Rationing Antiretroviral Therapy for HIV/AIDS in Africa: Efficiency, Equity, and Reality

Background: Rationing of access to antiretroviral therapy already exists in sub-Saharan Africa and will intensify as national treatment programs develop. The number of people who are medically eligible for therapy will far exceed the human, infrastructural, and financial resources available, making rationing of public treatment services inevitable. Methods: We identified 15 criteria by which antiretroviral therapy could be rationed in African countries and analyzed the resulting rationing systems across 5 domains: clinical effectiveness, implementation feasibility, cost, economic efficiency, and social equity. Findings: Rationing can be explicit or implicit. Access to treatment can be explicitly targeted to priority subpopulations such as mothers of newborns, skilled workers, students, or poor people. Explicit conditions can also be set that cause differential access, such as residence in a designated geographic area, co-payment, access to testing, or a demonstrated commitment to adhere to therapy. Implicit rationing on the basis of first-come, first-served or queuing will arise when no explicit system is enforced; implicit systems almost always allow a high degree of queue-jumping by the elite. There is a direct tradeoff between economic efficiency and social equity. Interpretation: Rationing is inevitable in most countries for some period of time. Without deliberate social policy decisions, implicit rationing systems that are neither efficient nor equitable will prevail. Governments that make deliberate choices, and then explain and defend those choices to their constituencies, are more likely to achieve a socially desirable outcome from the large investments now being made than are those that allow queuing and queue-jumping to dominate.

TCP Control Groups: Aggregated Congestion Control for TCP (MA Thesis)

This thesis presents a framework for aggregated congestion management for TCP flows and shows how to integrate such an approach in an existing TCP protocol stack. The thesis presents an initial implementation of this congestion management scheme in Linux, with performance evaluation in ns as well.

Mistreatment in Distributed Caching Groups: Causes and Implications

Although cooperation generally increases the amount of resources available to a community of nodes, thus improving individual and collective performance, it also allows for the appearance of potential mistreatment problems through the exposition of one node’s resources to others. We study such concerns by considering a group of independent, rational, self-aware nodes that cooperate using on-line caching algorithms, where the exposed resource is the storage of each node. Motivated by content networking applications – including web caching, CDNs, and P2P – this paper extends our previous work on the off-line version of the problem, which was limited to object replication and was conducted under a game-theoretic framework. We identify and investigate two causes of mistreatment: (1) cache state interactions (due to the cooperative servicing of requests) and (2) the adoption of a common scheme for cache replacement/redirection/admission policies. Using analytic models, numerical solutions of these models, as well as simulation experiments, we show that online cooperation schemes using caching are fairly robust to mistreatment caused by state interactions. When this becomes possible, the interaction through the exchange of miss-streams has to be very intense, making it feasible for the mistreated nodes to detect and react to the exploitation. This robustness ceases to exist when nodes fetch and store objects in response to remote requests, i.e., when they operate as Level-2 caches (or proxies) for other nodes. Regarding mistreatment due to a common scheme, we show that this can easily take place when the “outlier” characteristics of some of the nodes get overlooked. This finding underscores the importance of allowing cooperative caching nodes the flexibility of choosing from a diverse set of schemes to fit the peculiarities of individual nodes. To that end, we outline an emulation-based framework for the development of mistreatment-resilient distributed selfish caching schemes.

Notes on the Effect of Different Access Patterns on the Intensity of Mistreatment in Distributed Caching Groups

In this report, we extend our study of the intensity of mistreatment in distributed caching groups due to state interaction. In our earlier work (published as BUCS-TR-2006-003), we analytically showed how this type of mistreatment may appear under homogeneous demand distributions. We provided a simple setting where mistreatment due to state interaction may occur. According to this setting, one or more "overactive" nodes generate disproportionately more requests than the other nodes. In this report, we extend our experimental evaluation of the intensity of mistreatment to which non-overactive nodes are subjected, when the demand distributions are not homogeneous.