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August 2, 2011
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Greetings!
It's August already, which means the 2011-12 academic year is right around the corner! DGHI is looking forward to welcoming 29 members of the next Master of Science in Global Health students, as well as dozens of global health certificate students and at least three new faculty members. Read about our new global health faculty below. We're also making plans to recognize the first five years of DGHI. Mark your calendar for October 3 and plan to join us for the festivities. (More details to follow.) Today we're pleased to recognize the work of a number of DGHI faculty. From research on the mental health of South African bar-goers, to the award-winning, ARV-filled ketchup packets that prevent HIV in newborns, you never know what DGHI faculty will discover next.
Until next time,
Geelea Seaford and Everyone at DGHI
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Kramer Named Deputy Director of Duke Global Health Institute
Randall Kramer, professor of environmental economics and global health, has been appointed deputy director of the Duke Global Health Institute (DGHI). Kramer, a faculty member at the Nicholas School for the Environment, is currently  associate director for strategy at DGHI. In this new position, Kramer will take a more active role in day-to-day operations of DGHI, particularly in the areas of strategic planning, faculty recruiting and development, overseas operations and other emerging initiatives. He will also represent the director on various boards and committees. "I am grateful for Randy's commitment to DGHI and to continuing the progress we've made over the past four years," said Michael Merson, founding director of DGHI who last month was appointed interim vice president and vice provost for global strategy and programs at Duke. Since it began in November 2006, DGHI has become one of the world's leading academic global health institutes. DGHI now has more than 50 faculty spanning Duke's campus with more than 120 research and training activities in 28 countries throughout the world focused on a wide range of health issues.
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DGHI Welcomes Three Faculty Members to Duke
The Duke Global Health Institute is proud to introduce three new faculty members with specialties in cardiovascular medicine, environmental health and cultural anthropology. Gerald Bloomfield, William Pan and Harris Solomon are the latest of 25 new global health faculty members recruited to Duke since 2006. Most of the 25 have appointments in another Duke school or department, as well as DGHI. Gerald Bloomfield, MD,MPH, joins the faculty as Assistant Professor of Medicine and Global Health after completing his Cardiovascular Medicine fellowship training at Duke University Medical Center and Duke Clinical Research Institute in 2011.
William Pan, PhD, William Pan, PhD, Assistant Professor of Global Environmental Health, comes to Duke from a faculty position at Johns Hopkins Bloomberg School of Public Health.
Harris Solomon, PhD, MPH, Harris Solomon, PhD, Assistant Professor of Cultural Anthropology and Global Health, comes to Duke and DGHI from Brown University, where he received his doctoral training in cultural anthropology. 
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Poor Mental Health Increases HIV Risk Among South African Bar Goers
A new publication by Kathleen Sikkema in the Department of Psychology and Neuroscience suggests that alcohol-serving venues in South Africa may be strategic locations for targeting HIV prevention interventions and awareness programs. The research findings published in the July issue  of the Journal of Acquired Immune Deficiency Syndromes found that individuals who frequent bars in one South African township have high levels of traumatic experiences, which is associated with increased depression and PTSD. These mental health problems, in turn, lead to greater sexual risk behavior, putting people at increased risk of contracting HIV.
In surveys of 738 men and women who frequent bars and taverns in one township in Cape Town, half of those surveyed screened positive for depression and a third screened positive for Post Traumatic Stress Disorder or PTSD. Individuals who had experienced physical abuse by a sex partner, been raped, or were abused as a child were much more likely to exhibit mental health distress. Women with depression, and both men and women with PTSD, reported more unprotected sex, compared with people without mental health distress. The influence of mental health was above and beyond the influence of drug and alcohol consumption on sexual behavior.
"South Africa has one of the largest HIV epidemics in the world," said Sikkema, highlighting that these findings are important for addressing mental health as part of HIV prevention in South Africa. "Our response to the epidemic must address the synergy of co-occurring risk factors, which includes past traumas, poor mental health, and drug and alcohol use. Only when we address the larger context that pre-disposes people to HIV risk will we begin to curb the spread of the HIV epidemic."
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Walmer Advises Haitian OB/GYN Society on Cervical Cancer Screening
Family Health Ministries (FHM) founder, Duke physician and DGHI faculty member David Walmer presented new screening guidelines for cervical cancer prevention at the 2011 annual meeting of the Haitian OB/GYN Society. Walmer's recommendations are the culmination of 18 years of FHM-supported research conducted by Haitian gynecologists in partnership with the QIAGEN Corporation and most recently with the Duke Global Health Institute.
FHM, a Durham-based nongovernmental organization (NGO) devoted to improving maternal and child health and education in Haiti, has recommended that Pap smears be replaced with CareHPV testing, and when positive, women should be examined by colposcopy. Similar guidelines were proposed at the May annual meeting of the American Society of Clinical Oncology. T he Ministry of Health, Haitian OB/GYN Society, and Groupe de Support Contre le Cancer have also endorsed these new guidelines, which could make Haiti one of the leading countries in the world to adopt this promising new approach to cervical cancer prevention.
The incidence of cervical cancer in Haiti is the highest in the Western Hemisphere, 30 times higher than in the US. Approximately one in 20 women in Haiti coming to FHM's clinic has an advanced, untreatable cancer. At the request of a Haitian gynecologist, Walmer formed a partnership more than 15 years ago to address these staggering statistics.
One of the early discoveries by FHM researchers was an observation that Pap smears miss approximately 85% of treatable disease that could be visible by using a magnifying medical device called a colposcope.
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Pregnancy May Reduce Effectiveness of ART Treatment Among HIV-positive Women in South Africa
A new study by OB/GYN and DGHI faculty Daniel Westreich finds that an HIV-positive woman's response to antiretroviral treatment may be compromised by pregnancy. The findings underline the importance of family planning as part of care and treatment of HIV-positive women in sub-Saharan Africa, where the largest group of individuals living with HIV are women of child-bearing age.
Published today in the journal PLoS ONE, the study examines the effect of pregnancy on virologic response to highly active antiretroviral therapy (HAART). The study is important because little is known about the short- and long-term risks associated with pregnancy in HIV-positive women receiving HAART in sub-Saharan Africa.
In the observational study of more than 5,000 HIV-positive adult women who initiated HAART in Johannesburg, South Africa between 2004 and 2009, researchers found modest increases in the rate of virologic failure, or the inability to stop the spread of HIV in the body, among women who became pregnant. Virologic failure was more common during pregnancy than after pregnancy.
In this study, virologic failure was defined as virologic suppression of plasma HIV-1 RNA to less than 400 copies/ml within six months of HAART initiation, or a viral rebound to above 400 copies/ml at any time after initial suppression.
The increased risk of virologic failure among HIV-positive pregnant women may be the result of underdosing or underconcentration of drugs as a result of changes in hormone levels and increases in blood volume and body mass index during pregnancy. Another possible explanation for this effect is behavior change associated with pregnancy. For example, new responsibilities following the birth of a child might lead to decreased adherence to antiretroviral medications.
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Duke Innovation Wins Saving Lives at Birth Grand Challenge
Last week, nearly $14 million was awarded to innovations aimed at saving the lives of mothers and children around the world Thursday in a landmark event hosted by US Secretary of State Hillary Clinton and USAID Administrator  Rajiv Shah. The innovative Pratt Pouch developed by Pratt School of Engineering and DGHI faculty member Robert Malkin was selected as an awardee of the "Saving Lives at Birth" Grand Challenge, the first in a series of Grand Challenges for Development led by the U.S. Agency for International Development (USAID), the Bill & Melinda Gates Foundation, the Government of Norway, Grand Challenges Canada, and the World Bank.
The ketchup packet-like pouch developed by Malkin and the DHT-lab at Duke, contains anti-retroviral drugs which help HIV-positive moms prevent transmission of the virus to their newborns. Malkin's invention is the type of low-tech, high-impact device that can prevent the hundreds of thousands of newborns from contracting HIV at the time of birth.
In her remarks, Secretary Clinton said the Pratt Pouch is a good idea: "Now researchers are developing a pouch that can last for months and, apparently, looks like something that you get at a fast food restaurant, like one of those little ketchup containers. And then a mother can have it on hand and will be able to care for her child immediately. So we have lots of great ideas that are here."
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John Crump to Become Professor at University of Otago
 DGHI faculty member John Crump, who has served as site director for DGHI's longest-running partnership at the Kilimanjaro Christian Medical Centre in Moshi, Tanzania, has been appointed to a second endowed professorial chair in the Centre for International Health at the University of Otago.
From the official announcement: "An outstanding specialist on infectious diseases has been appointed to a second endowed professorial chair in the Centre for International Health at the University of Otago. He is Associate Professor John Crump, who currently heads a research centre in Tanzania for the Duke University Medical Center and the Duke Global Health Institute.
Since 2002, Dr Crump has been based at the Kilimanjaro Christian Medical Centre in Moshi, Tanzania where he leads a major collaboration with Duke University and serves as a medical epidemiologist with the CDC. He has an outstanding record of research and publication on many aspects of infectious diseases in resource-poor settings. In particular, he has worked on the syndrome of fever and its causes in East Africa, animal-associated infections, laboratory services in resource-poor areas, and HIV prevention, treatment and care, including HIV-associated opportunistic infections. He has also been involved in undergraduate and postgraduate education..."
DGHI Postdoctoral Fellows Accept New Positions
  Designed to provide postdoctoral trainees with a strong foundation in global health research, the DGHI Postdoctoral Training Program is proud to announce that fellows Jennifer Toller Erausquin and Nina Yamanis have accepted positions to further their research on health disparities, in two very different capacities.
Yamanis will become Assistant Professor of International Development at American University's School of International Service where she will teach courses on health in developing countries and micropolitics of development. Yamanis will also build upon five years of qualitative and quantitative field research on the social networks of young, urban men in Tanzania and their influence on the men's HIV risk behavior and partner violence. She and colleagues are currently piloting a combined health promotion/microfinance intervention for the men.
Erausquin, will become Senior Advisor for Healthy Schools within the North Carolina Division of Public Health in the Chronic Disease and Injury Section. She will work with the Department of Public Instruction to incorporate environmental, policy, and health education interventions in the public schools. The work fits well with her interests in communities and health, as well as structural interventions to reduce risk for chronic and infectious diseases.
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