Research

Selected Publications

For a complete list, please see my BUMC Faculty Profile or Google Scholar Profile.

Bor J, Moscoe E, Mutevedzi P, Newell ML, Bärnighausen T. Regression discontinuity designs in epidemiology: causal inference without randomized trials. Epidemiology 2014; 25(5): 729-737.

Bor J, Herbst AJ, Newell ML, Bärnighausen T. Increases in adult life expectancy in rural South Africa: valuing the scale-up of HIV treatment. Science 2013; 339(6122): 961-965.

Bor J, Tanser F, Newell ML, Bärnighausen T. In a study of a population cohort in South Africa, HIV patients on antiretrovirals had nearly full recovery of employment. Health Affairs 2012; 31(7): 1459-1469.

Working Papers

Bor J, MacLeod W, Oleinik K, Potter J, Candy S, Maskew M, Fox MP, Sanne I, Stevens W, Carmona S. Building a National HIV Cohort from Routine Laboratory Data: Probabilistic Record-Linkage with Graphs

ABSTRACT: Chronic disease management requires the ability to link patient records across multiple interactions with the health sector. South Africa’s National Health Laboratory Service (NHLS) conducts all CD4 count and viral load (VL) monitoring for the country’s national HIV program. However, the absence of a validated patient identifier has limited the potential of the NHLS database for epidemiological research, policy evaluation, and longitudinal patient care. We developed and validated a record linkage algorithm, creating a unique patient identifier and enabling analysis of the NHLS database as a national HIV cohort. To our knowledge, this is the first national HIV cohort in any low- or middle-income country.

Presented at: International Workshop on HIV Observational Databases, Budapest, Hungary, April 2016; International Health Economics Association, July 2017, Boston; National Science Foundation Big Data Hubs Webinar, February 2018.

Bor J, De Neve JW. A social vaccine? HIV, fertility, and the non-pecuniary returns to secondary schooling in Botswana.

ABSTRACT: Education has been hailed as a “social vaccine” against HIV infection; but there is little causal evidence to support this claim. A 1996 policy reform in Botswana changed the grade structure of secondary school and led to sharp increases in educational attainment among affected birth cohorts. We use this ‘natural experiment’ to identify the effect of secondary schooling on HIV infection risk, fertility, sexual behaviors, and labor market outcomes. Data were obtained from the 2004 and 2008 Botswana AIDS Impact Surveys, nationally-representative household surveys with HIV biomarker collection. Each additional year of secondary schooling induced by the policy change decreased the probability of HIV infection by 8.1 percentage points (se=3.1), relative to a baseline prevalence of 25.6%. Effects were particularly large among women, who also saw a 15.8% point (se=5.7) reduction in the probability of having ever given birth. Schooling had no effect on HIV knowledge; however it influenced norms and behaviors, increasing condom use, HIV testing, and reporting that it is acceptable for women to carry condoms. For women, education delayed sexual debut and increased labor force participation. For men, education increased number of partners, but also increased literacy, and discussion about HIV with others. Supply-side measures to expand access to education in developing countries may have large health benefits. Estimates of the returns to schooling that exclude these non-pecuniary benefits may be too low. JEL Codes: I1, I2, J12, O15

Presented at PopPov Conference, Addis Ababa, Ethiopia, June 2015. Poster at Population Association of America Annual Meeting, San Diego CA, May 2015. Top poster winner. Poster at Northeast Universities Development Consortium Conference, Boston MA, Nov 2014.

Bor J, Bärnighausen T. High stakes testing: chronic disease management in low resource settings.

ABSTRACT: Management of chronic diseases in resource-poor settings is based on standardized treatment guidelines. For example, HIV patients are eligible for antiretroviral therapy (ART) when their CD4+ (white blood) cell count is observed to have fallen below a threshold value. Little is known about the effect of such decision rules on patient behavior and health outcomes in low-resource settings. Using data on 4391 public sector HIV patients in rural South Africa, we estimate the effect of immediate vis-à-vis deferred ART eligibility on survival, immune recovery, and clinical retention. Treatment effects are estimated in a regression discontinuity framework using flexible parametric survival models, which are robust to unobserved heterogeneity, treatment effect heterogeneity, and time-varying effects of the treatment. Patients presenting for care with CD4+ counts just below 200 cells/µL were 4.8% points (95% CI 0.6, 9.0) more likely to be alive at three years compared to patients presenting with ineligible CD4+ counts just above the cut-off. Among patients whose treatment status was determined by the threshold rule, testing on the wrong side of the cut-off reduced three-year survival from 100% to 85%. Our data suggest that behavioral responses mediate the effect of treatment eligibility/ineligibility on outcomes and thus raise the stakes for diagnostic testing: patients who were ineligible for ART at baseline were much less likely to be retained in clinical care, leading to further delays in treatment and worse health outcomes. Immediate ART eligibility saved 0.18 years of life over five years at a cost of $1967 per year of life saved. JEL Codes: I12, O15, C41.

Presented at the 6th Annual Empirical Health Law Conference, 25 April 2015, Georgetown University, DC.

Previous version: Bor J, Bärnighausen T. When to start ART: quasi-experimental evidence from South Africa. Presented at PAA 2015 San Diego; BU/Harvard/MIT Health Economics Seminar 2015; NEUDC 2014, Boston University, USA.

Additional Conference Papers

Bor J, McLaren Z, Tanser F, Bärnighausen T. ART as economic stimulus: community spillover effects of HIV treatment in rural South Africa. Presented at the Population Association of America Annual Meeting, 2 May 2015, San Diego, CA. PopPov Conference, June 2015, Addis Ababa. International Health Economics Association Annual Meeting, July 2015, Milan.

Bor J. Cash transfers and teen pregnancy in South Africa: evidence from a natural experiment. Poster at Northeast Universities Development Consortium Conference (NEUDC), Nov 2013, Harvard University, USA. Dissertation chapter: Bor J. Essays on the Economics of HIV/AIDS in Rural South Africa. Harvard University, School of Public Health, 2013, dissertation.

Bor J, Tanser F, Newell M-L, B¨arnighausen T. Antiretroviral therapy as social protection: economic impacts of HIV treatment on South African households. Previous version presented as: Economic spillover effects of HIV treatment on households and communities, International AIDS and Economics Network Pre-Meeting, 21 July 2012, Washington DC. Bor J. HIV treatment and labor supply in rural South Africa. Presented at: Northeast Universities Development Consortium Conference (NEUDC), Nov 2012, Dartmouth College, USA. This paper substantially expands on Bor et al. 2012 Health Affairs.