health : Interdisciplinary, solutions-oriented research that seeks to improve health in low-resourced settings
• Research that addresses the health implications of climate change or other forms or environmental degradation
• Projects that explore the ways in which conservation efforts can impact human health
• Global Maternal and Child Health : Projects that seek solutions to improve maternal and child health in low-resource settings
• Global Emergency Medicine : Projects that support innovative research in emergency medicine in low-resource settings
• Global Surgery : Projects to develop or support educational programs, research, or innovations that improve global surgical care
• Global Ophthalmology : Projects that support research to improve global eye health
• Local Health Equity : Solutions-oriented research that seeks to improve health equity in the San Francisco Bay Area
• Anesthesiology, Perioperative, and Pain Medicine : Projects that support educational programs, research, or innovations to improve global anesthesiology, perioperative, critical care, and pain medicine
• Pathology : Projects that support innovative research in pathology in low-resource settings

Eligibility

All Stanford Faculty with PI eligibility may apply. This call is open to faculty from all seven schools. Post-doctoral fellows, clinical trainees, instructors, and research scientists/scholars must identify a faculty mentor and then may be included as co-PIs.

Projects that create new interdisciplinary collaborations are encouraged. Teams may include investigators in off-campus partner institutions, including in low- or middle-income countries. Teams may also partner with nonprofit organizations, industry, or government officials.

* At this stage, you do not have to prepare a PIF, a PDRF form, or work with your institutional representative (RPM or OSR).

Amount of funding

$10,000 – $50,000 for 18 months

We encourage investigators to consider submitting requests less than the maximum, as this will enable us to award more grants.

Budget Guidelines

Award amounts are based on analysis of a detailed budget request.

• Funds may be used for salary support of faculty, graduate students, postdocs, and other research staff. (Faculty PI support is limited to 5% of their total salary.)
• Eligible budget items include: operating supplies, equipment items, communications expenses, meeting costs, prototyping expenses, imaging time, and travel directly associated with the research activity.
• The grants will not support general (non-research-related) staff, administrative support, or tuition.
• No indirect charges need be included in your budget.

Submission Guidelines

All documents should be in pdf format, single-spaced, Arial 11-point font, with one-inch margins. Submissions must not exceed 3 pages, exclusive of cover page, citations, budget, and biographical information.

Each proposal must include:

1. Cover page with project title, one-paragraph summary, and each team member’s name, email, professional title, and department and school affiliation(s)

2. Proposal

• Introduction
• Specific aims
• Preliminary data (if available)
• Proposed project design and methods
• Collaboration plan: how will the multi-disciplinary team work together; what is the history of your relationship with any external / community partners?
• Description of potential for impact and follow-on funding

3. Supporting material

• Literature cited
• Itemized budget with brief budget justification
• Short (150 words max) bio-sketches for team members including faculty PI

Selection Criteria

The Stanford Center for Innovation in Global Health and funders will review proposals based on:

• Scientific merit of the proposal, with quality, innovation and creativity balanced by likelihood of success
• Interdisciplinary nature of the project and research team, including international collaborations where appropriate
• Likelihood that results or solutions will lead to improved health among vulnerable populations
• A persuasive case that results would lead to scale-up, and/or catalyze further funding from external sources
• Involvement of Stanford trainees and/or students; global health career development
• Alignment between the proposal’s goals and the program priority areas (outlined above)

Funders include the Stanford Center for Innovation in Global Health, the Woods Institute for the Environment, the Maternal and Child Health Research Institute, School of Medicine (SOM) Dean’s Office, the Stanford Health Care Department of Health Equity & Research, the SOM Departments of Anesthesiology, Perioperative, and Pain Medicine, Emergency Medicine, Medicine, Pathology, and Surgery.

• March 29, 2024: Proposals are due.
• May 13, 2024: Award letters are sent out.
• June 15, 2024: Grants begin. Awards will be for 18 months or less, all grantees are eligible for one no-cost extension if necessary.

Research Administration and Reporting Requirements:

Once grants are awarded, the project team must submit a PDRF form via SERA to set up their seed grant PTA. If research includes human subjects, projects will need to obtain IRB approval prior to incurring any costs related to the human subjects phase of research.

All grantees must submit annual progress reports by December 1, and a final report 45-days after the work has been completed. At the conclusion of their research, all seed grantees must also apply to present their funded research at the annual Stanford Global Health Research Convening, typically held every January.

Questions? Contact: S. Jill Mueller: [email protected]

Master of Science in Global Health

The path to realizing your global vision

On this page

Explore this section

The Duke Master of Science in Global Health (MS-GH) is offered jointly by the Graduate School and the Duke Global Health Institute, an interdisciplinary unit that leverages outstanding faculty from across Duke to take on the most complex health challenges facing the world today.

Our unique approach to global health offers:

• A small cohort of diverse students from around the world
• Individual attention from dedicated faculty and staff through small classes and one-on-one mentoring
• A strong culture of innovation and collaboration
• Duke’s commitment to knowledge in service of society
• Exceptional student services and resources
• A beautiful campus in a thriving city

As a student in the MS-GH, you will learn:

• How to identify and assess current and emerging global health challenges
• The influence of environmental, economic, social and political factors on health
• Culturally and ethically informed research methods and technologies that can aid health interventions
• The role of health policy and systems at local, national and international levels

The MS-GH program now carries the official STEM designation, giving international students whose jobs meet certain requirements 2 additional years to work in the United States.

The Duke Difference

Why there's no better place to study global health

Get More Information

Join our mailing list for program and application updates

See It In Print

Download a copy of our program brochure

Looking to study global health in Asia? Check out our affiliated MS program offered by Duke Kunshan University in Kunshan, Jiangsu Province, China. 

Program Features

Flexible, interdisciplinary coursework.

MS-GH coursework is guided by the principle that complex global health challenges require a multidisciplinary, multisector approach that leverages diverse perspectives. Our faculty include experts in medicine, engineering, the environment, public policy, law, business, social sciences and the humanities.

Through a tailored, flexible curriculum, you will examine the larger context of global health. The 38-credit curriculum, requiring at least three full-time terms of study, focuses on:

• An understanding of key global health concepts and challenges
• A solid foundation in core methodologies used in global health research
• Ethics training and considerations applicable across cultures
• Core concepts to help students evaluate and understand health systems

See a list of courses

Accelerated MS-GH Program: For select Duke undergraduates interested in global health, we also offer an Accelerated MS program that allows you to earn both a bachelor’s and a master’s degree in five years. Read more on the Undergraduate Programs page. 

Guidance from Caring Experts

Our global health faculty are innovative thinkers and problem solvers. But most of all, they are invested in your learning and professional development. You’ll receive one-on-one mentoring from a faculty advisor, as well as opportunities to learn alongside experts from a range of disciplines.

Meet Our Faculty

Research News

DGHI Professor Wendy O’Meara Wins Tropical Medicine Award

Education News

Pointing the Way, Even When You’re Thousands of Miles Away

The Secret to Liz Turner's Captivating Biostats Course

Browse the faculty directory

Experience in the Field

Hands-on learning is a hallmark of our global health education. In the MS-GH program, you’ll work closely with a faculty mentor to develop an original research project that includes at least 10 weeks of field experience. Field research typically occurs between the first and second years of the program.

MS-GH students have done fieldwork in more than 30 countries. Your field experience will be fully funded, including travel and research expenses. We’ll also help you prepare, with workshops on ethical engagement and respect for local cultures and practices.

Fieldwork Basics

The nuts and bolts of DGHI field experiences

Where We Work

See the global locations where we have longstanding partnerships

Project Examples

Learn what current M.S. students are working on

DGHI students talk about their field...

Careers with Impact

By the end of our two-year program, you will have a unique combination of skills, knowledge and hands-on experience necessary to make an impact in improving the health and well-being of people around the world.  In addition to coursework, mentorship and field research, you will interact with visiting global health professionals and receive career advising, skills-based workshops and professional development support.

Our alumni have become researchers and leaders in NGOs, academia and private industry. Many pursue further education at top-rated institutions while others forge successful careers in healthcare. Among our graudates who have pursued careers,  82%  are working in global health. 

Meet Our Alumni

Pathways to Change

Our graduates share how the MS-GH program gave them the practical skills – and the inspiration – to pursue their goals.

Where can an MS-GH take your career?

Program Requirements

35 credits of academic coursework

Core courses (required)

• GLHLTH 701 – Global Health Challenges ( Fall ), 3 credits
• GLHLTH 702 – Global Health Research: Design and Practice ( Fall ), 3 credits
• GLHLTH 705 – Biostatistics and Epidemiology for Global Health I ( Fall ), 4 credits
• GLHLTH 700 – Global Health Field Research: Planning and Skill Development ( Spring ), 1 credit
• GLHLTH 707 – Biostatistics and Epidemiology for Global Health II ( Spring ), 4 credits
• GLHLTH 740 – Global Health Ethics in Research, Policy & Practice ( Spring ), 2 credits
• GLHLTH 750 – Health Systems in Low and Middle Income Countries ( Spring ), 3 credits

Electives (five courses, including two focused on research methods)

4 credits of research, 10-week field-based project, academic thesis, costs and financial aid.

DGHI provides financial support to 100% of students enrolled in the MS-GH through:

• Merit-based scholarships, awarded on the basis of your program application
• Paid graduate teaching and research assistant positions
• Guaranteed funding for field research
• Guaranteed funding for professional development
• A tuition-free fourth semester for regularly-enrolled students in good academic standing

Annual tuition and fee rates  are established by the Duke Graduate School.

If you would like to explore U.S. federal financial aid/student loan options, the Duke Graduate School Financial Aid Office can assist. 

Scholarships and Fellowships

We award merit-based scholarships ranging from 10-75% of program tuition. International and US students are eligible for these departmental awards, and you are automatically considered for scholarships based on your Graduate School application – no additional application materials are required.

Duke University Peace Corps Coverdell Fellowship in Global Health

DGHI partners with the Peace Corps to offer targeted scholarships to returned Peace Corps volunteers (RPCVs). Through the Paul D. Coverdell Fellowship, eligible RPCVs enrolled in the MS-GH receive a 50% tuition scholarship, as well as funding to pursue field-based research and professional development activities. As part of the Coverdell fellowship, you will undertake a research or service project of value to underserved populations in the United States. 

If you are eligible for and interested in this opportunity, please notify your DGHI coordinator when submitting your application. 

Foreign Language and Area Studies (FLAS) Fellowship

Funded by the US Department of Education, the Duke Center for Latin American and Caribbean Studies offers a competitive Foreign Language and Area Studies (FLAS) fellowship. These fellowships require language and area studies coursework in addition to global health requirements and are an excellent way to increase your preparedness to undertake a career in global health in that region of the world.

Application deadlines typically fall in January/February. If you are interested in applying, notify your DGHI coordinator before submitting your application.

Take the Next Step

Sign up for email updates about our program and application deadlines, ready to apply.

The application cycle for  Fall 2024 admission is now closed.  If you are interested in the program, please contact our admissions coordinator, Amanda Frederick , directly.

When applications open for next cycle, here’s what you’ll need to complete your application:

• Statement of purpose
• Three academic letters of recommendation
• Transcript(s) from each post-secondary institution attended
• Evidence of preparation in quantitative methods, research, and/or academic writing
• Official TOEFL, IELTS, or DuoLingo scores (international applicants only)
• Official GRE or MCAT scores are optional for the Fall 2024 admissions cycle

Application Fee Waiver 

** All departmental application fee waivers have been awarded for the 2024 admissions cycle.**

DGHI offers a fee waiver option to support prospective students who may be experiencing economic stresses. To be eligible to request an application fee waiver, you must be a citizen from an LMIC, be in good academic standing and demonstrate high financial need. Fee waiver applications are reviewed on a rolling basis, so prospective applicants are encouraged to apply early.

Questions? Contact:

Lysa MacKeen

Senior Associate Director for Experiential Learning and Graduate Admissions

Amanda Frederick

Senior Graduate Admissions Coordinator

• GHS Advising

PROGRAM IN GLOBAL HEALTH STUDIES

Hands-on learning

Ready to apply.

While not a requirement of the major or minor, you are encouraged to conduct public health research both on campus and abroad under the supervision of faculty in any relevant discipline or program. In addition, research is a major component of the public health programs offered by Northwestern. Students are encouraged to continue their research upon their return to campus.

Global Health Studies Research Fellowships

Consider applying to one of the many fellowship opportunities through the Program in Global Health Studies. 

• Radulovacki Global Health Scholars Research Fellowship Designed to create research opportunities, this program funds strong, well-prepared, and creative projects for implementation abroad or in the US.
• John and Martha Mabie Fellowship for Public Health Research This fellowship allows Global Health Studies students to pursue independent research projects abroad.
• Leslie Frost Sable Global Health Fellowship Fund Provides fellowship support to undergraduate students enrolled in  Global Health Studies, with a preference for meritorious students who are underrepresented in research programs abroad. Support shall include, but is not limited to: costs and expenses relating to non-credit faculty –led and/or student-led research study abroad opportunities.

Find application suggestions on the  Fellowship Application Tips webpage .

Additional research opportunities

• The Northwestern Office of Fellowships
• Undergraduate Research Grants
• Undergraduate Language Grants
• Undergraduate Research and Arts Exposition Presentation Opportunity
• Northwestern Undergraduate Research Journal
• Chicago-area Undergraduate Research Symposium (CAURS)

How can you impact world health issues as a student?

Professor Bill Leonard takes you through the steps to get started.

What are other students doing?

Check out this video about projects in South Africa and Montana.

Global Public Health

Global public health archive.

“I feel the United States is in a unique position to offer solutions to potential agricultural safety and health conundrums and share experiences of lessons learned, This experience allowed me to understand barriers and opportunities to developing interventions internationally.” Josie Rudolphi, PhD Student Growing Global Citizens

Adeagbo awarded Global Public Health Faculty Pilot Grant

Oluwafemi Adeagbo, assistant professor of community and behavioral health, has been named the recipient of the College of Public Health’s inaugural Global Public Health Faculty Pilot Grant. The $25,000 grant will be used to complete the project titled, “Emigration and Mental Health Outcomes among Left-Behind Families in Ibadan, Nigeria.”

Student Ellie Madson’s learning experience in rural India

Graduate student Ellie Madson had the opportunity to travel to India and collaborate with engineering students to study drinking water and wells in rural areas…and brought an invaluable public health perspective to the projects.

Public health student interns in Chile, works to improve education standards

Guadalupe de la Rosa is a public health major from Washington, Iowa, and a recipient of the Dr. Ken Magid Scholarship intended for students who plan to complete an academic internship abroad. She recently returned from Santiago, Chile, where she interned for Good Neighbors Chile, an organization that empowers individuals through education and the promotion of human rights. She shares some of her experiences.

Global Public Health Week Food Drive Featured on DITV

MHA Fellowship with Nihon Keiei Consulting Group

As I sit down to write this blog post, I am filled with a sense of gratitude and accomplishment as I reflect on my time as an intern at Nihon Keiei Consulting Group in Osaka, Japan. This summer has been nothing short of remarkable, offering me a unique blend of professional development and cultural immersion that I will cherish forever.

An international Partnership Focuses on Safer Farming

A Mandela Washington Fellowship alumna and an Iowa professor are collaborating on a project to reduce pesticide exposure in rural Nigeria. ALTHOUGH IOWA AND NIGERIA are thousands of miles apart, they share common ties through agriculture. Farmers everywhere contend with volatile markets, bad weather, and occupational hazards, including exposure to pesticides.

UI student Anna Correa awarded Fulbright to India

Anna Correa, who will receive a Master of Public Health in community and behavior health from the University of Iowa in May 2022, is the winner of a Fulbright Study/Research grant in Public Health to India for 2022-23. ith my affiliates Dr. Johnson and Dr. Angeline of St. John’s Medical College, I will facilitate interviews and focus groups with migrant workers in Bangalore, India.

Iowa students place among top teams in Fulbright Canada Post-COVID Challenge

The competition invited young people from across Canada and the United States to provide creative ideas that address critical social, economic, technological, and public health challenges in the post-COVID world. After screening some 500 entries, the judges selected only 27 teams, including the Iowa team, to move to the second round.

International Research Collaboration to Study HIV Stigma Among Adolescents in Kenya

Will Story, assistant professor in the University of Iowa (UI) College of Public Health, and Nema Aluku, research associate at Tangaza University College in Nairobi, Kenya, were recently awarded a National Institutes of Health (NIH) grant to study HIV stigma among adolescents in western Kenya. The study represents a promising international collaboration with significant public health insights. Learn more about this important research project through the Q&A below with Dr. Story and Dr. Aluku.

Study finds pregnant Venezuelan refugees have worse birth outcomes than Colombian women

A new study from researchers at the University of Iowa College of Public Health and the National University of Colombia suggests that pregnant Venezuelan refugees in Colombia face significant health care barriers that result in worse birth outcomes when compared to native Colombians.

Critical Language Scholarship Winner Anna Correa to Study Hindi Virtually This Summer

University of Iowa student Anna Correa of Clive, Iowa, has been awarded a 2021 U.S. Department of State Critical Language Scholarship (CLS) for a virtual intensive language and cultural program to study Hindi this summer. The CLS scholarship is a program of the U.S. Department of State’s Bureau of Educational and Cultural Affairs.

Romitti participates in release of a new toolkit for global birth defects surveillance

In his role as executive committee chair for the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR), Paul Romitti, professor of epidemiology, recently participated in a World Health Organization (WHO) webinar to release a new global resource to support population-based surveillance programs for birth defects.

Podcast: Global public health – mental health, trauma, and the COVID-19 pandemic

This second episode of our global public health series focuses on mental health. Alexis and Steve talk to Rafael Muñoz, CEO of Human Reinvention based in Ecuador. He shares his thoughts on mental health and trauma as public health issues as well as how the pandemic is impacting the mental health of individuals.

Winners of the 2020 Global Public Health Case Competition announced

Congratulations to the students who participated in the 2020 Global Public Health Case Competition! The teams were composed of UI students from 4 colleges, 12 departments/disciplines, 9 degree programs, and a mix of undergraduate and graduate students. The teams addressed the topic “Chronic Disease Amongst Detained Migrant Populations in Chiapas, Mexico.” The winning teams were awarded cash prizes.

Podcast: Violence, trauma, and social determinants in Africa and Hong Kong

From the Front Row: This episode features a roundtable discussion between CPH students Oge Chigbo, Toluwani Adekunle, and Megan Pospisil. The three discuss examples of ongoing human rights violations in Africa and China and how they relate to global public health.

Building Capacity to Reduce HIV-Related Stigma among Adolescents in Western Kenya

Eight new awards were funded through Fogarty’s Reducing Stigma to Improve HIV/AIDS Prevention, Treatment and Care in Low- and Middle-Income Countries (LMICs) program, totaling approximately $3 million in support over the next two years. The awards are intended to spur development of innovative interventions to reduce stigma in LMICs, including among particularly marginalized or vulnerable communities, such as adolescent girls, people who inject drugs, and caregivers and children of people living with HIV.

As New Global Crises Emerge, Climate Change Continues

Globally and nationally, people are experiencing a multitude of crises. All at once, individuals are feeling the impact of a global pandemic, police brutality and the continuing effects of climate change. On this episode of River to River, host Ben Kieffer is joined by experts in environmental health and sustainability for a look at the intersection of these global crises. Featuring Peter Thorne, professor and head of of the Department of Occupational and Environmental Health, University of Iowa

CPH alumnus featured in Netflix docuseries

A College of Public Health alumnus is featured prominently in a new Netflix documentary series released last week. The series, “Pandemic: How to Prevent an Outbreak” bills itself as docuseries in which viewers “meet the heroes on the front lines of the battle against influenza and learn about their efforts to stop the next global outbreak.”

Podcast: Global Environmental Health Chat

In this podcast, we will hear from two CBPR practitioners who participated in the workshop in Delhi, India. First, we will hear from Edith Parker, a well-known practitioner of CBPR at the University of Iowa School of Public Health. She’ll explain how CBPR benefited her work in rural communities, and how she connected with Rajesh Tandon, founder of Participatory Research in Asia, or PRIA. Then, we’ll hear from Tandon himself, as he discusses how India utilizes CBPR today, and how he hopes it might create a better future for the country.

A Taste of Fieldwork in Xicotepec, Mexico

Thousands of tourists flock to Mexico for spring break every year, but few of them conduct field research during their visit like a group of University of Iowa students did in March. Dubbing themselves the Public Health Posse, the team of seven undergraduate and graduate students along with instructor Brandi Janssen traveled to Xicotepec, a small city in central-eastern Mexico, as part of a weeklong, interdisciplinary service-learning course. Coordinated with the support of Rotary International, the course has developed long-standing service projects with the UI colleges of pharmacy and dentistry. It was the first year that a group of public health students took part.

Peek-Asa participates in planning global violence prevention workshop

Corinne Peek-Asa, associate dean for research and professor of occupational and environmental health in the University of Iowa College of Public Health, served on the planning committee for a National Academy of Medicine Global Violence Prevention Forum workshop held May 16-17, 2019, in Washington, D.C. The workshop, “Interpersonal Violence Syndemics and Co-occurring Epidemics: Preventing Violence in the Context of Opioid Misuse, Suicide, Social Disparities, and HIV,” explored interconnections between these global public health issues and possible prevention and intervention strategies.

UI Partners with Congolese Community for Pregnancy Health Research

For nearly two years, the UI has partnered with the local Congolese community to identify cultural differences in health care and educate both immigrants and medical providers on how to facilitate more appropriate prenatal and pregnancy care.

UI student Michael Parisi-Mercado awarded Fulbright for research in Romania

During my time in Romania in 2017, I learned about different challenges faced by pharmacists in Romania as it relates to public health and the evolution of their role in society. This inspired me to identify ways in which pharmacists can help improve the health of populations; specifically, how to care for patients living with HIV/AIDS in the most culturally appropriate way.

How Do You Solve a Problem Like (Hurricane) Maria?

Armed with well-researched plans, information-packed slides, and seamless teamwork, six student teams competed for top honors and cash prizes in the inaugural IIPHRP Global Public Health Case Competition held April 4, 2018, at the College of Public Health. The multidisciplinary teams were given a case centered on the ongoing power crisis in Puerto Rico caused by the Category 5 Hurricane Maria in September 2017. Their mission: to present feasible, sustainable solutions to restore health, hope, and resiliency to Puerto Rico.

Baker appointed to national global health panel

University of Iowa faculty member Kelly Baker has been appointed to a three-year term on the National Academies Board of Global Health. The panel, comprised of global health experts representing a range of academic disciplines, carries out activities and studies aimed at advancing the health of people worldwide.

Study looks at impact of water, sanitation, and social conditions on birth outcomes in India

A new study by researchers in the University of Iowa College of Public Health examines the complex relationships between water and sanitation access and social conditions on birth outcomes among women in India. Globally, preterm birth (PTB) and low infant birth weight (LBW) are leading causes of maternal and child illnesses and death. In low-income countries, the challenges women face to meet their basic water, sanitation, and hygiene (WASH) needs may be a major contributor to adverse health outcomes.

UI Student Received a Fulbright Award for Research in Romania

I will be conducting a public health research study that will allow me to investigate water quality and water behavior in various rural and urban communities in Transylvania, Romania, and the impact water quality overall has on human health. Water contamination from nitrites/nitrates, pesticides, aluminum, iron, and phthalates has been a growing concern in the southern and northern areas of Romania for the past decade due to absent surveying and monitoring of private water sources.

Visceral Leishmaniasis Research in India

I traveled to India as a part of the Banaras Hindu University (BHU) Tropical Medicine Research Center faculty. The center is an NIH Specialized Center (P50) that is entering its 15th year of funding located at the Kala-Azar Medical Research Centre (KAMRC). I worked in and around a city called Muzaffarpur in the state of Bihar, which had the honor of being the last area of the world to eradicate smallpox.

Video: Story’s work, CPH global health initiatives featured

Will Story, CPH assistant professor of community and behavioral health, discusses his path to global public health and the UI College of Public Health’s biggest strengths and challenges in global community health.

UI Student Receives a Fulbright U.S. Student Program Award for Research in Romania

I will study smoking cessation education of student pharmacists at Cluj-Napoca’s Medical University Pharmacy Faculty. I will survey students’ preparation and perceptions of smoking cessation. As a pharmacy and public health student, I plan to integrate pharmacists into the global health workforce and equip them for interventions involving patient care.

Climate Change: A scientist helps separate facts from fiction

Of the 17 record-setting hottest years, 16 have occurred since 2000. This year, 2017, is expected to continue the trend—although it’s not expected to top 2016, which took the gold for hottest year on record. Despite this increasing urgency, 2016 marked another year of disconnect between science and politics. The current president of the United States has repeatedly stated that climate change is a hoax—although he has issued contradicting statements—and listed pulling out of the Paris Climate Agreement as part of his 100-day plan for his first days in office.

Global Research on Environmental Exposure

A study on pesticide exposures to farm workers in Oregon led Dr. Diane Rohlman on a path to Egypt. As one of the most hazardous industries, agricultural jobs expose workers to numerous risks, including injuries and contact with chemicals. In her work, Rohlman, Associate Professor in the Department of Occupational and Environmental Health at the University of Iowa College of Public Health, has collaborated with researchers from Brazil, Thailand, the Philippines and elsewhere. One of those collaborations has taken her to Egypt, to examine the health effects of organophosphorus pesticides on young Egyptian field workers.

HIV Services in Kenya

n the global fight against HIV and AIDS, there is hopeful news: The number of people who are newly infected with HIV is continuing to decline in most parts of the world, and fewer people are dying of AIDS-related illnesses. However, many regions still face significant barriers to prevention and treatment of the disease. Sub-Saharan Africa accounted for 74 percent of all AIDS-related deaths in 2013, according to the UNAIDS Gap Report, and young women in this region are particularly vulnerable to HIV infection.

Public Health Without Borders

When Tala Al-Rousan was training to be a doctor, she often stumped her professors with challenging questions. “Many things I asked during clinics or rotations couldn’t be answered by physicians,” Al-Rousan recalls. “They would tell me, maybe you should pursue a degree in public health because your questions are tackling social determinants of health, health disparities, and access to care.”

Growing global citizens

Discovering the world around us is a life-changing experience. When Linda Baker (’68 BA) traveled to Romania with the University of Iowa Alumni Association’s Iowa Voyagers program nearly 10 years ago, she worked for three weeks in an orphanage. It was an experience Linda Baker has not forgotten, and it’s why she and her husband, Dale Baker (’68 BA), have established scholarships to support UI students in similar endeavors. “When I returned from my own experience, I thought it would be great to be able to send students on the trip as well,” says Linda Baker.

A Passage to India

Josie Rudolphi and Maya Ramaswamy did not anticipate the leeches. The two College of Public health graduate students spent a month in summer 2015 conducting research on the working conditions of tea plantation workers in Tamil Nadu, a region of southern India. They went armed with questionnaires about occupational exposures, including strain and stress put on the body from bending or weight bearing. What they had not anticipated, however, were the leeches that found their ways into workers’ shoes and up sleeves, leaving bites and causing skin problems.

Gender disparities in water, sanitation, and global health

Celebrating World Water Day, The Lancet Editors highlighted the gains made towards Millennium Development Goal (MDG) 7c, “to halve, by 2015, the proportion of the population without sustainable access to safe drinking water and basic sanitation”, and noted UN-Water’s call for sustainable water management in view of future increases in demand and shortfalls in supply. As the primary water collectors worldwide, women are disproportionately affected by the scarcity of adequate resources; however, global estimates of improvements in water access do not reflect gender-disaggregated benefits and burdens.

A Quest for Clean Water

Water has been a consistent theme running through Kelly Baker’s work, one that has led her from her home state of Oklahoma to California, Mexico, India, Ghana, and elsewhere around the globe. “I’ve always been a bit of a vagrant,” says Baker, who joined the College of Public Health in 2014 as an assistant professor of occupational and environmental health. “Even before getting into global health work, I traveled a lot.”

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Open Access

Peer-reviewed

Research Article

Drivers of success in global health outcomes: A content analysis of Exemplar studies

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Resources, Software, Validation, Visualization, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliations Department of International Health, Johns Hopkins University, Baltimore, Maryland, United States of America, Exemplars in Global Health, Gates Ventures, Seattle, Washington, United States of America

Roles Conceptualization, Formal analysis, Funding acquisition, Investigation, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing

Affiliation Exemplars in Global Health, Gates Ventures, Seattle, Washington, United States of America

¶ Membership of the Exemplars in Global Health Partner Network is provided in S1 File .

• Nadia Akseer, 
• David E. Phillips, 
• on behalf of the Exemplars in Global Health Partner Network

• Published: May 9, 2024
• https://doi.org/10.1371/journal.pgph.0003000
• Reader Comments

Applying a positive outlier lens is one effective approach for generating evidence to inform global health policy, program, and funding decisions. Exemplars in Global Health (EGH) is a program that studies positive outlier countries that have made extraordinary progress in health outcomes (despite limited resources) and disseminates their successes through multiple types of outputs. To date, EGH has studied, or is studying, 14 global health topics in 28 countries. This paper aims to identify findings, summarized as themes and sub-themes, that appear among all completed EGH studies. We developed a conceptual framework and used a content analysis approach to identify the top thematic areas that appear as drivers for programmatic success across EGH studies that were completed between June 2020-May 2023. The EGH studies (N = 31) spanned six topics including under-five child mortality (n = 6), childhood stunting (n = 5), community health workers (CHW) (n = 4), vaccine delivery (n = 3), COVID-19 response (n = 6), and newborn and maternal mortality reduction (n = 7) across 19 countries in sub-Saharan Africa, Latin America, South and Central Asia, and the Caribbean regions. Top drivers of success were defined as those critical or catalytic in achieving the intended outcome. Eight key drivers were identified: (1) efficient data collection and use for decision-making, (2) strong political commitment and health leadership, (3) effective stakeholder coordination, (4) a local, connected, and capacitated workforce, (5) intentional women’s empowerment and engagement, (6) effective adoption and implementation of national policies, (7) effective and sustainable financing, and (8) equitable, efficient outreach and targeting. These cross-cutting drivers span a broad range of development outcomes, sectors, and populations, and indicate a need to effectively integrate people, systems, and sectors to improve global health outcomes. Findings from this study aim to support peer learning among countries and support evidence-based decision-making for funders, policymakers, and other key stakeholders.

Citation: Akseer N, Phillips DE, on behalf of the Exemplars in Global Health Partner Network (2024) Drivers of success in global health outcomes: A content analysis of Exemplar studies. PLOS Glob Public Health 4(5): e0003000. https://doi.org/10.1371/journal.pgph.0003000

Editor: Madhukar Pai, McGill University, CANADA

Received: January 6, 2024; Accepted: March 4, 2024; Published: May 9, 2024

Copyright: © 2024 Akseer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Data are available in a public, open access repository at https://www.exemplars.health/ .

Funding: This meta-analysis of completed research studies was funded by Gates Ventures, Seattle, WA, which was involved in the conception of the study, the critical review of findings and the decision to publish. Funding was provided to the first author, NA, doing business as Modern Scientist Global, Inc., via contract.

Competing interests: This meta-analysis of completed research studies was funded by Gates Ventures, Seattle, WA. This does not alter our adherence to PLOS Global Public Health policies on sharing data and materials. There are no patents, products in development, or marketed products associated with this research to declare.

Introduction

Global public health policy, program, and funding decisions ideally depend on timely and dependable evidence from a range of approaches, spanning experimental, quasi-experimental, and observational designs. Decision-makers in each of these sectors need a breadth of information about not only what interventions work, but also how they have been successfully delivered in different contexts.

One effective model for generating such evidence is known as a positive deviance, or positive outliers approach, whereby places, programs, or projects that have had exceptional success relative to their economic status are identified and studied for transferrable lessons [ 1 ]. This approach has been applied in global health in the past, with varying degrees of rigor [ 2 – 6 ].

In recent years, the Exemplars in Global Health (EGH) program has begun to identify and study positive outliers, with an aim of doing so as systematically and rigorously as possible [ 7 ]. EGH applies a consistent mixed methods design to study positive outlier countries and sub-national areas (referred to as Exemplars) via in-country research partners. To date, the EGH program has studied, or is currently studying, 14 major global health topics, which are determined through an inclusive, consultative process to identify information needs from country governments, norm-setting bodies, and donors. These topics include under-five mortality reduction, childhood stunting reduction [ 8 – 15 ], community health workers, vaccine delivery [ 16 – 26 ], neonatal and maternal mortality reduction [ 27 , 28 ], COVID-19 response [ 29 – 36 ], primary health care, anemia among women of reproductive age, family planning, adolescent sexual and reproductive health and rights, women’s health and wellbeing, digital health, diagnostics, and early warning systems for diseases with epidemic or pandemic potential ( Fig 1 ). Each topic’s consortium defines its own set of research questions about how its Exemplars achieved their success, conducts a study in each Exemplar country, and produces academic publications, case study reports, and narratives (content for the EGH web platform) from each study. Research questions are designed to be responsive to end-users through a participatory process of learning about information gaps among stakeholders and working with both topic and country experts to ensure the research addresses their needs. Research questions are answered through a combination of statistical analysis and qualitative research, guided by an a priori , evidenced-informed, conceptual framework. Topics are overseen by independent Technical Advisory Groups (TAGs), comprised of local and global thought leaders in the space, to ensure the quality, validity, and utility of the findings.

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Map Source: https://commons.m.wikimedia.org/wiki/File:Blank_world_map_Robinson_projection.svg .

https://doi.org/10.1371/journal.pgph.0003000.g001

Since its inception in 2017, the EGH program has completed 31 studies (i.e., research on one of the topics listed above, in a specific country), spanning 19 countries under the first 6 of the 14 topics listed above (the remaining topics currently have research in progress), as well as research into subnational positive outliers in large countries such as India and Nigeria ( Fig 1 ). Each EGH topic routinely produces a cross-country synthesis narrative that summarizes the overarching findings across countries studied for the same topic, but to date, no systematic effort has been taken to summarize findings across topics.

This paper aims to identify common themes and findings that resulted in unexpected health outcomes among the completed EGH studies. Specifically, we will present 1) the top thematic areas that appear across Exemplar studies (i.e., highlighting “what” different Exemplars did to achieve impressive outcomes); and 2) the key sub-themes in each of the thematic areas (i.e., highlighting “how” the Exemplars achieved successes in each thematic area). In documenting these lessons, we aim to demonstrate cross-cutting drivers of exceptional performance in global health so that decision-makers throughout the landscape of global health organizations can adopt more effective practices.

Materials and methods

Study design and sampling.

This qualitative study employed a descriptive content analysis approach to study key themes and patterns emerging from the EGH studies [ 37 – 47 ]. EGH studies used the positive deviance approach as described above; methods details have been published elsewhere [ 7 ] and in respective studies[ 9 – 14 , 21 , 22 , 24 – 26 , 28 , 36 ] We used purposive sampling, considering all completed EGH studies (N = 31) from June 2020 to May 2023 for inclusion in this analysis. Studies were excluded if validation of final results was ongoing or if research partners requested to independently publish findings prior to this study. Studies covered the following topics: under-five child mortality (n = 6), childhood stunting (n = 5), community health workers (n = 4), vaccine delivery (n = 3), COVID-19 response (n = 6), and neonatal and maternal mortality reduction (n = 7) across 19 countries in sub-Saharan Africa, Central and South Asia, East Asia-Pacific, Latin America, and the Caribbean regions ( Table 1 ).

https://doi.org/10.1371/journal.pgph.0003000.t001

Data sources

We conducted a desk review of all completed EGH country case study reports, online platform narratives, and peer-reviewed publications for the 31 completed studies. This included a total of 70 documents across the six topics. In addition, we consulted EGH cross-country and in-country research partners that were engaged in the original studies ( Table 2 ) as well as internal EGH research leads for additional contextual information.

https://doi.org/10.1371/journal.pgph.0003000.t002

Conceptual framework

We developed a conceptual framework that adapts several existing health systems frameworks [ 48 , 49 ] as well as frameworks used for the included EGH topics ( Fig 2 ). These frameworks were selected as they were designed or adapted by EGH research experts for the respective topics that were included in this study. All unique domains and sub-domains across these frameworks were included in the overall framework, and any duplicated concepts were harmonized (e.g., terminology, constructs reduced or expanded) as needed. The framework was developed a priori to guide the analysis for this study and was iterated with EGH research teams and research partners to refine the final set of concepts, nomenclature, and definitions. The framework identifies key factors of successful intervention delivery and illustrates the relationship between distal policies and systems, health system inputs (e.g., health facility resources and infrastructure), service delivery processes and coverage, and equity on key health outcomes. Underlying each of these spheres of influence is the macro political, social, environmental, and economic context of a country.

https://doi.org/10.1371/journal.pgph.0003000.g002

We undertook a conceptual content analysis approach, which maps and quantifies the presence of words, themes, or concepts across data, to identify any emerging patterns or themes [ 50 – 52 ]. Content analysis is a flexible approach that is well-suited for analyzing data on multifaceted phenomena and is increasingly used in nursing [ 53 – 55 ], public health [ 37 , 38 , 56 , 57 ], psychiatry [ 39 – 42 ], and health informatics [ 43 , 44 ], among other areas [ 45 , 46 ]. We initially utilized an inductive approach (i.e., open coding), followed by deductive coding that was guided by the conceptual framework [ 47 ]. After coding, data were then categorized and mapped in larger categories and grouped into emergent themes to identify top drivers of the successes achieved in Exemplar studies (i.e., factors that were critical or catalytic in achieving the intended outcome) [ 47 ].

Emergent themes were quantified (Yes/No– 0/1) and arranged in a master database aligned with the conceptual framework ( S2 File ). An indicator was developed to measure the presence (%) of the theme across Exemplar studies as follows: number of studies where the theme appeared in publications, case study reports, and/or narratives as a top driver of the successes / total number of Exemplar studies. A threshold (>75%) was set to select top drivers across studies. This threshold was set by examining the distribution of percentages among drivers and identifying a rough threshold above which only a small number of drivers remained. In this quantification, each Exemplar study was given equal weight to avoid inaccurately overrepresenting findings from some countries, i.e., if countries were weighted by population, findings from case studies in India would significantly outweigh those from other countries with lower populations. Some themes were not considered for all studies, especially if the theme was not studied (e.g., women’s education and empowerment in COVID-19 response) or if the theme was part of the outcome (e.g., existence of a CHW program could not be a top driver in studies focused on mapping drivers of the CHW program’s success). The analysis process was led by NA with continuous consultation with internal EGH research teams and additional consultation with research teams responsible for the original studies. Any discrepancies were discussed and resolved by cross-referencing study documents and consultations with research partners, where needed. Data coding was performed manually, and descriptive analyses were executed in Excel 2023 and Stata version 15.

The checklist for Standards for Reporting Qualitative Research (SRQR) was also consulted ( S3 File ).

Sensitivity analyses were also conducted using the country as the unit of analysis to account for countries that had multiple studies (e.g., Senegal was a region of study in stunting, under-five child mortality, vaccine delivery, and neonatal and maternal mortality reduction), which were given one weight in the final analyses to ensure each country was equally represented ( S2 File ). A theme was listed as a top driver if it emerged in any one of the included topics for the country.

A technical advisory group (TAG) comprised of experts, including research partners and principal investigators from the selected studies, were assembled to support validation of this EGH cross-topic synthesis. The TAG had research and policy expertise in key domains as relevant to this study including child nutrition, maternal, newborn and child mortality, community health workers, vaccine delivery systems and pandemic response/COVID-19. The TAG was engaged from the outset of the study. They joined a TAG meeting where the study approach and goals were shared. The TAG subsequently reviewed the content analysis methodology, development of broader framework, the emergent themes, and the final results in an iterative way over email between 2021 and 2023. Feedback from the TAG was discussed and reflected into the work as appropriate. Any discrepant suggestions or feedback was resolved by open dialogue between study researchers and TAG members until agreement was reached.

Countries included in the content analysis represented Sub-Saharan Africa (n = 8), South Asia (n = 4), Latin America and the Caribbean (n = 4), Middle East and North Africa (n = 1), Europe and Central Asia (n = 1), and East Asia and Pacific (n = 1) and were largely lower middle income (n = 14) and upper middle income countries (n = 5) in 2023 ( Table 1 ). The median population size across countries was approximately 30 million, ranging from 5 million (Costa Rica) to nearly 1.4 billion (India).

A total of eight themes emerged, as presented in Fig 3 . Sensitivity analyses based on country identified most of the same themes.

https://doi.org/10.1371/journal.pgph.0003000.g003

Key drivers of success included: (1) efficient data collection and use for decision-making, (2) strong political commitment and health leadership, (3) effective stakeholder coordination, (4) a local, connected, and capacitated workforce, (5) intentional women’s empowerment and engagement, (6) effective adoption and implementation of national policies, (7) effective and sustainable financing, and (8) equitable, efficient outreach and targeting.

Efficient data collection and use for decision-making

In 28/31 (90%) studies, efficient data collection was used to make strategic decisions. Exemplar countries invested in high-quality national and local data collection and analysis systems . An example of this was observed in Ethiopia, which prioritized their system’s interoperability by investing in national data collection structures such as the Health Management Information System (HMIS) (rolled out in 2008), an electronic version (mid-2010s), the establishment of the Central Statistical Agency (2005), and the National Statistical Development Strategies (2009, 2015) [ 58 ]. Other settings conducted small-scale or local research studies to pilot interventions before scale-up , complementing use of routine data. For example, researchers and health professionals relied heavily on local research to validate global best practices before considering scale-up of interventions in Nepal; the success in locally designed and implemented research informed adoption of chlorhexidine as a cord care treatment and the vitamin A campaign [ 59 ]. Additionally, using data to identify priorities and tailor interventions to local contexts was a key driver in many studies, including Zambia’s adapted “reaching every district” (RED) strategy, which strengthened community-level immunization campaigns using an inclusive, facility-level microplanning that included local leaders to successfully reach remote communities [ 22 , 60 ]. Lastly, fostering a culture of data for decision making proved critical, for example, in Ghana during COVID-19 where the country relied on existing (i.e., District Health Information Management System, DHIMS) and newly-developed systems (i.e., The Surveillance Outbreak and Response Management and Analysis System) for rapid data sharing with key health officials, health workers, and the public, as well as real-time tracking of new cases, allowing key decision makers to swiftly adjust mitigation strategies [ 61 ]. Despite these success factors, several countries also noted that challenges and opportunities remained to improve data quality, including in improving completeness and representation.

Strong political commitment and health leadership

In 28/31 (90%) of Exemplar studies, strong political commitment and government leadership was critical for achieving outcomes. This was often measured through the formation of new entities or national plans. A key strength of successful programs was the ability to seize windows of opportunity to mobilize leaders to advocate for change. For example, when Dominican Republic’s new president and administration were taking office in August 2020, they mobilized the country towards a common goal of protecting the population from COVID-19 through mass vaccination while gradually reopening the economy [ 62 ]. Other programs developed high-level coordinating bodies for key strategies and plans such as Senegal’s Cellule de Lutte Contre la Malnutrition (Coordination Unit for the Fight Against Malnutrition, CLM) [ 63 ]. Located in and chaired by the prime minister’s office, rather than within the Ministry of Health, brought together representatives of key stakeholders, the Ministry of Health, and additional ministries of Education, Agriculture, and Industry, all of which are involved in nutrition. This elevated its prominence, allowing for the successful launch of the multisectoral Programme de Renforcement de Nutrition (Nutrition Enhancement Program) in 2002, which impressively established 5,000 community-based nutrition workers delivered nationally. Another factor of success was the institution of contingency plans and processes to ensure continuity in service delivery during crises as was critical in Liberia when in the aftermath of the Ebola epidemic, the government, partners, and donors moved swiftly to provide basic health care to all citizens and establish an early warning system to mitigate any potential future epidemics [ 64 ].

Effective stakeholder coordination

In 26/31 (84%) of studies, effective stakeholder coordination was identified as a top driver of success. A key strategy was engaging partners meaningfully throughout the programs. In Bangladesh, a CHW program intentionally engaged key implementing partners such as the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), BRAC, and CARE to engage in the design, funding, implementation, and evaluation of various interventions, including family planning, pediatric diarrhea, and CHW capacity-building [ 65 ]. Another success factor was the institutionalization of stakeholder coordination in the form of official coordinating bodies. In Senegal, the Ministry of Health and Social Action’s Reproductive, Maternal, Newborn, and Child Health cluster–which included the United Nations Children’s Fund (UNICEF), World Health Organization (WHO), and the World Bank–led to an efficient and impactful strategy that helped drive the significant reduction in under-five child mortality [ 66 ]. Others engaged program champions to ensure stakeholder accountability and durability was key, like in Peru’s progress against stunting where regional leaders publicly pledged for stunting reduction through financial incentive programs such as the Fondo de Estimulo al Desempeño y Logro de Resultados Sociales (Fund to Stimulate Performance and Achievement of Social Results, RED) program [ 67 ].

Local, connected, and capacitated workforce

In 26/31 (84%) of Exemplar studies, having a strong, local, connected, and well-equipped workforce was key to achieving outcomes. This workforce was often a mix of paid and unpaid health professionals. Firstly, investments in strong community-based healthcare were pivotal. This sub-theme emerged in a majority of the case studies reviewed. Nepal’s Female Community Health Volunteer (FCHV) program was designed to extend health services to the most remote and hard-to-reach communities and very quickly became a central pillar of the health system, providing a source for local knowledge in addition to a critical link between last mile communities and the public health system [ 68 ]. During the COVID-19 pandemic, Thailand preemptively appointed nearly 40,000 contract nurses, frontline health workers, and other short-term health workers and deployed them into communities; this initiative was successful in preventing health worker shortages and ensuring health professionals could be available and designated for the COVID-19 wards as needed [ 69 ]. Exemplar countries were also successful at expanding the role of health workers to include service provision and health promotion when needed. Senegal’s success in creating an unusually diverse community health system that meets a wide range of community needs is one example. Innovations included health huts, agents de santé communautaires (community health workers, providing a wide range of preventative and curative services and referring complicated cases to higher-level facilities), matrones (matrons, focused on maternal and newborn health), dispensateurs de santé à domicile (home health providers, supporting curative services in the home for conditions such as malaria, diarrheal diseases, and acute respiratory infections), relais communautaires (community relays, covering a wide range of issues in the community), and bajenu gox (“godmothers”) [ 66 ]. Creating educational programs to train sufficient cadres of doctors , nurses , and other health workers was also a key driver in Exemplar countries. To address the problem of many Ethiopian doctors leaving the country to practice abroad where salaries are higher, the Ministry of Health adopted a policy of “deliberately overproducing” healthcare professionals [ 70 ]. In 2012, 13 new medical schools opened, more than doubling the country’s total. As of 2016, there were 33 medical schools, and those schools graduated approximately 3,000 new doctors. Exemplar countries also had success in s trengthening referral networks between community and facility-based health care and building integrated teams. A pillar in Brazil’s primary health care system is the Family Health Team (consisting of a nurse, nurse assistant, physician, and four to six CHWs). Brazil embedded CHWs within the Family Health Team to strengthen CHWs’ abilities to link communities to a continuum of preventive and curative care provided by the Family Health Team at nearby primary health care facilities and to leverage the deep knowledge of CHWs as community insiders to better serve families [ 71 ].

Women’s empowerment and engagement

In 20/25 (80%) of studies, the education and empowerment of girls and women were key facilitators in the successes achieved. As a note, the six COVID-19 response studies did not study this driver and hence were excluded for this theme. Many Exemplar countries were investing and implementing best practices in girls’ education . Senegal launched a flurry of education policies and investments, including the National Action Plan for Education for All and the Ten-Year Education and Training Plan, both of which were structured according to the Dakar Framework (2000–2015) and prioritized both girls and boys in these initiatives [ 63 ]. Given high drop-out rates among adolescent girls, some Exemplars created incentive programs to keep girls in school . Bangladesh’s Female Secondary School Stipend Project was successful in improving girls’ secondary school enrollment and retention [ 72 ]. It provided girls in rural areas with stipends for attending school at least 75 percent of the time, maintaining passing grades, and delaying marriage until the completion of secondary school or their 18 th birthday. Adopting policies and devising strategies on women’s rights , social inclusion , and equality were also key drivers in Exemplar countries. Nepal led in this area by establishing a Ministry of Women and Social Welfare (1990s), a National Plan of Action for Gender Equality and Women’s Empowerment (1997), and the Health Sector Gender Equality and Social Inclusion Strategy (2010) [ 59 ]–each of which played a key role in improving women’s representation in society and public life, including in parliament in Nepal.

Effective adoption and implementation of national policies

Another top driver (24/31, 77% of studies) was the effectiveness and scale at which key national or subnational laws, legislations, policies, or large-scale programs were adopted at a country level and successfully scaled to improve outcomes. This was often accomplished via bidirectionality of top-down and bottom-up approaches. One key strategy was to establish a national commission to tackle key priorities . Supported with a national champion, Morocco was able to establish a national commission to prioritize efforts to reduce maternal mortality; the commission developed the strategy to support the plan d’accélération de la réduction de la mortalité maternelle (accelerating the reduction of maternal mortality) (2008 to 2012), which was critical in improving maternal survival [ 73 ]. Another key approach was to institute effective plans and actions for stakeholders at all levels . In response to the COVID-19 pandemic, Sri Lanka coordinated a top-down response where national centers, such as the National Operations Centre for Prevention of COVID-19 Outbreak and task forces (i.e., Presidential Task Force for the COVID-19 response), were established to focus on preventive and management measures to ensure that health care and other services are well-geared to serve the general public [ 74 ]. To combat COVID-19, the Ugandan Ministry of Health also activated a centralized Public Health Emergency Operations Center (PHEOC) and National Task Force comprising public health experts and representatives from government agencies [ 75 ]. These multisectoral and multilevel coordination committees offered clear technical guidance and direction to district and local officials and health care providers and helped translate emerging data into national policy and practice. Several Exemplars also developed policies at the highest level that focused on priorities for marginalized communities or key family decision-makers , such as Niger’s écoles des maris , loosely translated as “husband schools” [ 73 ]. These schools focus on educating men in the household on critical maternal and child health and nutrition issues to improve healthcare decision-making for their families.

Effective and sustainable financing

In 25/31 (81%) of Exemplar studies, effective financing was key; countries found ways to extend use of their funds in many ways, including aligning funders to reduce duplication, using sophisticated financial planning tools to model spending scenarios, and implementing financing models that incentivize performance. Brazil’s c reation of innovative financing mechanisms expedited implementation of the Family Health Strategy by ensuring a steady revenue stream for participating municipalities through three innovative funding mechanisms: thresholds for health care spending, financial incentives for municipalities to adopt the Family Health Strategy and benefit the poorest municipalities, and a pay-for-performance program to improve quality [ 76 ]. In Liberia, using detailed financial planning tools was essential. During the early planning phase of Liberia’s community health assistant program, the government developed detailed financial costing and sustainability modeling to track and study three key variables: potential costs, potential benefits, and potential funding [ 77 ]. With these tools, those working in Liberia could understand, at an extremely granular level, the costs and benefits of various elements of the program, as well as who might be willing to pay for them, and for how long. The government of Rwanda consistently maintained relatively high levels of national health expenditure by keeping health a priority and including the ambitious rollout of a national health insurance plan [ 78 ]. Meanwhile, Rwanda successfully encouraged and coordinated foreign donors and partners to follow—and contribute to—a nationally-led agenda. This has enabled Rwanda to retain national control of its own health policy while benefitting from foreign insight and technical assistance. Meanwhile, the Kyrgyz Republic started to reform its Soviet-era social protection system by re-designing social protection programs based on local contexts . Successful programs such as the Universal Monthly Benefit (UMB), a means-tested cash benefit for the poorest families with children between the ages of 18 months and 16 years was a result [ 79 ].

Equitable, efficient outreach and targeting

In 24/31 (77%) of studies, addressing population health inequities through outreach and targeting was a key driver. Implementing multisectoral programs focused on high-burden communities was one effective approach. Peru’s Crecer (To Grow) program (launched in 2007) was a successful effort in consolidating the country’s existing poverty alleviation and nutrition programs. The program selected high-impact, evidence-based interventions and deployed them in key geographies (such as the poorest or hardest to reach) where they could make the most difference [ 67 ]. Several Exemplar countries also regularly used context-specific innovations and adapted service delivery to achieve optimal outcomes. To protect healthcare workers but also continue provision of essential healthcare services, Costa Rica, as part of its COVID-19 response, had 4,800 healthcare workers providing services remotely. Key services included online and telemedicine outpatient consultations and monitoring of asymptomatic COVID-19 patients by phone to reduce system burden [ 80 ]. Exemplar countries were also effective at delivering interventions based on need . In India, several states emphasized geographic targeting and developing tailored interventions based on need and evidence. District-level management infrastructure was leveraged to catalyze implementation of key maternal and newborn health programs tailored to local coverage and equity needs, while financial flexibility enabled effective and efficient resourcing [ 81 ].

Findings from this content analysis of Exemplar studies highlight cross-cutting drivers of success across broad health and development outcomes, including efficient data systems, effective leadership, effective stakeholder coordination, a capacitated workforce, women’s empowerment, a conducive national policy environment, sustainable financing, and outreach.

These findings generally align with previous efforts aimed at identifying drivers of global health improvements. The WHO’s Health Systems Framework identifies leadership and governance, including the creation of strategic policy frameworks, effective oversight, and coalition building, as health system building blocks [ 82 ]. Consistently, we have found that political commitment and health leadership as well as effective adoption and implementation of national policies are key drivers of health improvements. Also included in the WHO framework are a well-performing health workforce, functioning health information system, and adequate health funding that protects the public and provides effective goods and services [ 82 ]. This aligns with the identified themes of a local, connected, and capacitated workforce, data collection and use for decision-making, and effective and sustainable financing. The 2022 Sustainable Development Goals report also identified an urgent need for increased data investment as data collection costs rose and government funding for national statistics offices was cut during the pandemic [ 83 ]. The lessons learned from the Millennium Development Goals also reflected the findings that data are indispensable to the development agenda and that strong political commitment and more resources are needed to achieve targets [ 84 ].

The WHO’s Success Factors for Women’s and Children’s Health studies identified fast-track countries that were able to reduce maternal and child mortality, finding three effective approaches: engagement of multiple sectors, mobilization of partners across society using evidence for decision-making while maintaining accountability, and effective leadership through establishing guiding principles to orient and align stakeholder action [ 85 , 86 ]. Our study corroborates these findings through the identified themes of political commitment through cross-ministry collaboration, effective stakeholder coordination, data collection for decision-making, and effective adoption and implementation of national policies with overarching and cross-cutting strategies. The Countdown to 2015 work on tracking maternal, newborn and child survival found that key drivers of increased coverage of life-saving interventions included financing, human resources, commodities, and favorable health policies [ 87 ]. Furthermore, Good Health at Low Cost, an initiative to identify why some countries outperform others in health and social outcomes, identified attributes of success related to good governance and political commitment with institutions that preserved knowledge gained and learned from experience to adapt despite limited resources [ 3 ]. Women’s empowerment, education, transport infrastructure, and resilience-building were also identified as components of success [ 3 ]. Finally, the WHO and UNICEF’s Primary Health Care (PHC) framework identifies four core strategic levers that include political commitment and leadership, governance and policy frameworks, funding and allocation of resources, and engagement of community and other stakeholders [ 48 ].

Notably, the findings pose some differences with the broader literature as well. Although other similar initiatives shared several themes with the findings reported here (e.g., political commitment, national policies, data collection, financing, stakeholder coordination, workforce, and women’s empowerment, as noted above), our study supports other drivers that are more nascent in the broader literature, such as equitable outreach and targeting. Community engagement, a strategic lever supported by the WHO and UNICEF PHC framework among other comparable efforts, was not listed among the primary eight drivers of this study. However, community engagement to define problems, solutions and priority actions did emerge as a common driver among EGH studies, albeit below the 75% threshold.

Our findings on the education and empowerment of girls and women being key to successes achieved are very timely and important. Indeed, some countries today, such as Afghanistan, grapple with issues around how to engage girls and women in their societies including in the education system, the workforce and in public life. This study of drivers of success across diverse outcomes and geographies around the world over a 20-year period underscore, yet again, the importance that girls and women’s education and empowerment has to countries achieving optimal health and survival outcomes. We hope that donors and national governments can consider these findings in country development strategies and action plans.

Implications of findings

While the results of this study are not entirely new to the field, it does contribute meaningful information in at least two ways:

• It reinforces a set of principles that ought to influence national health strategies by showing that they are present in top-performing countries.
• It synthesizes a large (and growing) corpus of EGH literature, facilitating navigation to find deeper description of these themes in specific countries.

Additionally, countries can learn from and potentially adapt lessons from this study given the identified top drivers are often overarching issues that all nations must consider in their policy, strategy and programming decisions. For example, investments in data systems–despite varying contexts and challenges that countries experience, our study promotes the investment in rigorous data collection systems and its use for decision-making for achieving broader health goals. Details on how countries achieved these successes, as provided on the EGH platform and published studies, provide further guidance to countries on how to best design goals and activities for the driver. Certainly, the top drivers identified in this study are cross-cutting issues that would be helpful when countries are considering broader health and development agendas such as the Sustainable Development Goals or Universal Health Coverage. Whether its investments in data systems, coordinating key stakeholders, political commitment to the goals/plans, engaging and empowering women, or ensuring sustainable financing–by prioritizing these areas, EGH findings posit that the goals would be set up for success.

Strengths and limitations

Global health research that employs a positive outlier lens can uncover valuable lessons that are less apparent through other approaches. For example, observational analysis of this sort can include complex driving factors that may have an effect over a long period of time, in comparison to experimental and quasi-experimental designs that often must be limited to shorter periods of observation and simpler causal factors, especially those that are more amenable to direct intervention. A focus on positive outliers specifically serves to efficiently narrow the scope of observational analysis to places that are known to have succeeded, thus narrowing research findings to effective interventions and strategies by extension.

However, positive outlier studies pose their own challenges. Identification of positive outliers can be complex and subject to measurement error since definitions and quantification of success may vary widely across topics and geographic units of study. Complicating the identification of outliers further, the EGH studies included here intentionally included countries with varied geographic and other characteristics, in some cases eschewing some outliers in the interest of regional representativeness. Furthermore, given the number of real-world factors that could influence outcomes, it may be more difficult to confidently identify causality. A positive outlier approach alone also can fail to include a counterfactual; it merely focuses on description of what happened , not what was unique about a successful location (compared to a less successful location). Future EGH studies may seek to include counterfactual (i.e., non-Exemplar) settings as a basis for comparison. Finally, a focus on positive outliers can give undue weight to successes while ignoring potential failures, even within positive outlier countries. Results need to be presented with full context so that readers can understand exactly which factors contributed and in what way.

Certainly, previous studies that have applied the positive deviance approach [ 2 – 6 , 85 , 86 ] have generally been able to identify key drivers for success in topics of study, while also uncovering bottlenecks or challenges, and making recommendations for policy and action–despite varying in their methodology and rigor. EGH tried enhancing this approach by applying a standardized, comprehensive methodological framework for all topics studied, undertaking several complementary qualitative and quantitative analyses to test sensitivity of findings, drawing on expert consultations throughout the research process, engaging policy and decision maker from the outset of the study design to results interpretation, and acknowledging the remaining challenges and counterfactuals.

The content analysis conducted here poses its own strengths and weaknesses as well. It can be an effective tool to provide new insights and improve a researcher’s understanding of a particular phenomenon [ 88 ] and can make it possible to convert words into content-related categories [ 46 ]. Yet, the method has been criticized for being simplistic and lacking detailed statistical analysis, for not being sufficiently qualitative in nature, and for being relatively subjective [ 46 ]. However, for this exploratory hypothesis-generating study, we feel the method was robust and sufficient, and we tried to mitigate the risk of subjectivity by having multiple content reviewers and validations with topic and study experts throughout the process.

A final limitation relates to the Exemplar studies used in the analysis. While the studies generally have a common mixed methods approach, the individual frameworks and methodologies used to derive study results vary and may not be exactly comparable to one another for this content analysis. Study periods also varied from a few years (during the COVID pandemic) to decades (stunting), though the major drivers were consistent between studies, nonetheless. The scope of this study also excluded deep examination into the studies that did not include key themes; for example, three studies did not report political commitment as a key theme. Future analysis may explore such divergence. However, the goal of this study was to highlight top drivers across the successes irrespective of the approaches used for research; it is our understanding that individual research partners would use the most rigorous, exhaustive, and evidence-informed frameworks, datasets, and methodologies to determine success factors for their topics and content analysis meta-analyzed for topline findings. In that regard, it is our understanding that findings from this content analysis are methodologically sound and are reflective of the overarching common themes among global health successes.

Our sensitivity analyses focused on the country (n = 19) rather than the country-study as the unit (n = 31), verifying the results identified in this work and strengthening the main messages we have reported.

Future research

Further work will explore counterfactual Exemplar studies to understand “what doesn’t work” to drive national gains while exploring any subnational successes. This analysis of counterfactuals will also be used to contrast and compare cross-cutting challenges along with the cross-cutting success factors identified through this study. Further work will also explore instances where these cross-cutting themes did not emerge to understand how Exemplar countries achieved success without these factors to shed light on those studies where specific constructs were not studied or analyzed. Although we are not able to rank prioritize the set of cross-cutting drivers identified in this study, we will endeavor to explore the feasibility of such an assessment in future Exemplar multi-country analyses. Relatedly, countries and experts often are faced with the reality of identifying the relative costs and efficiencies of one intervention compared to another–while this analysis sheds some light on the key drivers, we were not able to link to costs or cost-effectiveness of these interventions. Future analyses will aim to explore this further.

Resources for development are severely limited, and inadequate funding hinders the ability to fully implement every policy, strategy, and program. Within this universal constraint, however, some countries are able to spend more on key development priorities, some are able to maximize the impact of what they spend, and some are able to do both. We hope that by summarizing the common factors among the countries who have been able to maximize impact, findings from this study can aid funders, policymakers, and other stakeholders in understanding strategies to achieve optimal outcomes across health and human development.

Supporting information

S1 file. acknowledgments..

https://doi.org/10.1371/journal.pgph.0003000.s001

S2 File. Analysis of themes.

https://doi.org/10.1371/journal.pgph.0003000.s002

S3 File. Standards for Reporting Qualitative Research (SRQR) checklist.

https://doi.org/10.1371/journal.pgph.0003000.s003

Acknowledgments

We acknowledge the valuable contributions of all research partners and their organizations involved in EGH studies and the support from Gates Ventures staff in maintaining the EGH platform, facilitating management and coordination for EGH studies, and preparing the graphics/copy-editing for this manuscript.

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Global Health Research

We aim to conduct high-quality research that leads to informed policy-making and innovative approaches to health challenges at local and global levels. Ultimately, we strive to make contributions to achieve the national goals identified in Healthy China 2030 and other Chinese policies as well as globally the health-related Sustainable Development Goals such as universal health coverage, health system strengthening, and infectious and NCD risk reduction.

With a growing number of faculty members and ever-expanding needs for more global health research in the world, we identify three key priority research domains and, in each domain, three specific priority areas. Priority setting is not meant to exclude other research domains or areas, but to focus our resources to achieve larger impacts in the time period covered by this plan (2022-2027). Innovation is at the core of all research endeavor and spans all priority areas. Of note, these domains and priority areas are not mutually exclusive due to the interdisciplinary and complex nature of global health issues.

Research Projects

Innovation Lab for Vaccine Delivery Research (VaxLab)

In December 2021, with the support of the Bill and Melinda Gates Foundation, the Global Health Research Center at Duke Kunshan University established the Innovation Lab for Vaccine Delivery Research (VaxLab). Led by Professor Shenglan Tang , VaxLab aims to strengthen the national immunization program and improve people’s health by producing high-quality scientific evidence and conducting policy advocacy activities. To comprehensively strengthen the immunization program in China, the VaxLab has identified four key research areas, including developing relevant strategies to strengthen the national immunization program, improving vaccine delivery efficiency and coverage, enhancing vaccine fundraising and services, and advocating for the inclusion of key vaccines recommended by the WHO in the national immunization program.

The project’s teams have cooperated on multiple parts of the vaccine delivery research and have achieved major milestones. VaxLab regularly produces high-quality policy briefings on the project’s WeChat Official Account (vaxlab_dku) to share important research findings with policymakers and the academic community. Partnered with experts from the Development Research Center of the State Council, VaxLab has published three high-quality policy briefings in 2022, entitled Strategic Thinking on Strengthening China’s National Immunization Program, Improving HPV Vaccine Access to Accelerate the Elimination of Cervical Cancer in China, and Increasing Uptake of Key Non-National Immunization Program Vaccines in China. 

Integrated Care for Tuberculosis and Diabetes Comorbidities in Asian Countries

Professor Abu Abdullah led a multi-country study that examined the health system efficiencies in integrated public health and primary care addressing tuberculosis (TB) and diabetes mellitus (DM) comorbidities in six Asian countries including Bangladesh, China, India, Indonesia, Nepal, and the Philippines. The dual burden of TB and diabetes is a major global concern in public health and a critical challenge in low- and middle-income countries. This multi-country study, completed in 18 months with collaboration from researchers in participating countries, explored the available policy initiatives and service provisions to address TB-DM comorbidity within the existing healthcare systems of these countries, documented potential health system challenges for integrated care for TB-DM co-morbidity, and made recommendations for potential policy initiatives. The study was funded by the Asia-Pacific Observatory on Health Systems and Policy (APO) of the World Health Organization (WHO). VaxLab has published several peer-reviewed articles in top international and national academic journals, including The Lancet Public Health, Human Vaccines & Immunotherapeutics, China Public Health, Modern Preventive Medicine, and China Health Economics. In addition, VaxLab regularly invites national and international experts to hold technical workshops, and actively conducts quarterly exchange meetings to facilitate networking and share current research findings. On a virtual social landscape, VaxLab has created a website to build a vibrant online vaccine delivery research community.

Integrated Primary Care for Co-Management of Tuberculosis (TB) and Diabetes Mellitus (DM) in Jakarta, Indonesia

Funded by Duke-NUS Global Health Institute, Dr. Qian Long led Duke Kunshan Health Policy and System team collaborated with researchers of University of Indonesia to investigate a model of integrated care for co-management of tuberculosis (TB) and diabetes mellitus (DM) in the primary healthcare setting in Jakarta, Indonesia. The study found improvement of DM screening and case detection among TB patients after the introduction of TB-DM co-management program. However, the program implementation remains sub-optimal, especially in the coordinated efforts of TB and DM control. The research team engaged the decision-makers for TB control at the regional and national level in Indonesia and discussed the key findings with them. Researchers proposed to strengthen policy dialogue and multi-sector cooperation for improving the performance of TB and DM co-management in Indonesia.

Monitoring, Learning and Evaluation for the China-Gates Project Phase III: Implementation of Comprehensive Models of TB Care and Control in China

This project, led by Professor Shenglan Tang and initiated in 2016, was completed in 2020 with the Gates Foundation’s final report. The project has produced robust evidence on the implementation and the effectiveness of the comprehensive TB care and control models including interventions in TB system strengthening, clinical quality improvement, human resources capacity building, new financing policies to reduce patients’ financial burden, the roll-out of the electronic medication monitor (EMM) and the pilot and promotion new information system. The final evaluation’s key results that show the major achievements of models especially in the improvement of the clinical quality of B diagnosis and treatment, have been presented to the academic experts and policy makers at the National Health Commission-Bill & Melinda Gates Foundation Tuberculosis Prevention and Control Cooperationl0-Year. In 2020 the evaluation report was finalized, and a special issue of academic papers on this project is under preparation.

National Basic Public Health Chronic Disease Management Service Quality Evaluation Project

With the support of United Nations agencies, the Health Policy and System Research Team led by Professor Qian Long at the Global Health Research Center participated in a series of studies on the quality of healthcare services for chronic disease management in low- and middle-income countries. The research team targeted the National Basic Public Health Services Project and analyzed the current situation and quality of chronic disease management services in China using quantitative and qualitative research methods. The research focused on the impact of current financing and payment models on the quality of chronic disease management services and summarized the experience and challenges during the implementation phase.

The study found that current chronic disease management interventions have not achieved the expected results. Preliminary results summarized the reasons from different perspectives, such as (1) insufficient project funding and a lack of effective incentive mechanisms; (2) a shortage of primary healthcare workers and inadequate professional skills among existing healthcare workers; (3) insufficient information to effectively evaluate project performance. The research team submitted the mid-term research report on October 2022 and the final report was completed on April 2023.

Integrated Care for Chronic Diseases in Asia Pacific Countries

Edited by Dr. Chang Liu, Managing Director for Singapore and mainland China at ACCESS Health International, and Dr. Shenglan Tang, Mary and James Semans Professor of Medicine and Global Health, the research paper addresses emerging health challenges posed by ageing populations across Asia Pacific through more integrated healthcare systems. The study looked at integrated care across the Asia Pacific region, examining systems in China, Singapore, the Philippines, India, Vietnam and Fiji, through a combination of desk-based research, interviews and deep-dive case studies. The paper recommends tackling these issues by shifting focus away from hospital care to “ensuring care coordination and continuity of care across primary, hospital, and post-acute settings.” It identifies several factors that help with the development of such a system including strong leadership combined with local flexibility, financial and non-financial incentives for both healthcare providers and users, training for community care workers, collecting accurate health information, and ongoing performance assessments for integrated care programs to measure their effectiveness.

Use of E-Health Programs to Deliver Urban Primary Healthcare Services for Non-Communicable Diseases in Middle-Income Countries

The research paper was authored by a group of researchers including three from DKU: Lijing Yan , Professor of Global Health, Shangzhi Xiong , a 2018-class Global Health master student and research analyst at GHRC, and Hongsheng Lu , a 2020-class Global Health master student. They worked on it with Lia Palileo-Villanueva, a professor at the University of the Philippines, Hao Li, Associate Professor at Wuhan University, Abha Shrestha, who works at Kathmandu University School of Medical Sciences, and Peter Otieno, a researcher at the African Population and Health Research Center. Healthcare providers saw multiple benefits to e-health measures, including reduced workloads, higher efficiency, and more convenient data storage and communications, according to the study. Patients described greater satisfaction with services, better continuity of care and higher quality of care.

Mechanisms and Path Analyses for Health Management among Chronic Diseases Patients in      Urban   China: A Community Empowerment-Based Approach

Non-communicable diseases (NCDs) have become a major challenge that threatens the health of residents and the national economy. Besides individual factors, community-level forces are potentially important for NCD prevention and control too. Led by Dr. Lijing Yan , Professor of Global Health at Duke Kunshan University, and funded by the National Natural Science Foundation of China, this four-year project was completed this year. The project was divided into two phases. The aim of the first phase was to develop and validate the “Community Efficacy for NCD (COEN)” evaluation system, which was defined as the communities’ abilities to provide NCD prevention and management and health promotion. The aim of the second phase was to collect information through the COEN scale to evaluate community-level factors associated with NCD control. 

Early Warning Signs, Diagnosis and Intervention Strategies of Sarcopenia in China

As the sub-project leader, Dr. Chenkai Wu , Assistant Professor of Global Health, participated in the research on early warning signs, diagnosis and multidimensional intervention strategies of sarcopenia in the project of “Active Health and Technological Response to Aging”, a national key research and development program of the Ministry of Science and Technology led by West China Hospital of Sichuan University. The project will last three years, with the overall goal of establishing a biological specimen bank and animal model of sarcopenia, developing a prevention and treatment system for sarcopenia in China, building an application demonstration area, and formulating guidelines for the diagnosis and intervention of sarcopenia in China. Dr. Wu’s team will develop a sarcopenia early warning system and sarcopenia prevention and treatment demonstration area by establishing sarcopenia risk prediction model, diagnostic techniques and differentiated intervention technology validation and evaluation suitable for the elderly in China.

System-integrated technology-enabled model of care for stroke secondary prevention in rural China (SINEMA Project)

Stroke is the first leading cause of death and disability in China and imposes a major societal and economic burden. Co-Funded by UK Medical Research Council, Economic and Social Research Council, Department for International Department and Wellcome Trust, the research team led by Professor Lijing L. Yan conducted the SINEMA project between 2016 and 2019, with an aim to develop and evaluate a system-integrated and technology-enabled model to improve stroke secondary prevention in rural China. The research team worked with multidisciplinary collaborators to co-design the intervention package, including Beijing Tiantan Hospital，Peking University First Hospital, China Mobile Research Institute, Hebei Province Centre for Disease Control and Prevention, village doctors, stroke patients and stake-holders in the study setting. A cluster randomized controlled trial involving 50 villages and 1299 stroke patients was conducted in the rural areas of Hebei province. Results from this project provide a new model of care that empowered the primary healthcare system to manage stroke patients in resource-limited settings with the support of innovative digital health technologies. The research team has published four manuscripts in international peer-reviewed journals, and the research findings have been presented in international conferences. The research team is also making efforts for scaling up this intervention model to benefit more people suffering cardio-metabolic diseases.

Adaptive Design to Reduce Unnecessary Caesarean Sections in China

This study, led by Prof. Qian Long , aims to identify local drivers of caesareans, and the barriers and facilitators to change, to inform the design of a multiple component intervention programs to promote optimal caesarean use in China. China has witnessed a dramatic increase of CS rate over the past three decades. In collaboration with University of Central Lancashire (UCLan) in UK and Hangzhou Normal University and Chongqing Medical University in China, the research team analyzed factors associated with caesarean use using the national household health survey data and conducted qualitative interviews with health professionals and pregnant and postpartum women to explore their perceptions on the potential interventions to improve quality and experience of maternity care. The preliminary findings have been presented in Global Women’s Research Society (GLOW) 2020 conference and Sixth Global Symposium on Health System Research 2020. The research team is planning a pilot trial study based on the evidence gained from this study.

Plakoglobin and High-Mobility Group Box 1 Mediate Intestinal Epithelial Cell Apoptosis Induced by Clostridioides difficile TcdB

A collaborative study involving researchers at Duke Kunshan University’s Global Health Research Center and Wang-Cai Biochemistry Laboratory has made important ground in understanding Clostridioides difficile infection, an antibiotic resistant pathogen that can cause severe diarrhoea, belly pain, fever and potentially lead to death. The research, published in the American Society for Microbiology journal mBio , sheds light on key genes that are involved in tissue damage caused by the infection, which is a growing problem across the globe, and could help with the development of medicines to treat it.

Clostridioides difficile infection (C. diff) is a “significant threat to public health,” said Linfeng Huang , associate professor of biology at DKU, who led the research. “As a global health care problem, there is an urgent need to understand the infection mechanism and develop efficient therapeutics.”

One Health projects

Gregory C. Gray leads emerging infectious disease projects with a particular focus on One Health research, which occurs at the intersection of human and animal health and the environment. China has seen numerous recent infectious dis-ease outbreaks-SARS, avian influenza and dengue fever to name a few that have their sources in animals and insects, therefore, focused multidisciplinary work among physicians,public health researchers, veterinarians and environmental health experts is critical.

Impact of Preconception and Onward Exposure to Air Pollution Growth Trajectories of Infants and Children

Prof. Jim Zhang leads environmental health research projects on topics such as air pollution exposure and health impact assessment. He and his team have discovered novel bio-markers that show human exposure to toxins in the air and have examined the biological mechanisms by which environmental exposures cause adverse health effects. They also assess health benefits resulting from air pollution interventions at the public policy and household levels. This study has received a S2 million grant from the National Institute of Environmental Health Sciences (NIEHS).

Knowledge Translation

There is much robust scientific evidence to improve health and health equity in China and around the world, but they are not fully used. A lot of research findings end at publication rather than timely and systematic translation into health policies and interventions to improve health outcomes and equity. The gap between what is known and what is done in practice is the so-called “know-do” gap. The Global Health Program will make efforts to bridge gaps between evidence, policy, and practice.

Knowledge Translation Projects

Initiated by MSD (China) and supported by the Global Health Research Center at Duke Kunshan University together with the International Center for Communication at Tsinghua University, the Media Academy Project (also known as the Knowledge Camp project) was launched in September 2021. The project is jointly led by Dr. Meifang Chen , Assistant Professor of Health Policy, and Dr. Fan Liang , Assistant Professor of Media, both of whom are from the Global Health Research Center. This project aims to provide more cutting-edge, professional, and reliable health education, information and insights to journalists working in health-related fields, and to foster a more sustainable educational ecosystem for health promotion.

The launch of the Media Academy Project marks an important exploration by the Global Health Research Center to popularize health science and strengthen interdisciplinary collaboration. As one of the academic support parties of Health Knowledge Camp, the Center will continue bringing together multiple sectors such as industry, academia, research, media, and others. The goals of these collaborations include: integrating high-quality academic resources, fostering health information dissemination activities with a global perspective, promoting the transformation of cutting-edge scientific research results and knowledge dissemination, and expanding the breadth and depth of science popularization content of the Health Knowledge Camp.

Since 2014, the Duke Kunshan University Global Health Research Center has held a series of global health seminars during the fall and spring semesters, featuring three to four talks per month. These seminars invite leaders, scientists, and industry experts in the global health field to exchange information on the latest research progress, international and domestic development trends, and global health teaching and practice experiences. Since 2020, Xingzheng Global Fund Management Co. and Ningquan Asset Management Co. have provided funding support to hold the global health seminars, which have now been named the Aegon-Industrial Global Health Seminar Series. As of the end of 2023, 186 seminars have been successfully held.

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GLOHRA Research Projects

The German Alliance for Global Health Research (GLOHRA) is proud to contribute to global health research by supporting interdisciplinary pilot projects, cross-sector projects and global health fellowships.

Research projects are funded by the Federal Ministry of Education and Research. 

CAP-PRE: Counselling for Alcohol Problems in Pregnancy

Cross-sector project.

GLOHRA Team Lead(s) : Prof. Dr. Daniela Fuhr, Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS (BIPS) & Dr. Isabelle Lange, Technische Universität München

South Africa has the highest prevalence of Fetal Alcohol Spectrum Disorders (FASD) in the world due to high alcohol consumption among pregnant women in this setting. To address this, the team of experts from public health and implementation science, psychology and anthropology is evaluating the feasibility and acceptability of a psychological intervention (CAP-PRE) in a pilot randomised control trial using mixed-methods. The team's findings will inform subsequent interventions in South Africa. Applicability of the intervention to the German setting will be explored.

Planned Duration : March 2024 - February 2026

Focus Areas : patient education & health literacy, prevention, child and adolescent health, maternal health

EDUROL: Bladder Cancer Early Detection and Treatment in Malawi

Cross-sector project.

GLOHRA Team Lead(s) : PD Dr. Angelika Borkowetz, Technische Universität Dresden, Prof. Dr. Benedikt Heuckmann, Universität Münster & PD Dr. Henning Mothes, Sophien- und Hufeland-Klinikum Weimar

International Team Lead(s) : Dr. Wanangwa Chisenga, Zomba Central Hospital (Malawi), Dr. Florence Le Calvez Kelm, International Agency for Research on Cancer (France), Dr. Jesudian Gnanaraj, Rural Surgery Innovation Pvt. Ltd. (India)

This project aims to test the feasibility and acceptability of a promising urinary biomarker for detecting schistosomiasis-related bladder cancer. To investigate this non-invasive screening method, the team will initiate a case-control study in Malawi. The international research team, in collaboration with an NGO and political stakeholders, further endeavors to launch a health literacy campaign to equip Malawians with the necessary knowledge and skills to adhere to urine-analysis protocols and subsequent treatments. Additional measures seek to extend urology services on the district level. The findings may lead to advancements in the early detection of schistosomiasis-related bladder cancer, offering a pathway to improved health outcomes.

Focus Areas : diagnostics, cancer / oncology, patient education & health literacy

INTEGRATIVE: Diabetes incidence and weight change following dolutegravir transition of ART among PLHIV from an African prospective cohort

Global health postdoc fellowship.

GLOHRA Team Lead(s) : Dr. Melani Ratih Mahanani, Universität Heidelberg

This project embraces a holistic perspective in its investigation of treatment regimens for HIV, which has associated risks for the development of non-communicable diseases. Specifically, the project seeks to determine the incidence and determinants of type 2 diabetes mellitus and weight change among people in Malawi living with HIV after transitioning antiretroviral therapy (ART) to dolutegravir. The INTEGRATIVE project will contribute to the assessment of the risk associated with dolutegravir and will provide a basis for program planning of integrated disease prevention and control, especially for resource-limited settings.

Focus Areas : non-communicable diseases, infectious diseases, epidemiology and population health

PreVio: School-based prevention of teacher and family violence: A pilot cluster-randomised controlled trial in Tanzania

Interdisciplinary pilot project.

GLOHRA Team Lead(s) : Prof. Dr. Tobias Hecker, Universität Bielefeld & Prof. Dr. Janina Steinert, Technische Universität München

This project focuses on addressing violent discipline in educational and domestic environments, acknowledging its adverse impact on children's development with potential long-term consequences. Integrating perspectives from development economics and psychology, the team will implement an intervention involving both parents and teachers to address violence in homes and schools. The team employs a cluster-randomized controlled trial to evaluate the intervention's feasibility, acceptability, and cost-effectiveness in Tanzanian schools. If effective, this project could lay the groundwork for a scale-up of the program.

Planned Duration : March 2024 - February 2025

Focus Areas : prevention, global mental health, injuries and violence

ViVac: Violence, trust, and vaccine hesitancy

GLOHRA Team Lead(s) : Dr. Liliana Abreu, Universität Konstanz & Prof. Dr. Max Schaub, Universität Hamburg and WZB Berlin Social Science Center

International Team Lead(s) : Dr. Musa Muhammmad Bello & Dr. Rabiu Ibrahim Jalo, Bayero University and Aminu Kano Teaching Hospital

The ViVac project sets out to better understand how behavioral responses to violence translate into health outcomes, especially in the domains of maternal and child health. Bringing together researchers from public health, health communication, and political science, the team investigates how exposure to violence shapes trust in state institutions, health literacy, vaccine hesitancy, and healthcare-seeking behavior more generally.  Based on a mixed-methods approach and data collected in three conflict-affected states in Nigeria, the project seeks to generate insights for public health interventions in conflict and post-conflict settings.

Focus Areas : injuries and violence, child and adolescent health, maternal health, health education, health policy

Children's well-being: The contribution of family dynamics and parental mental health to children's well-being

GLOHRA Team Lead(s) : Hawkar Ibrahim, Bielefeld Universität

This research project focuses on assessing the prevalence of post-traumatic stress disorder and depression in children displaced from Iraq and Syria and currently residing in Iraqi Kurdistan. By applying a longitudinal methodology that includes triadic (mother, father, and child) data sets, this study seeks to shed light on the previously ambiguous findings regarding the role of parental mental health and parental behaviors in shaping children's mental health outcomes. Drawing on insights from psychology, public health, epidemiology, and family science, the aim is to comprehensively understand the factors that impact the mental health trajectories of displaced children. This knowledge will be essential for the development of context-specific interventions and could also have implications for child refugees in Germany.

Planned Duration : October 2023 - September 2025

Focus Areas : global mental health, child and adolescent health, migration and health

MARS: Mosquito-based artemisinin resistance surveillance

GLOHRA Team Lead(s) : Dr. Welmoed van Loon, Charité - Universitätsmedizin Berlin

International Team Lead(s) : Dr. Esto Bahizire, Université Catholique de Bukavu, DR Congo

This research project aims to address the imminent threat of artemisinin resistant (AR) malaria in East Africa. The team will validate and evaluate mosquito-based AR surveillance (MARS) in Eastern DR Congo. In parallel, spatial data on potential AR hotspots will be generated, providing guidance for targeted vector control. The impact of this project extends beyond the DR Congo, as the cost-effective MARS approach could be scaled up to enhance surveillance strategies in other regions of Africa, contributing to a better and faster response to emerging hotspots of antimalarial drug resistance.

Planned Duration : July 2023 - June 2025

Focus Areas : antimicrobial resistance, infectious diseases, health policy

CaLioS: Improving cancer-related health literacy using online stories in sub-Saharan Africa, illustrated by the example of Kenya

GLOHRA Team Lead(s) : Dr. Stefanie Harsch, Albert-​Ludwigs-Universität Freiburg

This project aims to use digital stories to promote cancer literacy in Kenya. Objectives include closing the digital informational divide, improving well-being, and reducing cancer mortality. The study involves qualitative interviews, developing an evidence-based intervention and conducting a feasibility study. The interdisciplinary project draws on expertise from medicine, psychology, public health, education, communication, and media studies. Collaboration with international researchers and sharing findings with stakeholders are prioritized.

Planned Duration : June 2023 - May 2025

Focus Areas : cancer / oncology, patient education & health literacy

InnoCOV: Innovation policies for resilient biomedical R&D systems: lessons from the COVID-19 pandemic innovation response

GLOHRA Team Lead(s) : Dr. Rosa Jahn, Universität Heidelberg

This project aims to comprehensively study the COVID-19 vaccine innovation system to generate evidence, legal insights, and ethical considerations for sustainable and equitable innovation policies. The approach involves mapping the innovation system, analyzing the impact of COVID-19 policies on vaccine innovation and access, and conducting normative and socio-legal analyses of relevant negotiations. The interdisciplinary and multi-pronged approach should lead to meaningful recommendations which inform the Global Health Strategy of the German Federal Government.

Focus Areas : health policy, vaccine development, global health governance

PHONIC: Public health operations for climate change action - Development of a framework to identify priority operations

GLOHRA Team Lead(s) : Dr. med. Karin Geffert, Ludwig-Maximilians-Universität München; Dr. Franziska Matthies Wiesler, Helmholtz Zentrum München; Maike Voss, Deutsche Allianz Klimawandel und Gesundheit (KLUG)

This research project aims to assess and prioritize public health operations addressing climate change mitigation and adaptation. The interdisciplinary team will draw on existing evidence and expert interviews to develop an evidence-informed umbrella framework and a sub-framework of public health operations with indicators, which they will pilot in Germany and Kenya. The project's impact potential is substantial, offering decision-makers a practical tool to prioritize actions and address the health effects of climate change. Additionally, it fosters collaboration between public health and climate sectors, strengthens existing networks and facilitates new collaborations. 

Planned Duration: April 2023 - September 2024

Focus Areas:  climate change and health, health policy

MisInfo Vaccines: Drivers of misinformation, gender disparity and masculinity on vaccination decision-making among caregivers in sub-Saharan Africa

GLOHRA Team Lead(s) : Dr. Collins G. Adeyanju, Universität Erfurt

This project seeks to explore the factors informing childhood vaccination decision-making in Kenya, Malawi and Nigeria. Previous studies have identified immense disparities in childhood immunization coverage between boys and girls in Sub-Saharan Africa, in part due to misinformation that vaccines cause infertility in women among other socio-cultural factors. Drawing on communication science, gender studies and psychology, this project investigates the factors contributing to the gender gap, the drivers of misinformation and the role of men/fathers as patriarchal heads of households in vaccination decision-making, ultimately aiming to improve immunization initiatives for children and adolescents.

Planned Duration : November 2022 - October 2024

Focus Areas : child and adolescent health, patient education & health literacy, sociology of health, infectious diseases, health policy

Mobile TB Lab: Diagnostic algorithm for peripheral lymph node tuberculosis using portable station

GLOHRA Team Lead(s) : Dr. Sophie Schneitler, Universitätsklinikum des Saarlandes; Dr. Ahmed Abd El Wahed, Universität Leipzig; Prof. Dr. Martin Siegel, Technische Universität Berlin

This project will draw on a trilateral collaboration between European partners and institutions from Africa and Asia in order to support tuberculosis (TB) diagnostics. The main project objective is to introduce mobile diagnostic capabilities and capacity for peripheral lymph node TB in low resource settings in Uganda and Bangladesh. The strategy will follow a 4Ds concept: D ecentralization of diagnostics; D eliver results in short time; D eliver tests to poor resource settings; D ecrease the operation costs.

Focus Areas : infectious diseases, diagnostics, e-health/m-health

Racism and mental health: A qualitative study with humanitarian workers

GLOHRA Team Lead(s) : Dr. Hannah Strohmeier, Charité – Universitätsmedizin Berlin

Racism has been acknowledged as a social determinant of health, yet evidence for the prevalence of racism within humanitarian organizations has barely been systematically researched, and vast gaps in knowledge and data exist. This qualitative study will capture the voices of national and international humanitarian workers on their experiences of racism in humanitarian organizations, with a specific focus on the effects on mental health. Its ultimate objective is to support stakeholders (humanitarian practitioners, academics, and donors) in taking informed, evidence-based action to address racism in humanitarian organizations.

Focus Areas : global mental health, occupational health, sociology of health

AI-TB Screening Tool: Development of a novel, easy-to-use digital tuberculosis screening tool informed by machine learning approaches

GLOHRA Team Lead(s) : PD Dr. Claudia Denkinger, Universitätsklinikum Heidelberg; Prof. Dr. Lena Maier-Hein, Deutsches Krebsforschungszentrum

Tuberculosis (TB) is the leading infectious cause of death worldwide. Delayed and missed diagnoses are key drivers of TB-related mortality and community transmission and systematic TB screening approaches need to be improved. Drawing on the interdisciplinary team's expertise, the overall goal of this project is to use machine learning to develop an easy-to-use digital tool that combines information from multiple sources and can be implemented in resource-limited settings to improve screening for active TB disease, a WHO TB control priority.

This team has received funding for an additional Impact Booster from the BMZ to translate the findings of their research project into practice and policy in Zambia and Kenya. The project will support implementation of the tool developed in the first phase of the project.  It will also enable a strong and sustainable partnership that can identify additional opportunities to develop, assess, and introduce other innovative digital tools that improve TB care and train the next generation of researchers.

View Booster report

Planned Duration: June 2022 - May 2024

Focus Areas:  e-health / m-health, infectious disease, biomedical imaging & modeling

SWAPNO: Safe Water – Advances in purification options

GLOHRA Team Lead(s) : Dr. Amanda Wendt, Potsdam-Institut für Klimafolgenforschung; Dr. Martin Maier, Universität Heidelberg; Dr. Charlotte Stirn, AGAPE e.V.

Drinking water quality in Bangladesh has and continues to be a critical public health issue. This multidisciplinary team builds on their prior work in Bangladesh to address the adverse health effects from contaminated drinking water. Their aim is to finalize the development of a low-cost water treatment system for further scale-up in South Asia. To reach this objective, the research team will conduct a cluster-randomized controlled trial to test this water use system’s impact on health in the study community.

Planned Duration: May 2022 - April 2024

Focus Areas:  hygiene and patient safety; water, sanitation and hygiene; rural development and health

Completed Research Projects

Impede-cvd: human centered design to adapt and inform an integrated chronic disease management program.

GLOHRA Team Lead(s) : Prof. Dr. Felix Knauf, Charité - Universitätsmedizin Berlin; Dr. Shannon McMahon-Rössle, Prof. Dr. Dr. Till Bärnighausen, both Universitätsklinikum Heidelberg; Dr. Julius Emmrich, Dr. Samuel Knauss, both mTOMADY gGmbh

International Team Lead(s) : Dr. Robert Kalyesubula, Makerere University & ACCESS Uganda

Research meets implementation in this digital health project in Uganda. The team aims to assess the feasibility, acceptability, perception, and usefulness of a mobile phone-based program to detect and manage cardiovascular disease in a rural community in Uganda. This will ideally improve the detection and management of chronic diseases and reduce their financial burden in resource-poor communities.

View Project Report

This team has received funding for an additional Impact Booster from the BMZ to translate the findings of their research project into practice and policy in Uganda. The team aims to integrate the expertise of diverse stakeholder groups, including policy makers, to support sustainable implementation. The project will also provide support for early career researchers and expand the study area to ensure greater access to the platform.  

View Booster Report

Planned Duration: May 2021 - December 2023

Focus Areas:   non-communicable disease, e-health / m-health

IndoCerCa: Community cervical cancer screening and prevention in Indonesia

GLOHRA Team Lead(s) : Prof. Dr. Jörg Haier, Medizinische Hochschule Hannover; Prof. Peter Hillemanns, Medizinische Hochschule Hannover; Prof. Ralph Lellé, Universitätsklinikum Münster

International Team Lead(s):  Supriyatiningsih Wenang, Muhammadiyah University of Yogyakarta/PKU Muhammadiyah Gamping Teaching Hospital (Indonesia); Dwi Astuti, Gadjah Mada University (Indonesia)

This research project involves designing, implementing and testing a community-based screening approach for HPV in Indonesia. The team includes more than 10 individuals from academic and non-academic institutions in Germany and Indonesia. The overarching and long-term goal of this research project is to establish clinically effective, cost-effective and desirable community strategies to make possible the elimination of cervical cancer.

This team has received funding for an additional Impact Booster from the BMZ to translate the findings of their research project into practice and policy in Indonesia. The project combats barriers to screening programs related to cancer literacy. The team will create communication materials and training concepts for laypersons and healthcare professionals to improve their understanding of HPV-based screening for cervical cancer.

Duration : November 2021 – October 2023

Focus Areas : women's health, prevention, cancer, health literacy

WELLPAK: Integration of digital mental health intervention at community level in Pakistan

GLOHRA Team Lead(s) : Prof. Dr. Hajo Zeeb and Dr. Maham Saleem, Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS; PD Dr. Markus Kösters, Universität Ulm

Bringing together academic, civil society and policy actors in both Germany and Pakistan, this project aims to digitally adapt the WHO transdiagnostic intervention for common mental health disorders and pioneer this digital intervention in Islamabad, Pakistan. If proven feasible and acceptable this project will not only harness digital technologies for mental health issues but will also positively impact the uptake of these technologies for other health issues of the country. 

This team has received funding for an additional Impact Booster from the BMZ to translate the findings of their research project into practice and policy in Pakistan. The supplemental project aims to enhance the adaptation of a digital platform that is fully integrated into the routine work of lady healthcare workers, engage policy makers and scale-up the intervention. Capacity-building measures will help support early career researchers and community health workers.

Planned Duration : August 2021 – July 2023

Focus Areas : global mental health, e-health / m-health

Diarrhea, fiber and colon cancer: Environmental contributions to low colon cancer risk in sub-Saharan Africa

GLOHRA Fellow : Dr. Sören Ocvirk, Deutsche Institut für Ernährungsforschung Potsdam-Rehbrücke

This study proposes a novel mechanism for colorectal cancer (CRC) prevention. The team will examine a population with low risk for colon cancer, individuals in sub-Saharan Africa, with special attention to the role of dietary fiber consumption and pathogenic intestinal bacteria. Insights could have implication for targeted prevention of CRC in high-risk groups.

Planned Duration : May 2021 – September 2023

Focus Areas : nutrition, agriculture and health, prevention, cancer

RESAMP: Reducing schistosomiasis through aquaculture interventions in Madagascar: a pilot study

Interdisciplinary pilot project.

GLOHRA Team Lead(s) : Dr. Daniela Fusco & Dr. Ralf Krumkamp, Bernhard Nocht Institute for Tropical Medicine; Prof. Amena Almes Ahmad & Juliane Boenecke, Hochschule für Angewandte Wissenschaften Hamburg

International Team Lead(s) : Nicolas Jouanard, Université de Fianarantsoa, Madagascar; Prof. Rivo Andry Rokotoarivelo & Dr. Tahinamandranto Rasamoelina, Université d’Antananarivo, Madagascar; Prof. Raphaël Rakotozandrindrainy, Centre d'Infectiologie Charles Mérieux (CICM), Madagascar

The RESAMP research project aims to assess the feasibility of implementing an aquaculture intervention in rice fields in Madagascar as a potential infection control measure to reduce the transmission of schistosomiasis. The project is organized around three thematic areas i.e., aquaculture, public health and ecology. Ultimately the experienced European-African team seeks to collect sufficient data to serve as a proof of concept for scaling up the novel farming intervention to achieve broader health, social and ecological benefits. 

This team has received funding for an additional Impact Booster from the BMZ to translate the findings of their research project into practice and policy in Madagascar. The project will include support for an ecological assessment, field activities and for promoting the dissemination of findings in Madagascar across policy makers and stakeholders. 

Planned Duration : September 2021 – February 2023

Focus Areas : tropical diseases, agriculture and health, neglected and poverty-related diseases, nutrition

PROTECT: Protect migrant healthcare workers: closing a gap in Germany’s pandemic preparedness and global health policy

GLOHRA Team Lead(s) : Dr. Ellen Kuhlmann and PD Dr. Alexandra Jablonka, Medizinische Hochschule Hannover; Dr. Frank Müller, Universitätsmedizin Göttingen

International Team Lead(s):  Dr. Marius-Ionut Ungureanu, Babeș-Bolyai University Cluj-Napoca, Romania

Protecting migrant healthcare workers (HCWs) is an important dimension of pandemic preparedness. This pilot project introduces a ‘syndemic’ approach to COVID-19 with a focus on higher-skilled; it connects health policy/system and actor-centred approaches. The study investigates perceptions and needs of migrant HCWs, drawing on survey data gathered at Hannover Medical School and in-depth qualitative research with Romanian physicians in Germany, and explores policy solutions. It aims to improve migrant HCW protection and contribute to effective health workforce policy and European/global responses to HCW shortage and resilience.

Planned Duration : May 2022 - April 2023

Focus Areas : pandemic preparedness & response, migration and health, health policy

See publications on our media page . 

HelmSys: The impact of helminth infections on vaccine outcomes in humans – A systematic literature review

GLOHRA Team Lead(s) : Prof. Dr. Clarissa Prazeres da Costa, Prof. Dr. Stefanie Klug, Technische Universität München; Dr. Meral Esen, Eberhard Karls Universität Tübingen

Reflecting on the pivotal role of vaccines in prevention and control of infectious diseases, this interdisciplinary project seeks to systematically review and analyze the impact of helminth co-infections on the efficacy of routinely used and novel vaccines such as COVID-19. Insights from this project will help generate knowledge translation resources to inform clinical and public health practice guidelines, design studies investigating optimal vaccination schedules and formulate strategies for optimal anti-helminthic regimens.

Planned Duration: November 2021 - January 2023

Focus Areas: vaccine development, neglected and poverty-related diseases, tropical diseases

MeasureGender: Measuring gender-based discrimination to better understand maternal mortality

GLOHRA Team Lead(s) : PD. Dr. med. Wilm Quentin, Technische Universität Berlin and Prof. Dr. Manuela De Allegri, Heidelberg University

In a nutshell: Drawing on sociological and medical perspectives, this project aims to develop a culturally adapted tool for measuring gender-based discrimination. The team hopes that the tool, Measure-Gender, developed via field research and interviews, can be used in future surveys to improve our understanding of the relationship between gender-based discrimination and maternal health outcomes.

Planned Duration : May 2021 - June 2022

Focus Areas : women's health, maternal health, health care research

See publications on our media page .

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• Published: 08 May 2024

A meta-analysis on global change drivers and the risk of infectious disease

• Michael B. Mahon   ORCID: orcid.org/0000-0002-9436-2998 1 , 2   na1 ,
• Alexandra Sack 1 , 3   na1 ,
• O. Alejandro Aleuy 1 ,
• Carly Barbera 1 ,
• Ethan Brown   ORCID: orcid.org/0000-0003-0827-4906 1 ,
• Heather Buelow   ORCID: orcid.org/0000-0003-3535-4151 1 ,
• David J. Civitello 4 ,
• Jeremy M. Cohen   ORCID: orcid.org/0000-0001-9611-9150 5 ,
• Luz A. de Wit   ORCID: orcid.org/0000-0002-3045-4017 1 ,
• Meghan Forstchen 1 , 3 ,
• Fletcher W. Halliday 6 ,
• Patrick Heffernan 1 ,
• Sarah A. Knutie 7 ,
• Alexis Korotasz 1 ,
• Joanna G. Larson   ORCID: orcid.org/0000-0002-1401-7837 1 ,
• Samantha L. Rumschlag   ORCID: orcid.org/0000-0003-3125-8402 1 , 2 ,
• Emily Selland   ORCID: orcid.org/0000-0002-4527-297X 1 , 3 ,
• Alexander Shepack 1 ,
• Nitin Vincent   ORCID: orcid.org/0000-0002-8593-1116 1 &
• Jason R. Rohr   ORCID: orcid.org/0000-0001-8285-4912 1 , 2 , 3   na1  

Nature ( 2024 ) Cite this article

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• Infectious diseases

Anthropogenic change is contributing to the rise in emerging infectious diseases, which are significantly correlated with socioeconomic, environmental and ecological factors 1 . Studies have shown that infectious disease risk is modified by changes to biodiversity 2 , 3 , 4 , 5 , 6 , climate change 7 , 8 , 9 , 10 , 11 , chemical pollution 12 , 13 , 14 , landscape transformations 15 , 16 , 17 , 18 , 19 , 20 and species introductions 21 . However, it remains unclear which global change drivers most increase disease and under what contexts. Here we amassed a dataset from the literature that contains 2,938 observations of infectious disease responses to global change drivers across 1,497 host–parasite combinations, including plant, animal and human hosts. We found that biodiversity loss, chemical pollution, climate change and introduced species are associated with increases in disease-related end points or harm, whereas urbanization is associated with decreases in disease end points. Natural biodiversity gradients, deforestation and forest fragmentation are comparatively unimportant or idiosyncratic as drivers of disease. Overall, these results are consistent across human and non-human diseases. Nevertheless, context-dependent effects of the global change drivers on disease were found to be common. The findings uncovered by this meta-analysis should help target disease management and surveillance efforts towards global change drivers that increase disease. Specifically, reducing greenhouse gas emissions, managing ecosystem health, and preventing biological invasions and biodiversity loss could help to reduce the burden of plant, animal and human diseases, especially when coupled with improvements to social and economic determinants of health.

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Towards common ground in the biodiversity–disease debate

Biological invasions facilitate zoonotic disease emergences

Measuring the shape of the biodiversity-disease relationship across systems reveals new findings and key gaps

Data availability.

All the data for this Article have been deposited at Zenodo ( https://doi.org/10.5281/zenodo.8169979 ) 52 and GitHub ( https://github.com/mahonmb/GCDofDisease ) 53 .

Code availability

All the code for this Article has been deposited at Zenodo ( https://doi.org/10.5281/zenodo.8169979 ) 52 and GitHub ( https://github.com/mahonmb/GCDofDisease ) 53 . R markdown is provided in Supplementary Data 1 .

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Acknowledgements

We thank C. Mitchell for contributing data on enemy release; L. Albert and B. Shayhorn for assisting with data collection; J. Gurevitch, M. Lajeunesse and G. Stewart for providing comments on an earlier version of this manuscript; and C. Carlson and two anonymous reviewers for improving this paper. This research was supported by grants from the National Science Foundation (DEB-2109293, DEB-2017785, DEB-1518681, IOS-1754868), National Institutes of Health (R01TW010286) and US Department of Agriculture (2021-38420-34065) to J.R.R.; a US Geological Survey Powell grant to J.R.R. and S.L.R.; University of Connecticut Start-up funds to S.A.K.; grants from the National Science Foundation (IOS-1755002) and National Institutes of Health (R01 AI150774) to D.J.C.; and an Ambizione grant (PZ00P3_202027) from the Swiss National Science Foundation to F.W.H. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

Author information

These authors contributed equally: Michael B. Mahon, Alexandra Sack, Jason R. Rohr

Authors and Affiliations

Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, USA

Michael B. Mahon, Alexandra Sack, O. Alejandro Aleuy, Carly Barbera, Ethan Brown, Heather Buelow, Luz A. de Wit, Meghan Forstchen, Patrick Heffernan, Alexis Korotasz, Joanna G. Larson, Samantha L. Rumschlag, Emily Selland, Alexander Shepack, Nitin Vincent & Jason R. Rohr

Environmental Change Initiative, University of Notre Dame, Notre Dame, IN, USA

Michael B. Mahon, Samantha L. Rumschlag & Jason R. Rohr

Eck Institute of Global Health, University of Notre Dame, Notre Dame, IN, USA

Alexandra Sack, Meghan Forstchen, Emily Selland & Jason R. Rohr

Department of Biology, Emory University, Atlanta, GA, USA

David J. Civitello

Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT, USA

Jeremy M. Cohen

Department of Botany and Plant Pathology, Oregon State University, Corvallis, OR, USA

Fletcher W. Halliday

Department of Ecology and Evolutionary Biology, Institute for Systems Genomics, University of Connecticut, Storrs, CT, USA

Sarah A. Knutie

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Contributions

J.R.R. conceptualized the study. All of the authors contributed to the methodology. All of the authors contributed to investigation. Visualization was performed by M.B.M. The initial study list and related information were compiled by D.J.C., J.M.C., F.W.H., S.A.K., S.L.R. and J.R.R. Data extraction was performed by M.B.M., A.S., O.A.A., C.B., E.B., H.B., L.A.d.W., M.F., P.H., A.K., J.G.L., E.S., A.S. and N.V. Data were checked for accuracy by M.B.M. and A.S. Analyses were performed by M.B.M. and J.R.R. Funding was acquired by D.J.C., J.R.R., S.A.K. and S.L.R. Project administration was done by J.R.R. J.R.R. supervised the study. J.R.R. and M.B.M. wrote the original draft. All of the authors reviewed and edited the manuscript. J.R.R. and M.B.M. responded to reviewers.

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Correspondence to Jason R. Rohr .

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Extended data figures and tables

Extended data fig. 1 prisma flowchart..

The PRISMA flow diagram of the search and selection of studies included in this meta-analysis. Note that 77 studies came from the Halliday et al. 3 database on biodiversity change.

Extended Data Fig. 2 Summary of the number of studies (A-F) and parasite taxa (G-L) in the infectious disease database across ecological contexts.

The contexts are global change driver ( A , G ), parasite taxa ( B , H ), host taxa ( C , I ), experimental venue ( D , J ), study habitat ( E , K ), and human parasite status ( F , L ).

Extended Data Fig. 3 Summary of the number of effect sizes (A-I), studies (J-R), and parasite taxa (S-a) in the infectious disease database for various parasite and host contexts.

Shown are parasite type ( A , J , S ), host thermy ( B , K , T ), vector status ( C , L , U ), vector-borne status ( D , M , V ), parasite transmission ( E , N , W ), free living stages ( F , O , X ), host (e.g. disease, host growth, host survival) or parasite (e.g. parasite abundance, prevalence, fecundity) endpoint ( G , P , Y ), micro- vs macroparasite ( H , Q , Z ), and zoonotic status ( I , R , a ).

Extended Data Fig. 4 The effects of global change drivers and subsequent subcategories on disease responses with Log Response Ratio instead of Hedge’s g.

Here, Log Response Ratio shows similar trends to that of Hedge’s g presented in the main text. The displayed points represent the mean predicted values (with 95% confidence intervals) from a meta-analytical model with separate random intercepts for study. Points that do not share letters are significantly different from one another (p < 0.05) based on a two-sided Tukey’s posthoc multiple comparison test with adjustment for multiple comparisons. See Table S 3 for pairwise comparison results. Effects of the five common global change drivers ( A ) have the same directionality, similar magnitude, and significance as those presented in Fig. 2 . Global change driver effects are significant when confidence intervals do not overlap with zero and explicitly tested with two-tailed t-test (indicated by asterisks; t 80.62  = 2.16, p = 0.034 for CP; t 71.42  = 2.10, p = 0.039 for CC; t 131.79  = −3.52, p < 0.001 for HLC; t 61.9  = 2.10, p = 0.040 for IS). The subcategories ( B ) also show similar patterns as those presented in Fig. 3 . Subcategories are significant when confidence intervals do not overlap with zero and were explicitly tested with two-tailed one sample t-test (t 30.52  = 2.17, p = 0.038 for CO 2 ; t 40.03  = 4.64, p < 0.001 for Enemy Release; t 47.45  = 2.18, p = 0.034 for Mean Temperature; t 110.81  = −4.05, p < 0.001 for Urbanization); all other subcategories have p > 0.20. Note that effect size and study numbers are lower here than in Figs. 3 and 4 , because log response ratios cannot be calculated for studies that provide coefficients (e.g., odds ratio) rather than raw data; as such, all observations within BC did not have associated RR values. Despite strong differences in sample size, patterns are consistent across effect sizes, and therefore, we can be confident that the results presented in the main text are not biased because of effect size selection.

Extended Data Fig. 5 Average standard errors of the effect sizes (A) and sample sizes per effect size (B) for each of the five global change drivers.

The displayed points represent the mean predicted values (with 95% confidence intervals) from the generalized linear mixed effects models with separate random intercepts for study (Gaussian distribution for standard error model, A ; Poisson distribution for sample size model, B ). Points that do not share letters are significantly different from one another (p < 0.05) based on a two-sided Tukey’s posthoc multiple comparison test with adjustment for multiple comparisons. Sample sizes (number of studies, n, and effect sizes, k) for each driver are as follows: n = 77, k = 392 for BC; n = 124, k = 364 for CP; n = 202, k = 380 for CC; n = 517, k = 1449 for HLC; n = 96, k = 355 for IS.

Extended Data Fig. 6 Forest plots of effect sizes, associated variances, and relative weights (A), Funnel plots (B), and Egger’s Test plots (C) for each of the five global change drivers and leave-one-out publication bias analyses (D).

In panel A , points are the individual effect sizes (Hedge’s G), error bars are standard errors of the effect size, and size of the points is the relative weight of the observation in the model, with larger points representing observations with higher weight in the model. Sample sizes are provided for each effect size in the meta-analytic database. Effect sizes were plotted in a random order. Egger’s tests indicated significant asymmetries (p < 0.05) in Biodiversity Change (worst asymmetry – likely not bias, just real effect of positive relationship between diversity and disease), Climate Change – (weak asymmetry, again likely not bias, climate change generally increases disease), and Introduced Species (relatively weak asymmetry – unclear whether this is a bias, may be driven by some outliers). No significant asymmetries (p > 0.05) were found in Chemical Pollution and Habitat Loss/Change, suggesting negligible publication bias in reported disease responses across these global change drivers ( B , C ). Egger’s test included publication year as moderator but found no significant relationship between Hedge’s g and publication year (p > 0.05) implying no temporal bias in effect size magnitude or direction. In panel D , the horizontal red lines denote the grand mean and SE of Hedge’s g and (g = 0.1009, SE = 0.0338). Grey points and error bars indicate the Hedge’s g and SEs, respectively, using the leave-one-out method (grand mean is recalculated after a given study is removed from dataset). While the removal of certain studies resulted in values that differed from the grand mean, all estimated Hedge’s g values fell well within the standard error of the grand mean. This sensitivity analysis indicates that our results were robust to the iterative exclusion of individual studies.

Extended Data Fig. 7 The effects of habitat loss/change on disease depend on parasite taxa and land use conversion contexts.

A) Enemy type influences the magnitude of the effect of urbanization on disease: helminths, protists, and arthropods were all negatively associated with urbanization, whereas viruses were non-significantly positively associated with urbanization. B) Reference (control) land use type influences the magnitude of the effect of urbanization on disease: disease was reduced in urban settings compared to rural and peri-urban settings, whereas there were no differences in disease along urbanization gradients or between urban and natural settings. C) The effect of forest fragmentation depends on whether a large/continuous habitat patch is compared to a small patch or whether disease it is measured along an increasing fragmentation gradient (Z = −2.828, p = 0.005). Conversely, the effect of deforestation on disease does not depend on whether the habitat has been destroyed and allowed to regrow (e.g., clearcutting, second growth forests, etc.) or whether it has been replaced with agriculture (e.g., row crop, agroforestry, livestock grazing; Z = 1.809, p = 0.0705). The displayed points represent the mean predicted values (with 95% confidence intervals) from a metafor model where the response variable was a Hedge’s g (representing the effect on an infectious disease endpoint relative to control), study was treated as a random effect, and the independent variables included enemy type (A), reference land use type (B), or land use conversion type (C). Data for (A) and (B) were only those studies that were within the “urbanization” subcategory; data for (C) were only those studies that were within the “deforestation” and “forest fragmentation” subcategories. Sample sizes (number of studies, n, and effect sizes, k) in (A) for each enemy are n = 48, k = 98 for Virus; n = 193, k = 343 for Protist; n = 159, k = 490 for Helminth; n = 10, k = 24 for Fungi; n = 103, k = 223 for Bacteria; and n = 30, k = 73 for Arthropod. Sample sizes in (B) for each reference land use type are n = 391, k = 1073 for Rural; n = 29, k = 74 for Peri-urban; n = 33, k = 83 for Natural; and n = 24, k = 58 for Urban Gradient. Sample sizes in (C) for each land use conversion type are n = 7, k = 47 for Continuous Gradient; n = 16, k = 44 for High/Low Fragmentation; n = 11, k = 27 for Clearcut/Regrowth; and n = 21, k = 43 for Agriculture.

Extended Data Fig. 8 The effects of common global change drivers on mean infectious disease responses in the literature depends on whether the endpoint is the host or parasite; whether the parasite is a vector, is vector-borne, has a complex or direct life cycle, or is a macroparasite; whether the host is an ectotherm or endotherm; or the venue and habitat in which the study was conducted.

A ) Parasite endpoints. B ) Vector-borne status. C ) Parasite transmission route. D ) Parasite size. E ) Venue. F ) Habitat. G ) Host thermy. H ) Parasite type (ecto- or endoparasite). See Table S 2 for number of studies and effect sizes across ecological contexts and global change drivers. See Table S 3 for pairwise comparison results. The displayed points represent the mean predicted values (with 95% confidence intervals) from a metafor model where the response variable was a Hedge’s g (representing the effect on an infectious disease endpoint relative to control), study was treated as a random effect, and the independent variables included the main effects and an interaction between global change driver and the focal independent variable (whether the endpoint measured was a host or parasite, whether the parasite is vector-borne, has a complex or direct life cycle, is a macroparasite, whether the study was conducted in the field or lab, habitat, the host is ectothermic, or the parasite is an ectoparasite).

Extended Data Fig. 9 The effects of five common global change drivers on mean infectious disease responses in the literature only occasionally depend on location, host taxon, and parasite taxon.

A ) Continent in which the field study occurred. Lack of replication in chemical pollution precluded us from including South America, Australia, and Africa in this analysis. B ) Host taxa. C ) Enemy taxa. See Table S 2 for number of studies and effect sizes across ecological contexts and global change drivers. See Table S 3 for pairwise comparison results. The displayed points represent the mean predicted values (with 95% confidence intervals) from a metafor model where the response variable was a Hedge’s g (representing the effect on an infectious disease endpoint relative to control), study was treated as a random effect, and the independent variables included the main effects and an interaction between global change driver and continent, host taxon, and enemy taxon.

Extended Data Fig. 10 The effects of human vs. non-human endpoints for the zoonotic disease subset of database and wild vs. domesticated animal endpoints for the non-human animal subset of database are consistent across global change drivers.

(A) Zoonotic disease responses measured on human hosts responded less positively (closer to zero when positive, further from zero when negative) than those measured on non-human (animal) hosts (Z = 2.306, p = 0.021). Note, IS studies were removed because of missing cells. (B) Disease responses measured on domestic animal hosts responded less positively (closer to zero when positive, further from zero when negative) than those measured on wild animal hosts (Z = 2.636, p = 0.008). These results were consistent across global change drivers (i.e., no significant interaction between endpoint and global change driver). As many of the global change drivers increase zoonotic parasites in non-human animals and all parasites in wild animals, this may suggest that anthropogenic change might increase the occurrence of parasite spillover from animals to humans and thus also pandemic risk. The displayed points represent the mean predicted values (with 95% confidence intervals) from a metafor model where the response variable was a Hedge’s g (representing the effect on an infectious disease endpoint relative to control), study was treated as a random effect, and the independent variable of global change driver and human/non-human hosts. Data for (A) were only those diseases that are considered “zoonotic”; data for (B) were only those endpoints that were measured on non-human animals. Sample sizes in (A) for zoonotic disease measured on human endpoints across global change drivers are n = 3, k = 17 for BC; n = 2, k = 6 for CP; n = 25, k = 39 for CC; and n = 175, k = 331 for HLC. Sample sizes in (A) for zoonotic disease measured on non-human endpoints across global change drivers are n = 25, k = 52 for BC; n = 2, k = 3 for CP; n = 18, k = 29 for CC; n = 126, k = 289 for HLC. Sample sizes in (B) for wild animal endpoints across global change drivers are n = 28, k = 69 for BC; n = 21, k = 44 for CP; n = 50, k = 89 for CC; n = 121, k = 360 for HLC; and n = 29, k = 45 for IS. Sample sizes in (B) for domesticated animal endpoints across global change drivers are n = 2, k = 4 for BC; n = 4, k = 11 for CP; n = 7, k = 20 for CC; n = 78, k = 197 for HLC; and n = 1, k = 2 for IS.

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Mahon, M.B., Sack, A., Aleuy, O.A. et al. A meta-analysis on global change drivers and the risk of infectious disease. Nature (2024). https://doi.org/10.1038/s41586-024-07380-6

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