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.

Mermera: Non-Coherent Distributed Shared Memory for Parallel Computing

The proliferation of inexpensive workstations and networks has prompted several researchers to use such distributed systems for parallel computing. Attempts have been made to offer a shared-memory programming model on such distributed memory computers. Most systems provide a shared-memory that is coherent in that all processes that use it agree on the order of all memory events. This dissertation explores the possibility of a significant improvement in the performance of some applications when they use non-coherent memory. First, a new formal model to describe existing non-coherent memories is developed. I use this model to prove that certain problems can be solved using asynchronous iterative algorithms on shared-memory in which the coherence constraints are substantially relaxed. In the course of the development of the model I discovered a new type of non-coherent behavior called Local Consistency. Second, a programming model, Mermera, is proposed. It provides programmers with a choice of hierarchically related non-coherent behaviors along with one coherent behavior. Thus, one can trade-off the ease of programming with coherent memory for improved performance with non-coherent memory. As an example, I present a program to solve a linear system of equations using an asynchronous iterative algorithm. This program uses all the behaviors offered by Mermera. Third, I describe the implementation of Mermera on a BBN Butterfly TC2000 and on a network of workstations. The performance of a version of the equation solving program that uses all the behaviors of Mermera is compared with that of a version that uses coherent behavior only. For a system of 1000 equations the former exhibits at least a 5-fold improvement in convergence time over the latter. The version using coherent behavior only does not benefit from employing more than one workstation to solve the problem while the program using non-coherent behavior continues to achieve improved performance as the number of workstations is increased from 1 to 6. This measurement corroborates our belief that non-coherent shared memory can be a performance boon for some applications.