Retention on antiretroviral therapy in low- and middle-income countries: systematic review of papers and abstracts since 2008

This repository item contains a single issue of the Health and Development Discussion Papers, an informal working paper series that began publishing in 2002 by the Boston University Center for Global Health and Development. It is intended to help the Center and individual authors to disseminate work that is being prepared for journal publication or that is not appropriate for journal publication but might still have value to readers

Defining retention and attrition in pre-antiretroviral HIV care: proposals based on experience in Africa

This repository item contains a single issue of the Health and Development Discussion Papers, an informal working paper series that began publishing in 2002 by the Boston University Center for Global Health and Development. It is intended to help the Center and individual authors to disseminate work that is being prepared for journal publication or that is not appropriate for journal publication but might still have value to readers.Fewer than 33% of those testing HIV-positive in sub-Saharan Africa are continuously retained in pre-antiretroviral therapy (ART) HIV care until ART initiation. Existing evidence is difficult to synthesize, however, due to unclear and inconsistent definitions of terms. We developed practical, standardized definitions for reporting retention for the three stages of pre-ART care: Stage 1, testing HIV-positive to initial ART eligibility assessment; Stage 2, initial assessment to ART eligibility; and Stage 3, ART eligibility to ART initiation. For each stage, negative outcomes include death, loss, or not being retained. Stage 1 retention is defined as the proportion of patients who complete initial ART eligibility assessment within 3 months of HIV testing, with reporting of cohort outcomes at 3 and 12 months after HIV testing. Patients who end Stage 1 eligible for ART move directly to Stage 3. Stage 2 retention is defined as the proportion of patients who either complete all possible ART eligibility re-assessments within 6 months of the site’s standard visit schedule or had an assessment within 1 year of the time reported to and were not ART eligible at the last assessment. Retention should be reported at 12-month intervals. Stage 3 retention is defined as the proportion of patients eligible for ART who initiate ART (i.e.ARVs dispensed) within 3 months of determining ART eligibility, with reporting at 3 months after eligibility and 3 monthly intervals thereafter. If pre-ART retention is to improve, consistent terminology is needed for collecting data, measuring and reporting outcomes, and comparing results across programs and countries. The definitions we propose offer a strategy for improving the consistency and comparability of future reports

The Impact of AIDS on Government Service Delivery: The Case of the Zambia Wildlife Authority

Background: The loss of working-aged adults to HIV/AIDS has been shown to increase the costs of labor to the private sector in Africa. There is little corresponding evidence for the public sector. This study evaluated the impact of AIDS on the capacity of a government agency, the Zambia Wildlife Authority (ZAWA), to patrol Zambia’s national parks. Methods: Data were collected from ZAWA on workforce characteristics, recent mortality, costs, and the number of days spent on patrol between 2003 and 2005 by a sample of 76 current patrol officers (reference subjects) and 11 patrol officers who died of AIDS or suspected AIDS (index subjects). An estimate was made of the impact of AIDS on service delivery capacity and labor costs and the potential net benefits of providing treatment. Results: Reference subjects spent an average of 197.4 days on patrol per year. After adjusting for age, years of service, and worksite, index subjects spent 62.8 days on patrol in their last year of service (68% decrease, p<0.0001), 96.8 days on patrol in their second to last year of service (51% decrease, p<0.0001), and 123.7 days on patrol in their third to last year of service (37% decrease, p<0.0001). For each employee who died, ZAWA lost an additional 111 person-days for management, funeral attendance, vacancy, and recruitment and training of a replacement, resulting in a total productivity loss per death of 2.0 person-years. Each AIDS-related death also imposed budgetary costs for care, benefits, recruitment, and training equivalent to 3.3 years’ annual compensation. In 2005, AIDS reduced service delivery capacity by 6.2% and increased labor costs by 9.7%. If antiretroviral therapy could be provided for $500/patient/year, net savings to ZAWA would approach$285,000/year. Conclusion: AIDS is constraining ZAWA’s ability to protect Zambia’s wildlife and parks. Impacts on this government agency are substantially larger than have been observed in the private sector. Provision of ART would result in net budgetary savings to ZAWA and greatly increase its service delivery capacity

The impact of AIDS on government service delivery: the case of the Zambia Wildlife Authority

This repository item contains a single issue of the Health and Development Discussion Papers, an informal working paper series that began publishing in 2002 by the Boston University Center for Global Health and Development. It is intended to help the Center and individual authors to disseminate work that is being prepared for journal publication or that is not appropriate for journal publication but might still have value to readers.BACKGROUND: The loss of working-aged adults to HIV/AIDS has been shown to increase the costs of labor to the private sector in Africa. There is little corresponding evidence for the public sector. This study evaluated the impact of AIDS on the capacity of a government agency, the Zambia Wildlife Authority (ZAWA), to patrol Zambia’s national parks. METHODS: Data were collected from ZAWA on workforce characteristics, recent mortality, costs, and the number of days spent on patrol between 2003 and 2005 by a sample of 76 current patrol officers (reference subjects) and 11 patrol officers who died of AIDS or suspected AIDS (index subjects). An estimate was made of the impact of AIDS on service delivery capacity and labor costs and the potential net benefits of providing treatment. RESULTS: Reference subjects spent an average of 197.4 days on patrol per year. After adjusting for age, years of service, and worksite, index subjects spent 62.8 days on patrol in their last year of service (68% decrease, p<0.0001), 96.8 days on patrol in their second to last year of service (51% decrease, p<0.0001), and 123.7 days on patrol in their third to last year of service (37% decrease, p<0.0001). For each employee who died, ZAWA lost an additional 111 person-days for management, funeral attendance, vacancy, and recruitment and training of a replacement, resulting in a total productivity loss per death of 2.0 person-years. Each AIDS-related death also imposed budgetary costs for care, benefits, recruitment, and training equivalent to 3.3 years’ annual compensation. In 2005, AIDS reduced service delivery capacity by 6.2% and increased labor costs by 9.7%. If antiretroviral therapy could be provided for $500/patient/year, net savings to ZAWA would approach$285,000/year. CONCLUSION: AIDS is constraining ZAWA’s ability to protect Zambia’s wildlife and parks. Impacts on this government agency are substantially larger than have been observed in the private sector. Provision of ART would result in net budgetary savings to ZAWA and greatly increase its service delivery capacity

Advances in Supramolecular and Macromolecular Chemistry Through the Development of New Synthetic Methodologies

Development of complex supramolecular and macromolecular systems is driven by the development of new enabling synthetic methodologies. The demands placed upon specific chemical transformations are amplified for dendritic systems prepared via iterative synthesis. Three synthetic methods, Ni-catalyzed neopentylglycolborylation, Single-Electron Transfer Living Radical Polymerization, and “Thio-Bromo Click” Chemistry are elaborated and utilized in the synthesis of new covalent and supramolecular dendrimers and dendritic macromolecules. Sequential nickel catalyzed neopentylglycolborylation and cross-coupling of aryl halides is pioneered and harnessed as a tool for the synthesis of a new class of self-assembling dendron, biphenylpropyl ether dendrons. Through the synthesis of generational libraries of biphenylpropyl ether dendrons, new modes of self-assembly are discovered, including the first example of self-organizable vesicular spheres, which represent the largest reported spherical supramolecular dendrimers with MW of 1.7 x 106 g/mol. More importantly, comparison of all libraries of self-assembling dendrons with that of the biphenylpropyl ether dendrons, reveal predictability in their self-assembly and allow for the construction of a ‘nano-periodic’ table of dendrons. This predictability, while useful for rational design of new self-assembled systems, limits the likelihood of discovering new modes of self-assembly via library synthesis using existing design strategies. A new design strategy, the “Deconstruction Approach”, where a dendritic topology is systematically stripped of its branches, is developed and applied to biphenylpropyl ether dendrons. This first library of “Deconstructed” biphenylpropyl ether dendrons demonstrates the power of the strategy to uncover a multitude of new architectures hidden in previously unexplored dendron topologies. In addition to self-assembling dendrons, dendritic macromolecules possess their own unique synthetic challenges derived from the merging of organic iterative synthesis and polymerization. The mechanism of a new robust polymerization technique, Single-Electron Transfer Living Radical Polymerization (SET-LRP) is elaborated. “Thio-Bromo Click” chemistry is developed as a new tool for the construction of poly(thio-propionoate (PTP) dendrimers. Through the combination of SET-LRP “Thio-Bromo Click” chemistry, an expeditious three-step “Branch and Grow” strategy for the synthesis of dendritic macromolecules is possible

Interaction of lexical strata in hybrid compound words through gradient phonotactics

We analyse hybrid compound words in Japanese, where a hybrid compound is one formed from stems that belong to more than one lexical stratum. In native-foreign compounds, where one stem belongs to one of the three native strata: Yamato, Sino Japanese and mimetic, as identified by Itô and Mester (1995), and the other to the foreign stratum, we observe that violations of phonological wellformedness constraints in the foreign stem are significantly less probable than in pure foreign words. These observations are explainable through gradient phonotactic probability, where the probability of a phoneme is determined by the whole sequence of phonemes that precedes it. We shall argue that this observed phonotactic behaviour of hybrid compounds is best explained by the hypothesis that both lexical strata distinctions and phonotactics are graded rather than categorical

Learning a gradient grammar of French liaison

In certain French words, an orthgraphically-final consonant is unpronounced except, in certain environments, when it precedes a vowel. This phenomenon, liaison, shows significant interactions with several other patterns in French (including h-aspiré, schwa deletion, and the presence of other morphemes in the liaison context). We present a learning algorithm that acquires a grammar that accounts for these patterns and their interactions. The learned grammar employs Gradient Symbolic Computation (GSC), incorporating weighted constraints and partially-activated symbolic representations. Grammatical analysis in the GSC framework includes the challenging determination of the numerical strength of symbolic constituent activations (as well as constraints). Here we present the first general algorithm for learning these quantities from empirical examples: the Error-Driven Gradient Activation Readjustment (EDGAR). Smolensky and Goldrick (2016) proposed a GSC analysis, with hand-determined numerical strengths, in which liaison derives from the coalescence of partially-activated input consonants. EDGAR allows us to extend this work to a wider range of liaison phenomena by automatically determining the more comprehensive set of numerical strengths required to generate the complex pattern of overall liaison behaviour