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We sought to estimate the prevalence, severity and identify predictors of violence among adolescent girls and young women (AGYW) in informal settlement areas of Nairobi, Kenya, selected for DREAMS (Determined Resilient Empowered AIDS-free, Mentored and Safe) investment. Data were collected from 1687 AGYW aged 10-14 years (n = 606) and 15-22 years (n = 1081), randomly selected from a general population census in Korogocho and Viwandani in 2017, as part of an impact evaluation of the \"DREAMS\" Partnership. For 10-14 year-olds, we measured violence experienced either in the past 6 months or ever using a different set of questions from those used for 15-22 year-olds. Among 15-22 year-olds we measured prevalence of violence, experienced in the past 12 months, using World Health Organization (WHO) definitions for violence typologies. Predictors of violence were identified using multivariable logit models. Among 606 girls aged 10-14 years, about 54% and 7% ever experienced psychological and sexual violence, respectively. About 33%, 16% and 5% experienced psychological, physical and sexual violence in the past 6 months. The 10-14 year old girls who engaged in chores or activities for payment in the past 6 months, or whose family did not have enough food due to lack of money were at a greater risk for violence. Invitation to DREAMS and being a non-Christian were protective. Among 1081 AGYW aged 15-22 years, psychological violence was the most prevalent in the past year (33.1%), followed by physical violence (22.9%), and sexual violence (15.8%). About 7% experienced all three types of violence. Severe physical violence was more prevalent (13.8%) than moderate physical violence (9.2%). Among AGYW aged 15-22 years, being previously married/lived with partner, engaging in employment last month, food insecure were all risk factors for psychological violence. For physical violence, living in Viwandani and being a Muslim were protective; while being previously married or lived with a partner, or sleeping hungry at night during the past 4 weeks were risk factors. The odds of sexual violence were lower among AGYW aged 18-22 years and among Muslims. Engaging in sex and food insecurity increased chances for sexual violence. Prevalence of recent violence among AGYW is high in this population. This calls for increased effort geared towards addressing drivers of violence as an early entry point of HIV prevention effort in this vulnerable group.

Disasters tend to cross political, jurisdictional, functional, and geographic boundaries. As a result, disasters often require responses from multiple levels of government and multiple organizations in the public and private sectors. This means that public and private organizations that normally operate independently must work together to mount an effective disaster response. To identify and understand approaches to aligning health care system incentives with the American public's need for a health care system that is prepared to manage acutely ill and injured patients during a disaster, public health emergency, or other mass casualty event, the National Academies of Sciences, Engineering, and Medicine hosted a 2-day public workshop on March 20 and 21, 2018. This publication summarizes the presentations and discussions from the workshop.

Background HIV risk remains unacceptably high among adolescent girls and young women (AGYW) in southern and eastern Africa, reflecting structural and social inequities that drive new infections. In 2015, PEPFAR (the United States President’s Emergency Plan for AIDS Relief) with private-sector partners launched the DREAMS Partnership, an ambitious package of interventions in 10 sub-Saharan African countries. DREAMS aims to reduce HIV incidence by 40% among AGYW over two years by addressing multiple causes of AGYW vulnerability. This protocol outlines an impact evaluation of DREAMS in four settings. Methods To achieve an impact evaluation that is credible and timely, we describe a mix of methods that build on longitudinal data available in existing surveillance sites prior to DREAMS roll-out. In three long-running surveillance sites (in rural and urban Kenya and rural South Africa), the evaluation will measure: (1) population-level changes over time in HIV incidence and socio-economic, behavioural and health outcomes among AGYW and young men (before, during, after DREAMS); and (2) causal pathways linking uptake of DREAMS interventions to ‘mediators’ of change such as empowerment, through to behavioural and health outcomes, using nested cohort studies with samples of ~ 1000–1500 AGYW selected randomly from the general population and followed for two years. In Zimbabwe, where DREAMS includes an offer of pre-exposure HIV prophylaxis (PrEP), cohorts of young women who sell sex will be followed for two years to measure the impact of ‘DREAMS+PrEP’ on HIV incidence among young women at highest risk of HIV. In all four settings, process evaluation and qualitative studies will monitor the delivery and context of DREAMS implementation. The primary evaluation outcome is HIV incidence, and secondary outcomes include indicators of sexual behavior change, and social and biological protection. Discussion DREAMS is, to date, the most ambitious effort to scale-up combinations or ‘packages’ of multi-sectoral interventions for HIV prevention. Evidence of its effectiveness in reducing HIV incidence among AGYW, and demonstrating which aspects of the lives of AGYW were changed, will offer valuable lessons for replication.

A critical component of the nation's economic vitality is ensuring that all Americans can contribute and prosper. Such contributions presuppose an intentional focus on achieving the highest levels of health possible, which requires that conditions in communities, schools workplaces, and other settings promote health and address the social determinants of health for all community members. Many organizations, in both the private and public sectors, have been establishing partnerships to further healthy workplaces and health equity in general. Many are taking the lead in producing economic growth that is inclusive and responsive to the nation's diverse needs and populations. Increasingly, private-public partnerships are emerging as ways of doing business. Additionally, a variety of new developments in health, health care, and community benefits obligations that are part of the Affordable Care Act have contributed to this interest in economic growth and health and in the creation of new partnerships. To examine past successes and future opportunities, the National Academies of Sciences, Engineering, and Medicine held a workshop in November 2015. The workshop focused on the potential of the private sector to produce a triple bottom line: economic opportunity (including workforce development) and growth, healthy work and community environments, and improved employee health. At the same time, participants looked beyond the private sector to public-private partnerships and to public-sector actions that combine opportunities for economic growth and good health for all. This publication summarizes the presentations and discussions from the workshop.

The leading challenges in public health-ranging from rising obesity rates to the fast-growing population of older adults-are complex and cannot be solved effectively by any one silver bullet or any one sector in isolation. Instead, their solutions require collaborative actions of many sectors, including industry, government, academia, and nongovernmental organizations. To better understand how to build multisectoral food and nutrition partnerships that achieve meaningful public health results, the IOM's Food Forum held a workshop on November 1-2, 2011, in Washington, D.C. The workshop brought together stakeholders from various sectors to discuss the benefits and risks of pursuing cross-sector partnerships, foster communication between sectors, and explore opportunities of mutual interest in food and nutrition that are most conducive for partnerships. Participants also discussed the perspectives of the various sectors, key features of successful partnerships, and what needs to be done to facilitate partnership development. This report, Building Public-Private Partnerships in Food and Nutrition: Workshop Summary, summarizes the workshop.

In low-and middle-income countries (LMICs), the private sector—including international donors, non-governmental organizations, for-profit providers and traditional healers—plays a significant role in health financing and delivery. The use of the private sector in furthering public health goals is increasingly common. By working with the private sector through public–private engagement (PPE), states can harness private sector resources to further public health goals. PPE initiatives can take a variety of forms and understanding of these models is limited. This paper presents the results of a Campbell systematic literature review conducted to establish the types and the prevalence of PPE projects for health service delivery and financing in Southern Africa. PPE initiatives identified through the review were categorized according to a PPE typology. The review reveals that the full range of PPE models, eight distinct models, are utilized in the Southern African context. The distribution of the available evidence—including significant gaps in the literature—is discussed, and key considerations for researchers, implementers, and current and potential PPE partners are presented. It was found that the literature is disproportionately representative of PPE initiatives located in South Africa, and of those that involve for-profit partners and international donors. A significant gap in the literature identified through the study is the scarcity of information regarding the relationship between international donors and national governments. This information is key to strengthening these partnerships, improving partnership outcomes and capacitating recipient countries. The need for research that disaggregates PPE models and investigates PPE functioning in context is demonstrated. Dans les pays à faible revenu et à revenu intermédiaire (PFR-PRI), le secteur privé, - notamment les donateurs internationaux, les organisations non-gouvernementales, les prestataires de services à but lucratif et les tradipraticiens -, joue un rôle important dans le financement et la prestation des services de santé. Le recours au secteur privé dans la poursuite des objectifs de santé publique est de plus en plus courant. En collaborant avec le secteur privé par le biais de l’engagement public-privé (PPE), les États peuvent exploiter les ressources du secteur privé pour promouvoir des objectifs de santé publique. Les initiatives PPE peuvent prendre une variété de formes et la compréhension de ces modèles est limitée. Le présent article présente les résultats d’une recension Campbell systématique de la littérature menée pour établir les types et la prévalence des projets PPE pour la prestation et le financement des services de santé en Afrique australe. Les initiatives PPE identifiées à la suite de cette revue ont été classées selon une typologie PPE. L’examen révèle que dans le contexte de l’Afrique australe, la gamme complète des modèles PPE est utilisée, soit huit modèles distincts. On examine la répartition des données probantes disponibles - y compris sur d’importantes lacunes de la littérature, et on présente les considérations cruciales pour les chercheurs, les agents d’exécution ainsi que les partenaires PPE actuels et potentiels. Il a été constaté que la littérature est davantage représentative des initiatives PPE localisées en Afrique du Sud, ainsi que de celles où les partenaires à but lucratif et les donateurs internationaux sont impliqués. La rareté des informations concernant la relation entre les bailleurs de fonds internationaux et les gouvernements nationaux est une autre grosse lacune de la littérature identifiée par l’étude. Cette information est essentielle pour le renforcement de ces partenariats, l’amélioration des résultats du partenariat et le renforcement des capacités des pays bénéficiaires. On démontre ainsi la nécessité d’une recherche qui désagrège les modèles PPE et mène des investigations sur le fonctionnement des initiatives PPE dans le contexte. En los países de ingresos bajos y medios (PIBMs), el sector privado -incluyendo donantes internacionales, organizaciones no gubernamentales, proveedores con ánimo de lucro y curanderos tradicionales -juega un papel importante en la financiación y la entrega de la salud. El uso del sector privado en la promoción de los objetivos de salud pública es cada vez más común. Trabajando con el sector privado a través del compromiso público-privado (CPP), los estados pueden aprovechar los recursos del sector privado para promover metas de salud pública. Las iniciativas del CPP pueden tomar una variedad de formas y la comprensión de estos modelos es limitada. Este artículo presenta los resultados de una revisión sistemática de la literatura Campbell llevada a cabo para establecer los tipos y la prevalencia de los proyectos del CPP para la prestación y la financiación de servicios de salud en Suráfrica. Las iniciativas del CPP identificadas a través de la revisión se clasificaron de acuerdo con una tipología CPP. La revisión revela que toda la gama de modelos del CPP, ocho modelos distintos, se utilizan en el contexto de Suráfrica. Se discute la distribución de la evidencia disponible -incluyendo vacíos significativos en la literatura- y se presentan las consideraciones claves para los investigadores, los implementadores, y los socios de CPP actuales y potenciales. Se encontró que la literatura es desproporcionadamente representativa de las iniciativas del CPP ubicadas en Suráfrica, y de aquellos que involucran socios con ánimo de lucro y donantes internacionales. Una brecha significativa en la literatura identificada a través del estudio es la escasez de información con respecto a la relación entre los donantes internacionales y los gobiernos nacionales. Esta información es clave para fortalecer estas asociaciones, mejorando los resultados de la asociación y capacitando a los países receptores. Se demuestra la necesidad de investigar los modelos que analizan minuciosamente el CPP e investigan el funcionamiento del CPP en su contexto. 在中低收入国家(LMICs), 国际捐助者、非政府组织、营利服 务者和传统治疗师等私人部门在卫生筹资和卫生服务提供中 发挥着重要作用。利用私人部门来实现公立卫生目标正越来 越常见。通过公私参与(PPE) 方式与私人部门合作, 政府可 以使用私人部门的资源来推进公立卫生目标。PPE可采取多 种形式, 目前对这些模式的理解有限。本文描述了一项 Campbell系统综述的结果, 该文献综述的目的是明确非洲南 部卫生服务提供和筹资PPE项目的种类和普及率。综述纳入 的PPE项目根据PPE类型进行分类。本综述发现全部八种不同 的PPE模式在非洲南部均有使用。本文讨论了现有证据的分 布, 包括文献中的重要缺口;描述了研究者、实施者以及现有 和潜在的PPE合作伙伴的主要考虑因素。结果显示, 文献大多 是关于南非的PPE项目, 以及有营利服务者和国际捐助者参与 的项目。本研究发现, 现有文献缺乏关于国际捐助者与国家政 府间关系的信息。此类信息对于加强合作伙伴关系、改善合 作伙伴结果、提供受援国能力非常关键。需要进一步研究来 分解PPE模式, 调查在具体环境中运行的PPE项目。

In the past three decades, levels of and contributors to global health aid have increased at an unprecedented pace. Development assistance for health—financial contributions from public and private institutions to low‐ and middle‐income countries to help improve health and health systems—nearly quintupled from 1990 to 2012 (from$5.7 billion to $ 28.1 billion). DAH is now provided by more than one hundred seventy major global health agencies and organizations, 15 percent of which are private entities (such as the Bill and Melinda Gates Foundation), other not‐for‐profit organizations, and public‐private partnerships. Governments are still the largest source for DAH. While increased DAH is essential and welcome, these system developments raise numerous ethical questions. Are the resources sustainable, and do expenditures target correct priorities? Who should decide, and how should these decisions be made?.

More than half of artemisinin combination therapies (ACTs) consumed globally are dispensed in the retail sector, where diagnostic testing is uncommon, leading to overconsumption and poor targeting. In many malaria-endemic countries, ACTs sold over the counter are available at heavily subsidized prices, further contributing to their misuse. Inappropriate use of ACTs can have serious implications for the spread of drug resistance and leads to poor outcomes for nonmalaria patients treated with incorrect drugs. We evaluated the public health impact of an innovative strategy that targets ACT subsidies to confirmed malaria cases by coupling free diagnostic testing with a diagnosis-dependent ACT subsidy. We conducted a cluster-randomized controlled trial in 32 community clusters in western Kenya (population approximately 160,000). Eligible clusters had retail outlets selling ACTs and existing community health worker (CHW) programs and were randomly assigned 1:1 to control and intervention arms. In intervention areas, CHWs were available in their villages to perform malaria rapid diagnostic tests (RDTs) on demand for any individual >1 year of age experiencing a malaria-like illness. Malaria RDT-positive individuals received a voucher for a discount on a quality-assured ACT, redeemable at a participating retail medicine outlet. In control areas, CHWs offered a standard package of health education, prevention, and referral services. We conducted 4 population-based surveys-at baseline, 6 months, 12 months, and 18 months-of a random sample of households with fever in the last 4 weeks to evaluate predefined, individual-level outcomes. The primary outcome was uptake of malaria diagnostic testing at 12 months. The main secondary outcome was rational ACT use, defined as the proportion of ACTs used by test-positive individuals. Analyses followed the intention-to-treat principle using generalized estimating equations (GEEs) to account for clustering with prespecified adjustment for gender, age, education, and wealth. All descriptive statistics and regressions were weighted to account for sampling design. Between July 2015 and May 2017, 32,404 participants were tested for malaria, and 10,870 vouchers were issued. A total of 7,416 randomly selected participants with recent fever from all 32 clusters were surveyed. The majority of recent fevers were in children under 18 years (62.9%, n = 4,653). The gender of enrolled participants was balanced in children (49.8%, n = 2,318 boys versus 50.2%, n = 2,335 girls), but more adult women were enrolled than men (78.0%, n = 2,139 versus 22.0%, n = 604). At baseline, 67.6% (n = 1,362) of participants took an ACT for their illness, and 40.3% (n = 810) of all participants took an ACT purchased from a retail outlet. At 12 months, 50.5% (n = 454) in the intervention arm and 43.4% (n = 389) in the control arm had a malaria diagnostic test for their recent fever (adjusted risk difference [RD] = 9 percentage points [pp]; 95% CI 2-15 pp; p = 0.015; adjusted risk ratio [RR] = 1.20; 95% CI 1.05-1.38; p = 0.015). By 18 months, the ARR had increased to 1.25 (95% CI 1.09-1.44; p = 0.005). Rational use of ACTs in the intervention area increased from 41.7% (n = 279) at baseline to 59.6% (n = 403) and was 40% higher in the intervention arm at 18 months (ARR 1.40; 95% CI 1.19-1.64; p < 0.001). While intervention effects increased between 12 and 18 months, we were not able to estimate longer-term impact of the intervention and could not independently evaluate the effects of the free testing and the voucher on uptake of testing. Diagnosis-dependent ACT subsidies and community-based interventions that include the private sector can have an important impact on diagnostic testing and population-wide rational use of ACTs. Targeting of the ACT subsidy itself to those with a positive malaria diagnostic test may also improve sustainability and reduce the cost of retail-sector ACT subsidies. ClinicalTrials.gov NCT02461628.