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.

In the Anglo-American constitutional tradition, judicial checks and balances are often seen as crucial guarantees of freedom. Hayek (1960) distinguishes two ways in which the judiciary provides such checks and balances: judicial independence and constitutional review. We create a new data base 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.

This paper applies a regression discontinuity design to the Romanian secondary school system, generating two findings. First, students who have access to higher achievement schools perform better in a (high stakes) graduation test. Second, the stratification of schools by quality in general, and the opportunity to attend a better school in particular, result in significant behavioral responses: (i) teachers sort in a manner consistent with a preference for higher achieving students; (ii) children who make it into more selective schools realize they are relatively weaker and feel marginalized; (iii) parents reduce effort when their children attend a better school. (JEL I21, I28, J13)

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.

ObjectivesOur 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.Setting3 randomised controlled trials conducted between 2010 and 2012 in rural and urban centres in Cameroon and Kenya (two studies) were used.ParticipantsA total of 1166 participants were included in this analysis (Cameroon=200; Kenya=428 and 538).Primary and secondary outcomesThe primary outcome was adherence to ART >95%. The secondary outcomes were mortality, losses to follow-up, transfers and withdrawals.ResultsText 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.ConclusionsText 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.

This paper examines the relative benefits of general education and vocational training during Romania's 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. © 2010 The President and Fellows of Harvard College and the Massachusetts Institute of Technology.

This paper uses a regression discontinuity design to estimate the effect of home computers on child and adolescent outcomes by exploiting a voucher program in Romania. Our main results indicate that home computers have both positive and negative effects on the development of human capital. Children who won a voucher to purchase a computer had significantly lower school grades but show improved computer skills. There is also some evidence that winning a voucher increased cognitive skills, as measured by Raven’s Progressive Matrices. We do not find much evidence for an effect on non-cognitive outcomes. Parental rules regarding homework and computer use attenuate the effects of computer ownership, suggesting that parental monitoring and supervision may be important mediating factors.

This paper uses a regression discontinuity design to estimate the effect of home computers on child and adolescent outcomes. We collected survey data from households who participated in a unique government program in Romania which allocated vouchers for the purchase of a home computer to low-income children based on a simple ranking of family income. We show that children in households who received a voucher were substantially more likely to own and use a computer than their counterparts who did not receive a voucher. Our main results indicate that that home computer use has both positive and negative effects on the development of human capital. Children who won a voucher had significantly lower school grades in Math, English and Romanian but significantly higher scores in a test of computer skills and in self-reported measures of computer fluency. There is also evidence that winning a voucher increased cognitive ability, as measured by Raven's Progressive Matrices. We do not find much evidence for an effect on non-cognitive outcomes. Finally, the presence of parental rules regarding computer use and homework appear to mitigate the effects of computer ownership, suggesting that parental monitoring and supervision may be important mediating factors.