Human Capital Initiative hosts meeting on the economics of HIV/AIDS

On March 7, 2018, BU’s new Global Development Policy Center hosted a “Research Meeting on the Empirical Microeconomics of HIV.” Organized by BU School of Public Health professor Jacob Bor and Harsha Thirumurthy of the University of Pennsylvania, the meeting brought together thirty experts in HIV economics from around the world. The meeting was timed to coincide with CROI (Conference on Retroviruses and Opportunistic Infections), the large national HIV conference held this year in Boston.

Globally there are 2 million new HIV infections and 1 million HIV-related deaths each year (UNAIDS 2017). Biomedical advances in the prevention of HIV transmission – treatment as prevention, pre-exposure prophylaxis, and male circumcision – have raised hopes that with sufficient scale-up, the world could see an end to AIDS. Yet success depends on widespread uptake of these interventions among at-risk populations and on the ability of health systems to provide these services at scale. These questions of behavior and resource allocation are fundamental questions of economics.

The meeting featured presentations and discussions around three topics: knowledge gaps and behavior, financial incentives and habit formation, and optimizing health services. Prof. Laura Derksen of the University of Toronto presented results of a community-randomized trial showing that providing information on the prevention benefits of treatment led to reductions in HIV stigma and increases in HIV testing. “These results suggest a promising avenue to increase uptake of HIV treatment,” said Dr. Bor. “There are large gaps in knowledge about treatment as prevention even though it is a key pillar of current HIV policy.“

Prof. Sandi McCoy of UC Berkeley shared the results of a trial, which demonstrated that short run cash transfers at the time of HIV treatment initiation can increase clinical retention and facilitate habit formation during a critical period when many patients drop out of care. Interestingly, a measure of intrinsic motivation increased over time during the intervention. “The study suggests that incentives should be timed to critical window periods when new habits are being formed,” said Dr. Bor.

Prof. Till Bärnighausen shared results from recent population-based trials and quasi-experiments showing that small tweaks to service delivery can substantially improve care. The meeting also featured presentations from Mead Over, Omar Galarraga, and Dr. Bor. “Meetings like this are really helpful in building a research community, identifying the research frontier, and forming new collaborations,” said Dr. Bor. “The research meeting foregrounded questions of behavior in thinking about how to optimize the global HIV response. Understanding why people make the choices they do is key to support patients in starting and staying on treatment.”