Facing famine: Somali experiences in the famine of 2011.

In 2011-12, Somalia experienced the worst famine of the twenty- first century. Since then, research on the famine has focused almost exclusively on the external response, the reasons for the delay in the international response, and the implications for international humanitarian action in the context of the "global war on terror." This paper focuses on the internal, Somali response to the famine. Themes of diversification, mobility and flexibility are all important to understanding how people coped with the famine, but this paper focuses on the factor that seemed to determine whether and how well people survived the famine: social connectedness, the extent of the social networks of affected populations, and the ability of these networks to mobilize resources. These factors ultimately determined how well people coped with the famine. The nature of reciprocity, the resources available within people's networks, and the collective risks and hazards faced within networks, all determined people's individual and household outcomes in the famine and are related to the social structures and social hierarchies within Somali society. But these networks had a distinctly negative side as well-social identity and social networks were also exploited to trap humanitarian assistance, turn displaced people into "aid bait," and to a large degree, determined who benefited from aid once it started to flow. This paper addresses several questions: How did Somali communities and households cope with the famine of 2011 in the absence of any state-led response-and a significant delay in a major international response? What can be learned from these practices to improve our understanding of famine, and of mitigation, response and building resilience to future crises?

Cost and cost threshold analyses for 12 innovative US HIV linkage and retention in care programs.

Out of >1,000,000 people living with HIV in the USA, an estimated 60% were not adequately engaged in medical care in 2011. In response, AIDS United spearheaded 12 HIV linkage and retention in care programs. These programs were supported by the Social Innovation Fund, a White House initiative. Each program reflected the needs of its local population living with HIV. Economic analyses of such programs, such as cost and cost threshold analyses, provide important information for policy-makers and others allocating resources or planning programs. Implementation costs were examined from societal and payer perspectives. This paper presents the results of cost threshold analyses, which provide an estimated number of HIV transmissions that would have to be averted for each program to be considered cost-saving and cost-effective. The methods were adapted from the US Panel on Cost-effectiveness in Health and Medicine. Per client program costs ranged from $1109.45 to $7602.54 from a societal perspective. The cost-saving thresholds ranged from 0.32 to 1.19 infections averted, and the cost-effectiveness thresholds ranged from 0.11 to 0.43 infections averted by the programs. These results suggest that such programs are a sound and efficient investment towards supporting goals set by US HIV policy-makers. Cost-utility data are pending.

Cost-Utility Analysis of Three U.S. HIV Linkage and Re-engagement in Care Programs from Positive Charge.

Linking and retaining people living with HIV in ongoing, HIV medical care is vital for ending the U.S. HIV epidemic. Yet, 41-44 % of HIV+ individuals are out of care. In response, AIDS United initiated Positive Charge, a series of five HIV linkage and re-engagement projects around the U.S. This paper investigates whether three Positive Charge programs were cost effective and calculates a return on investment for each program. It uses standard methods of cost utility analysis and WHO-CHOICE thresholds. All three projects were found to be cost effective, and two were highly cost effective. Cost utility ratios ranged from $4439 to $137,271. These results suggest that HIV linkage to care programs are a productive and efficient use of public health funds.

Cost and threshold analysis of positive charge, a multi-site linkage to HIV care program in the United States.

Positive Charge (PC) is a linkage to HIV care initiative implemented by AIDS United with sites in New York, Chicago, Louisiana, North Carolina, and the San Francisco/Bay Area. This study employed standard methods of cost and threshold analyses, as recommended by the US Panel on Cost-effectiveness in Health and Medicine, to calculate cost-saving and cost effective thresholds of the initiative. The overall societal cost of the linkage to care programs ranged from $48,490 to $370,525. The study found that PC's five unique evidence-based linkage to care programs have relatively low costs per client served and highly achievable cost-saving and cost-effectiveness thresholds. The findings from this study suggest that HIV linkage to care programs have the potential to be a highly productive use of public health resources.

The development and implementation of the national evaluation strategy of Access to Care, a multi-site linkage to care initiative in the United States.

The Access to Care (A2C) is a multi-site initiative that seeks to increase the access to and retention in effective HIV healthcare and support services by people living with HIV across the United States. As the initiative implemented evidence-based programs in new settings with diverse populations, it was important to document these innovative efforts to contribute to the evidence base for best practices. In a partnership between Johns Hopkins University, AIDS United, and the A2C sites, a national evaluation strategy was developed and implemented to build knowledge about how linkage to care interventions could be most effectively implemented within the context of local, real-world settings. This article provides an overview of the efforts to develop and implement a national monitoring and evaluation strategy for a multi-site initiative. The findings may be of utility for other HIV interventions that are seeking to incorporate a monitoring and evaluation component into their efforts.

Famines in Africa: is early warning early enough?

Following the second Sahelian famine in 1984-1985, major investments were made to establish Early Warning Systems. These systems help to ensure that timely warnings and vulnerability information are available to decision makers to anticipate and avert food crises. In the recent crisis in the Horn of Africa, alarming levels of acute malnutrition were documented from March 2010, and by August 2010, an impending food crisis was forecast. Despite these measures, the situation remained unrecognised, and further deteriorated causing malnutrition levels to grow in severity and scope. By the time the United Nations officially declared famine on 20 July 2011, and the humanitarian community sluggishly went into response mode, levels of malnutrition and mortality exceeded catastrophic levels. At this time, an estimated 11 million people were in desperate and immediate need for food. With warnings of food crises in the Sahel, South Sudan, and forecast of the drought returning to the Horn, there is an immediate need to institutionalize change in the health response during humanitarian emergencies. Early warning systems are only effective if they trigger an early response.