Scholars@Duke
Paul Pronyk

Paul Pronyk

Adjunct Professor of Global Health
Duke Global Health Institute

Selected Publications

Integrating a mental health referral system within adolescent HIV clinics in Tanzania.

Journal Article AIDS · June 19, 2025 OBJECTIVE: To evaluate the acceptability and feasibility of integrating a mental health (MH) stepped-care referral pathway for young people with HIV (YPWH) who screened positive for MH distress using task-sharing and stepped-care approaches. DESIGN: This i ... Full text Link to item Cite

Progressing towards the 2030 health-related SDGs in ASEAN: A systematic analysis.

Journal Article PLoS Med · April 2025 BACKGROUND: The Sustainable Development Goals (SDGs) articulate an ambitious global agenda and set of targets to achieve by 2030. Among the health-related SDGs, many formidable challenges remain in settings like the Association of Southeast Asian Nations ( ... Full text Link to item Cite

National investment case development for pathogen genomics.

Journal Article Cell genomics · March 2025 Sustaining and expanding genomic surveillance capacity requires broader investment in genomics that target both novel and pandemic pathogens. Currently, there is no standardized methodology to evaluate the cost and benefit of a multi-pathogen surveillance ... Full text Cite

Epidemiology and delays in neurosurgical care among patients with traumatic brain injury in a regional referral hospital in Sri Lanka: a retrospective cohort study.

Journal Article Neurosurgical focus · March 2025 ObjectiveThe objective of this study was to develop a pilot traumatic brain injury (TBI) registry through a retrospective review of medical records. This was done to investigate the epidemiology and the prevalence of delays to care, both before an ... Full text Cite

A scoping review on peer-led interventions to improve youth mental health in low- and middle-income countries.

Journal Article Glob Ment Health (Camb) · 2025 Youth living in low- and middle-income countries (LMICs) have an increased vulnerability to mental illnesses, with many lacking access to adequate treatment. There has been a growing body of interventions using task sharing with trained peer leaders to add ... Full text Link to item Cite

Pathogen genomic surveillance status among lower resource settings in Asia.

Journal Article Nature microbiology · October 2024 Asia remains vulnerable to new and emerging infectious diseases. Understanding how to improve next generation sequencing (NGS) use in pathogen surveillance is an urgent priority for regional health security. Here we developed a pathogen genomic surveillanc ... Full text Cite

Advancing pathogen genomics in resource-limited settings.

Journal Article Cell genomics · December 2023 Genomic sequencing has emerged as a powerful tool to enhance early pathogen detection and characterization with implications for public health and clinical decision making. Although widely available in developed countries, the application of pathogen genom ... Full text Cite

Cost-effectiveness of sub-national geographically targeted vaccination programs: A systematic review.

Journal Article Vaccine · March 2023 Immunization is an essential component of national health plans. However, the growing number of new vaccine introductions, vaccination campaigns and increasing administrative costs create logistic and financial challenges, especially in resource-limited se ... Full text Cite

SARS-CoV-2 Antibody Seroprevalence in Jakarta, Indonesia

Journal Article Kesmas · August 1, 2022 The SARS-CoV-2 transmission dynamics in low- and middle-income countries remain poorly understood. This study aimed to estimate the SARS-CoV-2 antibodies seroprevalence in Jakarta, Indonesia, and to increase knowledge of SARS-CoV-2 transmission in urban se ... Full text Cite

Factors affecting vaccination demand in Indonesia: a secondary analysis and multimethods national assessment.

Journal Article BMJ open · August 2022 ObjectivesVaccine hesitancy remains a major barrier to immunisation coverage worldwide. We explored influence of hesitancy on coverage and factors contributing to vaccine uptake during a national measles-rubella (MR) campaign in Indonesia.Desi ... Full text Cite

Prevalence of, and factors associated with anaemia in children aged 1-3 years in Aceh, Indonesia: A cross-sectional study.

Journal Article Nutrition and health · July 2022 Background: Child anaemia continues to represent a major public health challenge in lower-and-middle income countries. It has serious long-term consequences for child growth and development. In Indonesia, there was a 10% increase in the national pre ... Full text Cite

Alarmingly High HIV Prevalence Among Adolescent and Young Men Who have Sex with Men (MSM) in Urban Indonesia.

Journal Article AIDS and behavior · November 2021 Indonesia's HIV epidemic is concentrated among key populations. While prevalence among men who have sex with men (MSM) is high, transmission among young MSM (15-24-years-old) remains poorly understood. We conducted a respondent driven sampling survey of 21 ... Full text Cite

Stability of Zika Virus Antibodies in Specimens from a Retrospective Serological Study.

Journal Article The American journal of tropical medicine and hygiene · July 2021 Full text Cite

Spatiotemporal Heterogeneity of Zika Virus Transmission in Indonesia: Serosurveillance Data from a Pediatric Population.

Journal Article The American journal of tropical medicine and hygiene · May 2021 The presence of Zika virus (ZIKV) in Indonesia has been recognized since the 1970s, but its transmission dynamics there have been poorly understood. To understand more fully the geographic distribution and burden of ZIKV infection, we performed retrospecti ... Full text Cite

Digital health for real-time monitoring of a national immunisation campaign in Indonesia: a large-scale effectiveness evaluation.

Journal Article BMJ open · December 2020 ObjectiveTo assess the contribution of a digital health real-time monitoring platform towards the achievement of coverage targets during a national immunisation campaign in Indonesia.InterventionsA digital health platform was introduced t ... Full text Cite

Achieving the Sustainable Development Goals for water and sanitation in Indonesia - Results from a five-year (2013-2017) large-scale effectiveness evaluation.

Journal Article International journal of hygiene and environmental health · September 2020 BackgroundAccess to safe sanitation and the elimination of open defecation are pre-conditions for improved child health and nutrition and wider achievement of the Sustainable Development Goals (SDGs). While Indonesia has a solid policy framework, ... Full text Cite

Progress towards the UN Commission on Life Saving Commodities recommendations after five years: a longitudinal assessment

Journal Article Journal of Global Health Reports · January 1, 2020 Background In 2012, the UN Commission on Life Saving Commodities (UNCoLSC) articulated a series of recommendations to expand access to 13 life-saving reproductive, maternal, newborn and child health (RMNCH) commodities with the greatest potential to reduce ... Full text Cite

Vaccine hesitancy in Indonesia.

Journal Article The Lancet. Planetary health · March 2019 Full text Cite

Zika Virus Seropositivity in 1-4-Year-Old Children, Indonesia, 2014.

Journal Article Emerging infectious diseases · September 2018 We assessed Zika virus seroprevalence among healthy 1-4-year-old children using a serum sample collection assembled in 2014 representing 30 urban sites across Indonesia. Of 662 samples, 9.1% were Zika virus seropositive, suggesting widespread recent Zika v ... Full text Cite

Malaria elimination in Indonesia: halfway there.

Journal Article The Lancet. Global health · June 2018 Full text Cite

Two clusters of Plasmodium knowlesi cases in a malaria elimination area, Sabang Municipality, Aceh, Indonesia.

Journal Article Malaria journal · May 2018 In malaria elimination areas, malaria cases are sporadic and consist predominantly of imported cases. Plasmodium knowlesi cases have been reported throughout Southeast Asia where long-tailed and pig-tailed macaques and Anopheles leucosphyrus group mosquito ... Full text Cite

The UN Commission on Life Saving Commodities 3 years on: global progress update and results of a multicountry assessment.

Journal Article The Lancet. Global health · April 2016 BackgroundIn September, 2012, the UN Commission on Life Saving Commodities (UNCoLSC) outlined a plan to expand availability and access to 13 life saving commodities. We profile global and country progress against these recommendations between 2012 ... Full text Cite

The Effect of Community-Based Prevention and Care on Ebola Transmission in Sierra Leone.

Journal Article American journal of public health · April 2016 ObjectivesTo examine the acceptability, use, effects on early isolation, and contribution to Ebola virus disease (EVD) transmission of Community Care Centers (CCCs), which were rapidly deployed in Sierra Leone during an accelerated phase of the 20 ... Full text Cite

A seroepidemiological study of pandemic A/H1N1(2009) influenza in a rural population of Mali.

Journal Article Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · October 2012 The swine-origin H1N1 influenza A virus (pH1N1(2009)) started to circulate worldwide in 2009, and cases were notified in a number of sub-Saharan African countries. However, no epidemiological data allowing estimation of the epidemic burden were available i ... Full text Cite

The effect of an integrated multisector model for achieving the Millennium Development Goals and improving child survival in rural sub-Saharan Africa: a non-randomised controlled assessment.

Journal Article Lancet (London, England) · June 2012 BackgroundSimultaneously addressing multiple Millennium Development Goals (MDGs) has the potential to complement essential health interventions to accelerate gains in child survival. The Millennium Villages project is an integrated multisector app ... Full text Cite

Errors in a paper on the Millennium Villages project.

Journal Article Lancet (London, England) · May 2012 Full text Cite

Reply to MA Clemens and G Demombynes

Journal Article American Journal of Clinical Nutrition · March 1, 2012 Full text Cite

HIV attitudes, awareness and testing among older adults in Africa.

Journal Article AIDS and behavior · January 2012 In Africa, older adults aged 50 and older are still sexually active and play a critical role as caregivers, yet little is known about their attitudes towards HIV and awareness of services. In this study, surveys were conducted in nine African sites. A mult ... Full text Cite

Multisector intervention to accelerate reductions in child stunting: an observational study from 9 sub-Saharan African countries.

Journal Article The American journal of clinical nutrition · December 2011 BackgroundIn sub-Saharan Africa, ~ 40% of children <5 y old are stunted, with levels that have remained largely unchanged over the past 2 decades. Although the complex determinants of undernutrition are well recognized, few studies have evaluated ... Full text Cite

Does accessibility to antiretroviral care improve after down-referral of patients from hospitals to health centres in rural South Africa?

Journal Article African Journal of AIDS Research · December 1, 2011 We conducted an evaluation of healthcare accessibility among patients taking antiretroviral treatment (ART) after they were 'down-referred' from hospital-based programmes to primary healthcare (PHC) centres in a rural South African setting. A cross-section ... Full text Cite

Economic evaluation of a combined microfinance and gender training intervention for the prevention of intimate partner violence in rural South Africa.

Journal Article Health policy and planning · September 2011 ObjectiveAssess the cost-effectiveness of an intervention combining microfinance with gender and HIV training for the prevention of intimate partner violence (IPV) in South Africa.MethodsWe performed a cost-effectiveness analysis alongsid ... Full text Cite

Patterns and implications of medical pluralism among HIV/AIDS patients in rural South Africa.

Journal Article AIDS and behavior · May 2011 In some societies, medical pluralism has been demonstrated to delay access to care. We identified sources of health care, and explored utilization patterns and triggers of care-seeking behavior among HIV/AIDS patients in rural South Africa. A longitudinal ... Full text Cite

The impact of highly active antiretroviral therapy on activities of daily living in HIV-infected adults in South Africa.

Journal Article AIDS and behavior · May 2011 This study investigated the relationship between highly active antiretroviral therapy (HAART) and instrumental activities of daily living (IADLs) among two clinical cohorts in South Africa. Between 2003 and 2008 structured questionnaires were administered ... Full text Cite

A review of global progress toward the millennium development goal 1 hunger target

Journal Article Food and Nutrition Bulletin · January 1, 2011 Background: The hunger component of the first Millennium Development Goal (MDG) aims to reduce the proportion of people who suffer from hunger by half between 1990 and 2015. In low- and middle-income countries, progress has been mixed, with approximately 9 ... Full text Cite

A 3-year cohort study to assess the impact of an integrated food-and livelihood-based model on undernutrition in rural western Kenya

Chapter · November 30, 2010 Reducing extreme poverty and hunger is the first Millennium Development Goal (MDG). With undernutrition contributing to one third of all child deaths, improving nutrition is a precondition for accelerating progress towards other MDG targets. While the role ... Cite

Decreased sexual risk behavior in the era of HAART among HIV-infected urban and rural South Africans attending primary care clinics.

Journal Article AIDS (London, England) · November 2010 ObjectiveIn light of increasing access to HAART in sub-Saharan Africa, we conducted a longitudinal study to assess the impact of HAART on sexual risk behaviors among HIV-infected South Africans in urban and rural primary care clinics.Design Full text Cite

High rates of AIDS-related mortality among older adults in rural Kenya.

Journal Article Journal of acquired immune deficiency syndromes (1999) · October 2010 BackgroundHealth challenges faced by older people in developing countries are often neglected amidst a wide range of competing priorities. This is evident in the HIV field where the upper age limit for reporting HIV prevalence remains 49 years. Ho ... Full text Cite

Process evaluation of the Intervention with Microfinance for AIDS and Gender Equity (IMAGE) in rural South Africa.

Journal Article Health education research · February 2010 The Intervention with Microfinance for AIDS and Gender Equity (IMAGE) combines microfinance, gender/HIV training and community mobilization (CM) in South Africa. A trial found reduced intimate partner violence among clients but less evidence for impact on ... Full text Cite

Combining vital events registration, verbal autopsy and electronic medical records in rural Ghana for improved health services delivery

Conference Studies in Health Technology and Informatics · January 1, 2010 This paper describes the process of implementing a low-cost 'real-time' vital registration and verbal autopsy system integrated within an electronic medical record within the Millennium Village cluster in rural Ghana. Using MGV-Net, an open source health i ... Full text Cite

Assessing the incremental effects of combining economic and health interventions: the IMAGE study in South Africa.

Journal Article Bulletin of the World Health Organization · November 2009 ObjectiveTo explore whether adding a gender and HIV training programme to microfinance initiatives can lead to health and social benefits beyond those achieved by microfinance alone.MethodsCross-sectional data were derived from three rand ... Full text Cite

Characteristics of sexual partnerships, not just of individuals, are associated with condom use and recent HIV infection in rural South Africa.

Journal Article AIDS care · August 2009 Characteristics of sexual partnerships, as well as those of the individuals involved, might influence the use of condoms and risk of HIV transmission. We set out to identify characteristics of non-spousal sexual partnerships associated with condom use at l ... Full text Cite

Feasibility, acceptability and cost of home-based HIV testing in rural Kenya.

Journal Article Tropical medicine & international health : TM & IH · August 2009 ObjectiveTo demonstrate the feasibility, acceptability and cost of home-based HIV testing and to examine the applicability of the model to high HIV prevalence settings.MethodsQuantitative, qualitative and cost data were collected during a ... Full text Cite

Mortality and loss to follow-up among HAART initiators in rural South Africa.

Journal Article Transactions of the Royal Society of Tropical Medicine and Hygiene · June 2009 A retrospective cohort study of mortality rates and potential predictors of death was conducted in public-sector patients initiating highly active antiretroviral therapy (HAART) between October 2005 and September 2007 in a rural, under-resourced region of ... Full text Cite

Towards a global fund for the health MDGs?

Journal Article Lancet (London, England) · June 2009 Full text Cite

Isoniazid preventive therapy, HAART and tuberculosis risk in HIV-infected adults in South Africa: a prospective cohort.

Journal Article AIDS (London, England) · March 2009 BackgroundThe World Health Organization recommends isoniazid preventive therapy (IPT) for preventing tuberculosis in HIV-infected adults, although few countries have instituted this policy. Both IPT and highly active antiretroviral therapy (HAART) ... Full text Cite

Socioeconomic disparities in access to HIV/AIDS treatment programs in resource-limited settings.

Journal Article AIDS care · January 2009 This study employs data from rural South Africa to determine whether there were socioeconomic differences in the profile of HIV-infected persons living in the community and HIV-infected patients presenting for hospital-based outpatient HIV/AIDS care and re ... Full text Cite

"They have opened our mouths": increasing women's skills and motivation for sexual communication with young people in rural South Africa.

Journal Article AIDS education and prevention : official publication of the International Society for AIDS Education · December 2008 Communication between parents and young people about sex has been identified as a positive influence on young people's sexual behavior. This article presents findings from South Africa, where a social intervention to reduce levels of HIV and intimate partn ... Full text Cite

Exploring the role of economic empowerment in HIV prevention.

Journal Article AIDS (London, England) · December 2008 It has been argued that women's economic vulnerability and dependence on men increases their vulnerability to HIV by constraining their ability to negotiate the conditions, including sexual abstinence, condom use and multiple partnerships, which shape thei ... Full text Cite

Can social capital be intentionally generated? a randomized trial from rural South Africa.

Journal Article Social science & medicine (1982) · November 2008 While much descriptive research has documented positive associations between social capital and a range of economic, social and health outcomes, there have been few intervention studies to assess whether social capital can be intentionally generated. We co ... Full text Cite

A combined microfinance and training intervention can reduce HIV risk behaviour in young female participants.

Journal Article AIDS (London, England) · August 2008 ObjectiveTo assess effects of a combined microfinance and training intervention on HIV risk behavior among young female participants in rural South Africa.Design: Secondary analysis of quantitative and qualitative data from a cluster rand ... Full text Cite

Is social capital associated with HIV risk in rural South Africa?

Journal Article Social science & medicine (1982) · May 2008 The role of social capital in promoting health is now widely debated within international public health. In relation to HIV, the results of previous observational and cross-sectional studies have been mixed. In some settings it has been suggested that high ... Full text Cite

Sexual behavior and reproductive health among HIV-infected patients in urban and rural South Africa.

Journal Article Journal of acquired immune deficiency syndromes (1999) · April 2008 BackgroundWith the rollout of antiretroviral therapy in South Africa and its potential to prolong the lives of HIV-infected individuals, understanding the sexual behavior of HIV-positive people is essential to curbing secondary HIV transmission. Full text Cite

Accounting for institutional change in health economic evaluation: a program to tackle HIV/AIDS and gender violence in Southern Africa.

Journal Article Social science & medicine (1982) · February 2008 There has been growing interest in the application of institutionalist perspectives in the health economics literature. This paper investigates the institutionalist notion of social value and its use in economic evaluation with particular reference to a pr ... Full text Cite

The association between school attendance, HIV infection and sexual behaviour among young people in rural South Africa.

Journal Article Journal of epidemiology and community health · February 2008 ObjectivesTo investigate whether the prevalence of HIV infection among young people, and sexual behaviours associated with increased HIV risk, are differentially distributed between students and those not attending school or college.Design Full text Cite

Systematic review exploring time trends in the association between educational attainment and risk of HIV infection in sub-Saharan Africa.

Journal Article AIDS (London, England) · January 2008 ObjectiveTo assess the evidence that the association between educational attainment and risk of HIV infection is changing over time in sub-Saharan Africa.Design and methodsSystematic review of published peer-reviewed articles. Articles we ... Full text Cite

Explaining continued high HIV prevalence in South Africa: socioeconomic factors, HIV incidence and sexual behaviour change among a rural cohort, 2001-2004.

Conference AIDS (London, England) · November 2007 ObjectivesTo estimate HIV incidence and explore evidence for changing sexual behaviour over time among men and women belonging to different socioeconomic groups in rural South Africa.Design and methodsA cohort study conducted between 2001 ... Full text Cite

Understanding the impact of a microfinance-based intervention on women's empowerment and the reduction of intimate partner violence in South Africa.

Journal Article American journal of public health · October 2007 ObjectivesWe sought to obtain evidence about the scope of women's empowerment and the mechanisms underlying the significant reduction in intimate partner violence documented by the Intervention With Microfinance for AIDS and Gender Equity (IMAGE) ... Full text Cite

Using health and demographic surveillance to understand the burden of disease in populations: the case of tuberculosis in rural South Africa.

Journal Article Scandinavian journal of public health. Supplement · August 2007 AimsTo utilize the Agincourt health and demographic surveillance system (HDSS) platform to assess the burden of pulmonary tuberculosis (PTB) in a rural South African sub-district.MethodsDuring 1999, data from three sources were combined t ... Full text Cite

"Hearing the Voices of the Poor": Assigning Poverty Lines on the Basis of Local Perceptions of Poverty. A Quantitative Analysis of Qualitative Data from Participatory Wealth Ranking in Rural South Africa

Journal Article World Development · February 1, 2007 We applied a mixed-methods approach to participatory wealth ranking (PWR) to identify the number of poor households in eight villages of rural South Africa and describe how poor they are. We generated a household wealth index on the basis of the ranking pr ... Full text Cite

Assessing household wealth in health studies in developing countries: A comparison of participatory wealth ranking and survey techniques from rural South Africa

Journal Article Emerging Themes in Epidemiology · January 1, 2007 Background. Accurate tools for assessing household wealth are essential for many health studies in developing countries. Household survey and participatory wealth ranking (PWR) are two approaches to generate data for this purpose. Methods. A household surv ... Full text Cite

Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: a cluster randomised trial.

Journal Article Lancet (London, England) · December 2006 BackgroundHIV infection and intimate-partner violence share a common risk environment in much of southern Africa. The aim of the Intervention with Microfinance for AIDS and Gender Equity (IMAGE) study was to assess a structural intervention that c ... Full text Cite

Should structural interventions be evaluated using RCTs? The case of HIV prevention.

Journal Article Social science & medicine (1982) · September 2006 Structural interventions addressing macro-social determinants of risk have been suggested as potentially important adjuncts to biomedical and behavioural interventions for the prevention of HIV and other diseases. A few interventions of this type have been ... Full text Cite

HIV and hepatitis B coinfection in Southern Africa: A review for general practitioners

Journal Article Southern African Journal of HIV Medicine · January 1, 2006 Sub-Saharan Africa is facing serious HIV and hepatitis B epidemics, with coinfection becoming a major public health problem. In addition, the prevention and treatment of concurrent illnesses such as hepatitis B in HIV-infected people is becoming increasing ... Cite

Adherence to TB preventive therapy for HIV-positive patients in rural South Africa: implications for antiretroviral delivery in resource-poor settings?

Journal Article The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · March 2005 ObjectivesTo explore patient and health worker perspectives on adherence to tuberculosis preventive therapy (TBPT), and to derive lessons for improving access to care amongst human immunodeficiency virus (HIV) infected individuals in resource-poor ... Cite

Microfinance and HIV prevention - Emerging lessons from rural South Africa

Journal Article Small Enterprise Development · January 1, 2005 Do the gains in confidence and economic well being that can come from participation in a microfinance programme reduce clients' vulnerability to HIV infection? Until now practical experience and an evidence base relating to such activities have been limite ... Full text Cite

Undiagnosed pulmonary tuberculosis deaths in rural South Africa.

Journal Article The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · June 2004 This research explores death from pulmonary tuberculosis (PTB) using a verbal autopsy (VA) tool within the established Agincourt Health and Demographic Surveillance System site in South Africa's rural northeast. Previous work on active case finding in the ... Cite

Introduction of voluntary counselling and rapid testing for HIV in rural South Africa: from theory to practice.

Journal Article AIDS care · December 2002 Expanding access to voluntary counselling and testing (VCT) for HIV is an important first step in the development of a comprehensive package of HIV services. This article describes the introduction of VCT among five primary health care (PHC) facilities in ... Full text Cite

Health seeking behaviour among tuberculosis patients in rural South Africa.

Journal Article The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · April 2002 Cite

Whose priorities? A response to the issue of antiretrovirals in Africa.

Journal Article Tropical medicine & international health : TM & IH · August 2001 Full text Cite

Assessing health seeking behaviour among tuberculosis patients in rural South Africa.

Journal Article The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · July 2001 SettingSouth Africa's rural Northern Province.ObjectivesTo examine patterns of health seeking behaviour among hospitalised tuberculosis patients.DesignInformation on personal characteristics, health seeking behaviour and delays t ... Cite

Infectious disease policy: towards the production of health.

Journal Article Health policy and planning · December 1999 This paper reflects on current infectious disease control methods, their biomedical history and the management structures they are driven by. It asks whether a broader concept of 'infectious disease policy', with an emphasis on 'process' rather than outcom ... Full text Cite