Non-clinical outcomes of antiretroviral therapy for HIV/AIDS in developing countries: a systematic literature review

The impacts of antiretroviral therapy on quality of life, mental health, labor productivity, and economic wellbeing for people living with HIV/AIDS in developing countries are only beginning to be measured. We conducted a systematic literature review to analyze the effect of antiretroviral therapy (ART) on these non-clinical indicators in developing countries and assess the state of research on these topics. Both qualitative and quantitative studies were included, as were peer-reviewed articles, gray literature, and conference abstracts and presentations. Findings are reported from 12 full-length articles, 7 abstracts, and 1 presentation (representing 16 studies). Compared to HIV-positive patients not yet on treatment, patients on ART reported significant improvements in physical, emotional and mental health and daily function. Work performance improved and absenteeism decreased, with the most dramatic changes occurring in the first three months of treatment and then leveling off. Little research has been done on the impact of ART on household wellbeing, with modest changes in child and family wellbeing within households where adults are receiving ART reported so far. Studies from developing countries have not yet assessed non-clinical outcomes of therapy beyond the first year; therefore, longitudinal outcomes are still unknown. As ART roll out extends throughout high HIV prevalence, low-resource countries and is sustained over years and decades, both positive and adverse non-clinical outcomes need to be empirically measured and qualitatively explored in order to support patient adherence and maximize treatment benefits.

Principles of Safe Policy Routing Dynamics

We introduce the Dynamic Policy Routing (DPR) model that captures the propagation of route updates under arbitrary changes in topology or path preferences. DPR introduces the notion of causation chains where the route flap at one node causes a flap at the next node along the chain. Using DPR, we model the Gao-Rexford (economic) guidelines that guarantee the safety (i.e., convergence) of policy routing. We establish three principles of safe policy routing dynamics. The non-interference principle provides insight into which ASes can directly induce route changes in one another. The single cycle principle and the multi-tiered cycle principle provide insight into how cycles of routing updates can manifest in any network. We develop INTERFERENCEBEAT, a distributed algorithm that propagates a small token along causation chains to check adherence to these principles. To enhance the diagnosis power of INTERFERENCEBEAT, we model four violations of the Gao-Rexford guidelines (e.g., transiting between peers) and characterize the resulting dynamics.