This proposed four-year development period will be used for research and training activities that will give Dr. Bor the skills and experience necessary to become an independent investigator. Dr. Bor's long-term career goal is to apply the theory and analytical tools of economics to the study of population health, with a focus on HIV treatment and prevention. Building on a strong background in quantitative data analysis, Dr. Bor has proposed a training plan to develop skills in mixed methods study designs, content area expertise in behavioral economics, and epidemiological approaches to causal inference. The training plan will involve formal coursework, directed readings on specific topics, and a mentored research project. The research will investigate how the scale-up of HIV treatment in rural South Africa has shaped beliefs about the HIV risk environment, and how these beliefs influence behaviors related to HIV testing, sexual behavior, and human capital investment (e.g., education). Although the health benefits of ART for HIV patients are well documented, less is known about how increased availability of ART has influenced economic, health, and care-seeking behaviors at the community level. These spillover effects have implications for cost-benefit analyses of ART scale-up, and may inform interventions to increase HIV testing, care, and treatment. The proposed research will combine analysis of existing data from a health and demographic surveillance site in rural KwaZulu-Natal with collection of primary qualitative, survey, and experimental data in a mixed methods design. A brief intervention to increase take up of HIV testing will be developed and piloted in a randomized evaluation.

Public Health Relevance

To maximize the effectiveness of large-scale ART programs, evidence is needed on methods to increase HIV testing and linkage to care early in the course of HIV infection. I will undertake a mixed methods study to understand how young South Africans perceive the HIV risk environment in the age of ART, and how these perceptions affect HIV testing and care seeking, sexual risk behaviors, and future-oriented investments in themselves, e.g. education. The findings of this research will inform economic evaluations of the full benefits of ART scale-up, as well as interventions to increase rates of HIV testing and early care seeking.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Scientist Development Award - Research & Training (K01)
Project #
1K01MH105320-01A1
Application #
8847174
Study Section
Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
Program Officer
Stoff, David M
Project Start
2015-03-20
Project End
2019-01-31
Budget Start
2015-03-20
Budget End
2016-01-31
Support Year
1
Fiscal Year
2015
Total Cost
$153,911
Indirect Cost
$11,401
Name
Boston University
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
604483045
City
Boston
State
MA
Country
United States
Zip Code
02118
Bor, Jacob; Venkataramani, Atheendar S; Williams, David R et al. (2018) Police killings and their spillover effects on the mental health of black Americans: a population-based, quasi-experimental study. Lancet 392:302-310
Kluberg, Sheryl A; Fox, Matthew P; LaValley, Michael et al. (2018) Do HIV treatment eligibility expansions crowd out the sickest? Evidence from rural South Africa. Trop Med Int Health 23:968-979
Bor, Jacob; Chiu, Calvin; Ahmed, Shahira et al. (2018) Failure to initiate HIV treatment in patients with high CD4 counts: evidence from demographic surveillance in rural South Africa. Trop Med Int Health 23:206-220
Brennan, Alana T; Bor, Jacob; Davies, Mary-Ann et al. (2018) Medication Side Effects and Retention in HIV Treatment: A Regression Discontinuity Study of Tenofovir Implementation in South Africa and Zambia. Am J Epidemiol 187:1990-2001
Hontelez, Jan A C; Bor, Jacob; Tanser, Frank C et al. (2018) HIV Treatment Substantially Decreases Hospitalization Rates: Evidence From Rural South Africa. Health Aff (Millwood) 37:997-1004
Reniers, Georges; Blom, Sylvia; Lieber, Judith et al. (2017) Tuberculosis mortality and the male survival deficit in rural South Africa: An observational community cohort study. PLoS One 12:e0185692
Reniers, Georges; Blom, Sylvia; Calvert, Clara et al. (2017) Trends in the burden of HIV mortality after roll-out of antiretroviral therapy in KwaZulu-Natal, South Africa: an observational community cohort study. Lancet HIV 4:e113-e121
Brennan, Alana T; Davies, Mary-Ann; Bor, Jacob et al. (2017) Has the phasing out of stavudine in accordance with changes in WHO guidelines led to a decrease in single-drug substitutions in first-line antiretroviral therapy for HIV in sub-Saharan Africa? AIDS 31:147-157
Maskew, Mhairi; Bor, Jacob; Hendrickson, Cheryl et al. (2017) Imputing HIV treatment start dates from routine laboratory data in South Africa: a validation study. BMC Health Serv Res 17:41
Bor, Jacob; Fox, Matthew P; Rosen, Sydney et al. (2017) Treatment eligibility and retention in clinical HIV care: A regression discontinuity study in South Africa. PLoS Med 14:e1002463

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