Essays on HIV and Malaria Treatment in Sub-Saharan Africa
Published: 2015
Language: eng
Description: Malaria and HIV are the two diseases that cause the most disability and loss of life in sub-Saharan Africa. Treatments play a critical role in ameliorating the impact of these diseases on patients and their communities. This dissertation focuses on three elements of treatment: The impact of HIV treatment on childhood education, integration of HIV care and sexual and reproductive healthcare, and adherence to treatment.

In chapter one, we assessed the impact of adult HIV treatment on the educational attainment of children in the same household through a regression discontinuity analysis. Adult HIV treatment results in large gains in the educational attainment of children in the same household (intention-to-treat [ITT]: 0.30 years, p=0.017; complier average causal effect [CACE]: 1.17, p=0.036). This increase in educational attainment is important for increasing individual and community well-being and human capital.

In chapter two, we estimated the association between moving through the HIV treatment cascade and contraceptive use through a bivariate probit analysis. We find large increases in condom use among HIV-positive women as they move through the treatment cascade, with increases of 22.8 percentage points (p<0.001) among women on ART for 4-7 years relative to women who are unaware of their HIV-positive status. This finding is a positive indication of the integration of HIV care and reproductive healthcare.

In chapter three, we conducted a randomized trial to assess the impact of text message reminders on adherence to antimalarial treatment and in chapter four we estimated whether patient factors predict antimalarial treatment adherence and modify the impact of text reminders using logistic regression models. We found that a short, simple text message reminder increases adherence to antimalarial treatment (OR: 1.45, p=0.030) and that no patient factors we assessed statistically significantly predicted antimalarial treatment adherence. While adherence to treatment remains difficult to predict, short, simple text message reminders could increase antimalarial treatment adherence.
Notes: Keywords: Global health; public health; malaria; HIV; treatment; adherence; mHealth; health systems; reproductive health; contraception; artemisinin; ACT; ART; antiretroviral therapy; text reminders; infectious disease.

Doctor of Science (SD) Harvard University 2015.

Thesis (Doctor of Science (SD))--Global Health and Population, Harvard T.H. Chan School of Public Health, May 2015.

Author embargo expires May 1, 2017