Community-based interventions to improve and sustain antiretroviral therapy adherence, retention in HIV care and clinical outcomes in low- and middle-income countries for achieving the UNAIDS 90-90-90 targets

Little is known about the effect of community versus health facility-based interventions to improve and sustain antiretroviral therapy (ART) adherence, virologic suppression, and retention in care among HIV-infected individuals in low- and middle-income countries (LMICs). We systematically searched four electronic databases for all available randomized controlled trials (RCTs) and comparative cohort studies in LMICs comparing community versus health facility-based interventions. Relative risks (RRs) for pre-defined adherence, treatment engagement (linkage and retention in care), and relevant clinical outcomes were pooled using random effect models. Eleven cohort studies and eleven RCTs (N = 97,657) were included. Meta-analysis of the included RCTs comparing community- versus health facility-based interventions found comparable outcomes in terms of ART adherence (RR = 1.02, 95 % CI 0.99 to 1.04), virologic suppression (RR = 1.00, 95 % CI 0.98 to 1.03), and all-cause mortality (RR = 0.93, 95 % CI 0.73 to 1.18). The result of pooled analysis from the RCTs (RR = 1.03, 95 % CI 1.01 to 1.06) and cohort studies (RR  = 1.09, 95 % CI 1.03 to 1.15) found that participants assigned to community-based interventions had statistically significantly higher rates of treatment engagement. Two studies found community-based ART delivery model either cost-saving or cost-effective. Community- versus facility-based models of ART delivery resulted in at least comparable outcomes for clinically stable HIV-infected patients on treatment in LMICs and are likely to be cost-effective

Improving Antiretroviral Therapy Adherence in Resource-Limited Settings at Scale: a Discussion of Interventions and Recommendations

INTRODUCTION: Successful population-level antiretroviral therapy (ART) adherence will be necessary to realize both the clinical and prevention benefits of antiretroviral scale-up and, ultimately, the end of AIDS. Although many people living with HIV are adhering well, others struggle and most are likely to experience challenges in adherence that may threaten virologic suppression at some point during lifelong therapy. Despite the importance of ART adherence, supportive interventions have generally not been implemented at scale. The objective of this review is to summarize the recommendations of clinical, research, and public health experts for scalable ART adherence interventions in resource-limited settings. METHODS: In July 2015, the Bill and Melinda Gates Foundation convened a meeting to discuss the most promising ART adherence interventions for use at scale in resource-limited settings. This article summarizes that discussion with recent updates. It is not a systematic review, but rather provides practical considerations for programme implementation based on evidence from individual studies, systematic reviews, meta-analyses, and the World Health Organization Consolidated Guidelines for HIV, which include evidence from randomized controlled trials in low- and middle-income countries. Interventions are categorized broadly as education and counselling; information and communication technology-enhanced solutions; healthcare delivery restructuring; and economic incentives and social protection interventions. Each category is discussed, including descriptions of interventions, current evidence for effectiveness, and what appears promising for the near future. Approaches to intervention implementation and impact assessment are then described. RESULTS AND DISCUSSION: The evidence base is promising for currently available, effective, and scalable ART adherence interventions for resource-limited settings. Numerous interventions build on existing health care infrastructure and leverage available resources. Those most widely studied and implemented to date involve peer counselling, adherence clubs, and short message service (SMS). Many additional interventions could have an important impact on ART adherence with further development, including standardized counselling through multi-media technology, electronic dose monitoring, decentralized and differentiated models of care, and livelihood interventions. Optimal targeting and tailoring of interventions will require improved adherence measurement. CONCLUSION: The opportunity exists today to address and resolve many of the challenges to effective ART adherence, so that they do not limit the potential of ART to help bring about the end of AIDS

Fiscal Dominance and Inflation in the Democratic Republic of the Congo

This paper examines the fiscal dominance hypothesis in the Democratic Republic of the Congo (DRC) during 1981-2003, using multivariate cointegration analysis and vector errorcorrection modeling. Empirical results point to strong and statistically significant long-run relationships between budget deficits and seigniorage, and between money creation and inflation. The long-run inflationary impact of budget deficits is robust to the inclusion of output growth or velocity in the inflation and monetary growth equations. The paper offers some policy recommendations for long-term price stability in the DRC.

A Cointegration Analysis of Broad Money Demand in Cameroon

This paper applies cointegration analysis and error-correction modeling to investigate the behavior of broad money demand in Cameroon over 1963/64-1993/94. The cointegrated VAR analysis first describes an open-economy model of money, prices, income, and a vector of rates of return, within which three steady state relations are identified: a stable money demand function, an excess aggregate demand relationship, and the uncovered interest rate relation under fixed exchange rates and perfect capital mobility. Empirical support is thereafter provided for both PPP and the international Fisher parity between Cameroon and France, and the stability of the short-run dynamics of the broad money demand function is confirmed.Economic models;Data analysis;Exchange rates;inflation, money demand, monetary policy, demand for money, money balances, money market, monetary fund, rate of inflation, real money, inflation rate, monetary economics, aggregate demand, central bank, rates of inflation, money supply, quantity theory of money, quantity theory, price level, discount rate, monetary aggregates, foreign currency, monetary union, monetary regime, inflationary expectations, real money supply, monetary growth, monetary policy instruments, theory of money, real interest rates, real interest rate, monetary policy objectives, high inflation, rediscount rate, monetary transmission mechanisms, adaptive expectations ? hypothesis, monetary policy reaction function, general level of prices, inflationary impact, coefficient on inflation, adaptive expectations, price stability, open market operations, reserve requirements, monetary unions, monetary transmission, monetary standard, fisher relation

Financial Liberalization, Money Demand, and Inflation in Uganda

This paper uses cointegration analysis to investigate the empirical relationship among money, prices, income, and a vector of interest rates in Uganda from 1982 to 1998. Despite the substantial financial market liberalization that has taken place in the early 1990s, quarterly time-series data confirm that a stable relationship prevailed among real broad money, income, and domestic and foreign interest rates. The empirical results indicate income homogeneity, a strong own-rate-of-return effect, a high degree of international capital mobility and asset substitutability, and demonstrate that both domestic and foreign factors are important determinants of inflation in Uganda.

Budgetary Convergence in the WEAMU

A regional convergence pact adopted recently by the Conference of Heads of States of WAEMU provides a framework for fiscal convergence similar to the European Union’s Maastricht Treaty. Using bivariate co-integration and error-correction models, this paper investigates the relationship between revenue and expenditure in seven member countries to determine the feasibility and nature of the policy adjustment required to meet the new convergence criteria. The results indicate that, in the long run, there is causality running from revenue to expenditure in Burkina Faso and Senegal, from expenditure to revenue in Benin and Togo, a bidirectional causality in Côte d’Ivoire and Mali, and no causality in Niger.Fiscal management;West African Economic and Monetary Union;Government expenditures;expenditure, fiscal policy, expenditures, public debt, budget deficit, government revenue, government spending, fiscal adjustment, fiscal variables, government expenditure, fiscal imbalances, fiscal balance, tax revenue, fiscal data, fiscal discipline, public expenditure, fiscal performance, budget deficits, public finance, fiscal positions, public finances, fiscal deficit, budget constraint, taxation, fiscal policies, budgetary adjustment, budget imbalances, spending cuts, public spending, fiscal indicators, budgetary process, fiscal revenue, fiscal imbalance, expenditure increases, fiscal responsibility, government deficit, fiscal position, debt service, fiscal decisions, fiscal outcomes, fiscal difficulties, fiscal surplus, tax increases, fiscal authorities, budgetary rules, higher expenditure, fiscal equilibrium, fiscal illusion, expenditure objectives, debt obligations, fiscal convergence, primary fiscal balance, total expenditure, expenditure decisions, fiscal consolidation, expansionary fiscal, fiscal criterion, primary fiscal deficit, budget balance, public external debt, fiscal institutions, budgetary discipline, federal government expenditures, foreign debt, current level of debt, budget expenditures, expansionary fiscal policies, expenditure data, government budget, tax increase, fiscal instrument, cuts in government spending

Economic Growth and total Factor Productivity in Niger

This paper investigates empirically the sources of aggregate output growth and the determinants of total factor productivity (TFP) in Niger between 1963 and 2003. A growth accounting analysis indicates that the erosion in output per capita over the sample period is due to the negative growth of both TFP and physical capital per capita. Sound macroeconomic policies, supported by official development assistance and structural reforms, are found to be key to raising TFP growth.Economic growth;growth rate, cointegration, equation, real gdp, growth accounting, statistics, total factor productivity, growth rates, gdp per capita, heteroscedasticity, rate of change, gdp growth, autocorrelation, per capita income, time series, dummy variable, per capita income growth, logarithms, capital formation, statistic, number of parameters, regression analysis, functional form, growth rate of output, pro-poor growth, real per capita income, growth model, linear regression, financial statistics, source of business cycles, estimation period, survey, maximum likelihood estimation, correlation, constant term, econometrics, predictions, time series analysis, parsimonious model, statistical analysis, kurtosis, neoclassical growth model, skewness, logarithm, vector autoregression, standard deviation

Assessing Competitiveness After Conflict

This paper assesses competitiveness in the case of the Central African Republic, a postconflict country. The paper presents several conventional techniques for assessing competitiveness, namely the real exchange rate and recent trade performance. Several other measures are considered, in particular transport costs and governance measures, which may be more effective in capturing the obstacles to competitiveness posed by the poor security environment and weak institutions common to many post-conflict situations. The real exchange measure and trade measures suggest some mild erosion of competitiveness in recent years, while the other measures indicate that the competitiveness challenges faced by the Central African Republic are much deeper.Trade;Transport;Governance;transport costs, exchange rate, exchange rates, transport cost, real exchange rates, real exchange rate, terms of trade, trade performance, external trade, trade deficit, home currency, export performance, balance of payments, real effective exchange rate, exchange rate policy, investor protection, international trade, foreign exchange, exchange rate movements, nominal exchange rate, effective exchange rate, effective exchange rates, movements in exchange rates, factor markets, open economy, fixed exchange rate, trade barriers, equilibrium exchange rate, trade data, market exchange rate, export earnings, domestic prices, trade reforms, world prices, exchange rate behavior, exchange rate misalignment, trade liberalization, domestic production, imported goods, exchange rate changes, commercial policy, tariff rates, external tariff, per capita income, competitive market, competitive position, quantitative restrictions, monetary union, export diversification, nontariff barriers, external shocks, trade costs, common market, trade protection, external protection