How Much Does It Cost to Provide Antiretroviral Therapy for HIV/AIDS in Africa?

Background: Many African countries are rapidly expanding HIV/AIDS treatment programs. Empirical information on the cost of delivering antiretroviral therapy (ART) for HIV/AIDS is needed for program planning and budgeting. Methods: We searched published and gray sources for estimates of the cost of providing ART in service delivery (non-research) settings in sub-Saharan Africa. Estimates were included if they were based on primary local data for input prices. Results: 17 eligible cost estimates were found. Of these, 10 were from South Africa. The cost per patient per year ranged from $396 to $2,761. It averaged approximately $850/patient/year in countries outside South Africa and $1,700/patient/year in South Africa. The most recent estimates for South Africa averaged $1,200/patient/year. Specific cost items included in the average cost per patient per year varied, making comparison across studies problematic. All estimates included the cost of antiretroviral drugs and laboratory tests, but many excluded the cost of inpatient care, treatment of opportunistic infections, and/or clinic infrastructure. Antiretroviral drugs comprised an average of one third of the cost of treatment in South Africa and one half to three quarters of the cost in other countries. Conclusions: There is very little empirical information available about the cost of providing antiretroviral therapy in non-research settings in Africa. Methods for estimating costs are inconsistent, and many estimates combine data drawn from disparate sources. Cost analysis should become a routine part of operational research on the treatment rollout in Africa.

Structure Sharing and Parallelization in a GB Parser

By utilizing structure sharing among its parse trees, a GB parser can increase its efficiency dramatically. Using a GB parser which has as its phrase structure recovery component an implementation of Tomita's algorithm (as described in [Tom86]), we investigate how a GB parser can preserve the structure sharing output by Tomita's algorithm. In this report, we discuss the implications of using Tomita's algorithm in GB parsing, and we give some details of the structuresharing parser currently under construction. We also discuss a method of parallelizing a GB parser, and relate it to the existing literature on parallel GB parsing. Our approach to preserving sharing within a shared-packed forest is applicable not only to GB parsing, but anytime we want to preserve structure sharing in a parse forest in the presence of features.

Unicast Routing: Cost-Performance Tradeoffs

The objective of unicast routing is to find a path from a source to a destination. Conventional routing has been used mainly to provide connectivity. It lacks the ability to provide any kind of service guarantees and smart usage of network resources. Improving performance is possible by being aware of both traffic characteristics and current available resources. This paper surveys a range of routing solutions, which can be categorized depending on the degree of the awareness of the algorithm: (1) QoS/Constraint-based routing solutions are aware of traffic requirements of individual connection requests; (2) Traffic-aware routing solutions assume knowledge of the location of communicating ingress-egress pairs and possibly the traffic demands among them; (3) Routing solutions that are both QoS-aware as (1) and traffic-aware as (2); (4) Best-effort solutions are oblivious to both traffic and QoS requirements, but are adaptive only to current resource availability. The best performance can be achieved by having all possible knowledge so that while finding a path for an individual flow, one can make a smart choice among feasible paths to increase the chances of supporting future requests. However, this usually comes at the cost of increased complexity and decreased scalability. In this paper, we discuss such cost-performance tradeoffs by surveying proposed heuristic solutions and hybrid approaches.

Improving the Performance of Overlay Routing and P2P File Sharing using Selfish Neighbor Selection

A foundational issue underlying many overlay network applications ranging from routing to P2P file sharing is that of connectivity management, i.e., folding new arrivals into the existing mesh and re-wiring to cope with changing network conditions. Previous work has considered the problem from two perspectives: devising practical heuristics for specific applications designed to work well in real deployments, and providing abstractions for the underlying problem that are tractable to address via theoretical analyses, especially game-theoretic analysis. Our work unifies these two thrusts first by distilling insights gleaned from clean theoretical models, notably that under natural resource constraints, selfish players can select neighbors so as to efficiently reach near-equilibria that also provide high global performance. Using Egoist, a prototype overlay routing system we implemented on PlanetLab, we demonstrate that our neighbor selection primitives significantly outperform existing heuristics on a variety of performance metrics; that Egoist is competitive with an optimal, but unscalable full-mesh approach; and that it remains highly effective under significant churn. We also describe variants of Egoist's current design that would enable it to scale to overlays of much larger scale and allow it to cater effectively to applications, such as P2P file sharing in unstructured overlays, based on the use of primitives such as scoped-flooding rather than routing.

On the Cost of Supporting Multihoming and Mobility

As the Internet has evolved and grown, an increasing number of nodes (hosts or autonomous systems) have become multihomed, i.e., a node is connected to more than one network. Mobility can be viewed as a special case of multihoming—as a node moves, it unsubscribes from one network and subscribes to another, which is akin to one interface becoming inactive and another active. The current Internet architecture has been facing significant challenges in effectively dealing with multihoming (and consequently mobility). The Recursive INternet Architecture (RINA) [1] was recently proposed as a clean-slate solution to the current problems of the Internet. In this paper, we perform an average-case cost analysis to compare the multihoming / mobility support of RINA, against that of other approaches such as LISP and MobileIP. We also validate our analysis using trace-driven simulation.

Differentiated Predictive Fair Service for TCP Flows

The majority of the traffic (bytes) flowing over the Internet today have been attributed to the Transmission Control Protocol (TCP). This strong presence of TCP has recently spurred further investigations into its congestion avoidance mechanism and its effect on the performance of short and long data transfers. At the same time, the rising interest in enhancing Internet services while keeping the implementation cost low has led to several service-differentiation proposals. In such service-differentiation architectures, much of the complexity is placed only in access routers, which classify and mark packets from different flows. Core routers can then allocate enough resources to each class of packets so as to satisfy delivery requirements, such as predictable (consistent) and fair service. In this paper, we investigate the interaction among short and long TCP flows, and how TCP service can be improved by employing a low-cost service-differentiation scheme. Through control-theoretic arguments and extensive simulations, we show the utility of isolating TCP flows into two classes based on their lifetime/size, namely one class of short flows and another of long flows. With such class-based isolation, short and long TCP flows have separate service queues at routers. This protects each class of flows from the other as they possess different characteristics, such as burstiness of arrivals/departures and congestion/sending window dynamics. We show the benefits of isolation, in terms of better predictability and fairness, over traditional shared queueing systems with both tail-drop and Random-Early-Drop (RED) packet dropping policies. The proposed class-based isolation of TCP flows has several advantages: (1) the implementation cost is low since it only requires core routers to maintain per-class (rather than per-flow) state; (2) it promises to be an effective traffic engineering tool for improved predictability and fairness for both short and long TCP flows; and (3) stringent delay requirements of short interactive transfers can be met by increasing the amount of resources allocated to the class of short flows.