Cristian Pop-Eleches

Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders.

Objective:There is limited evidence on whether growing mobile phone availability in sub-Saharan Africa can be used to promote high adherence to antiretroviral therapy (ART). This study tested the efficacy of short message service (SMS) reminders on adherence to ART among patients attending a rural clinic in Kenya. Design:A randomized controlled trial of four SMS reminder interventions with 48 weeks of follow-up. Methods:Four hundred and thirty-one adult patients who had initiated ART within 3 months were enrolled and randomly assigned to a control group or one of the four intervention groups. Participants in the intervention groups received SMS reminders that were either short or long and sent at a daily or weekly frequency. Adherence was measured using the medication event monitoring system. The primary outcome was whether adherence exceeded 90% during each 12-week period of analysis and the 48-week study period. The secondary outcome was whether there were treatment interruptions lasting at least 48 h. Results:In intention-to-treat analysis, 53% of participants receiving weekly SMS reminders achieved adherence of at least 90% during the 48 weeks of the study, compared with 40% of participants in the control group (P = 0.03). Participants in groups receiving weekly reminders were also significantly less likely to experience treatment interruptions exceeding 48 h during the 48-week follow-up period than participants in the control group (81 vs. 90%, P = 0.03). Conclusion:These results suggest that SMS reminders may be an important tool to achieve optimal treatment response in resource-limited settings.

Judicial Checks and Balances

In the Anglo‐American constitutional tradition, judicial checks and balances are often seen as crucial guarantees of freedom. Hayek distinguishes two ways in which the judiciary provides such checks and balances: judicial independence and constitutional review. We create a new database of constitutional rules in 71 countries that reflect these provisions. We find strong support for the proposition that both judicial independence and constitutional review are associated with greater freedom. Consistent with theory, judicial independence accounts for some of the positive effect of common‐law legal origin on measures of economic freedom. The results point to significant benefits of the Anglo‐American system of government for freedom.

The Impact of an Abortion Ban on Socioeconomic Outcomes of Children: Evidence from Romania

This study examines educational and labor outcomes of children affected by a ban on abortions. I use evidence from Romania, where in 1966 dictator Nicolae Ceauşescu declared abortion and family planning illegal. Birth rates doubled in 1967 because formerly abortion had been the primary method of birth control. Children born after the abortion ban attained more years of schooling and greater labor market success. The reason is that urban, educated women were more likely to have abortions prior to the policy change, and the relative number of children born to this type of woman increased after the ban. However, when I control for composition using observable background variables, children born after the ban on abortions had worse educational and labor market achievements as adults.

General Education versus Vocational Training: Evidence from an Economy in Transition

This paper examines the relative benefits of general education and vocational training during Romanias transition to a market economy. We examine a 1973 educational reform that shifted a large proportion of students from vocational training to general education. Using census and household survey data, we analyze the effect of this policy with a regression discontinuity design. We find that men affected by the policy are significantly less likely to work in manual or craft-related occupations but have similar levels of labor market participation and earnings compared to their counterparts unaffected by the policy. We conclude that differences in labor market returns between graduates of vocational and general schools are largely driven by selection.

Mobile phone text messages for improving adherence to antiretroviral therapy (ART): a protocol for an individual patient data meta-analysis of randomised trials

Objectives Our objectives were to analyse the effects of text messaging versus usual care in improving adherence to antiretroviral therapy (ART) in people living with HIV using individual patient data meta-analysis. Adjusted, sensitivity and subgroup analyses were conducted. Setting 3 randomised controlled trials conducted between 2010 and 2012 in rural and urban centres in Cameroon and Kenya (two studies) were used. Participants A total of 1166 participants were included in this analysis (Cameroon=200; Kenya=428 and 538). Primary and secondary outcomes The primary outcome was adherence to ART >95%. The secondary outcomes were mortality, losses to follow-up, transfers and withdrawals. Results Text messaging improved adherence to ART (OR 1.38; 95% CIs 1.08 to 1.78; p=0.012), even after adjustment for baseline covariates (OR 1.46; 95% CI 1.13 to 1.88; p=0.004). Primary education (compared with no formal education) was associated with a greater intervention effect on adherence (OR 1.65; 95% CI 1.10 to 2.48; p=0.016) and also showed a significant subgroup effect (p=0.039). In sensitivity analysis, our findings were robust to a modified threshold of adherence, multiple imputation for missing data and aggregate level data pooling, but not to fixed-effects meta-analyses using generalised estimation equations. There was a significant subgroup effect for long weekly (p=0.037), short weekly text messages (p=0.014) and interactive messaging (p=0.010). Text messaging did not significantly affect any of the secondary outcomes. Conclusions Text messaging has a significant effect on adherence to ART, and this effect is influenced by level of education, gender, timing (weekly vs daily) and interactivity. We recommend the use of interactive weekly text messaging to improve adherence to ART, which is most effective in those with at least a primary level of education.

The Impact of HIV/AIDS and ARV Treatment on Worker Absenteeism: Implications for African Firms.

We characterize medium and long-run labor market impacts of HIV/AIDS and ARV treatment using unique panel data of worker absenteeism and information from an AIDS treatment program at a large mining firm in Botswana. We present robust evidence of an inverse-V shaped pattern in worker absenteeism around the time of ARV treatment inception. Absenteeism one to four years after treatment start is low and similar to nonenrolled workers at the firm. Furthermore, our analysis suggests that for the typical manufacturing firm in Africa, the benefits of treatment to the firm cover 8-22 percent of the cost of treatment.

Differences between self-reported and electronically monitored adherence among patients receiving antiretroviral therapy in a resource-limited setting.

Background:Measurement of adherence to antiretroviral therapy (ART) by patient self-report is common in resource-limited settings but widely believed to overstate actual adherence. The extent to which these measures overstate adherence has not been examined among a large patient population. Methods:HIV-infected adult patients in Kenya who initiated ART within the past 3 months were followed for 6 months. Adherence was measured by participants’ self-reports of doses missed in the past 7 days during monthly clinic visits and by continuous Medication Event Monitoring System (MEMS) in participants’ pill bottles. Seven-day self-reported adherence was compared to 7-day MEMS adherence, 30-day MEMS adherence, and adherence more than 90% during each of the first 6 months. Results:Self-reported and MEMS adherence measures were linked for 669 participants. Mean 7-day self-reported adherence was 98.7% and mean 7-day MEMS adherence was 86.0%, a difference of 12.7% (P < 0.01). The difference between the two adherence measures increased over time due to a decline in 7-day MEMS adherence. However, patients with lower MEMS adherence were in fact more likely to self-report missed doses and the difference between self-reported and MEMS adherence was similar for each number of self-reported missed doses. When analysis was limited to patients who reported rarely or never removing multiple doses at the same time, mean difference was 10.5% (P < 0.01). Conclusion:There is a sizable and significant difference between self-reported and MEMS adherence. However, a strong relationship between the measures suggests that self-reported adherence is informative for clinical monitoring and program evaluation.

The Supply of Birth Control Methods, Education, and Fertility: Evidence from Romania

This paper investigates the effect of the supply of birth control methods on fertility behavior by examining Romanias 23-year period of pronatalist policies. Following the lifting of the restrictions in 1989 the immediate decrease in fertility was 30 percent. Women who spent most of their reproductive years under the restrictive regime experienced increases in life-cycle fertility of about 0.5 children. Less-educated women had bigger increases infertility after policy implementation and larger fertility decreases following the lifting of restrictions. These findings suggest that access to abortion and birth control are significant determinants of fertility levels, particularly for less-educated women.

Targeted Government Spending and Political Preferences

This article addresses the question of whether incumbents can buy political support through targeted public spending. Using a regression discontinuity approach which takes advantage of the design of a recent Romanian government program that distributed coupons worth 200 Euros to poor families towards the purchase of a computer, we find that program beneficiaries were significantly more likely to support the parties of the incumbent governing coalition. These effects occurred both through higher political mobilization and through party-switching. The article also analyzes the drivers of such political gains and we find that program beneficiaries did not trust either the central government or the governing parties any more than the control group. Instead, it appears that local governments reaped the benefits of increased trust, and the political support for incumbent parties occurred mostly in towns where the local government was controlled by one of the parties of the national ruling coalition.

The effects of home-based HIV counseling and testing on HIV/AIDS stigma among individuals and community leaders in western Kenya: Evidence from a cluster-randomized trial

HIV counseling and testing services2 play an important role in HIV treatment and prevention efforts in developing countries. Community-wide testing campaigns to detect HIV earlier may additionally impact community knowledge and beliefs about HIV. We conducted a cluster-randomized evaluation of a home-based HIV testing campaign in western Kenya and evaluated the effects of the campaign on community leaders’ and members’ stigma toward people living with HIV/AIDS. We find that this type of large-scale HIV testing can be implemented successfully in the presence of stigma, perhaps due to its “whole community” approach. The home-based HIV testing intervention resulted in community leaders reporting lower levels of stigma. However, stigma among community members reacted in mixed ways, and there is little evidence that the program affected beliefs about HIV prevalence and prevention.