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Pilot Projects / Visiting Scholar / Post Doctoral Fellowship / Travel Funding / NIH Funding

Researcher Traveling Fellowship

In the summer of 2005, The Program on the Global Demography of Aging awarded travel funds for three researchers, Yoko Akachi, Till Barnighausen and Iris G. Boutros, to undertake field work at the Africa Centre for Health and Population Studies in Mtubatuba, South Africa. The Mtubatuba site covers an area of high HIV prevalence and work related to HIV/AIDS, as well as aging. 

In January of 2006, PGDA awarded Diana Bowser funds to travel to the Mississippi Delta to conduct research.

Please read below for more information on the research to be undertaken by the recipients of this fellowship.



Yoko Akachi

Doctor of Science degree in Population and International Health, candidate
Harvard School of Public Health

The objective of analysis is to examine the correlates of people’s decisions to learn their HIV status.

The individual who is eligible for the test (being in age range 15-45 and living in the district) has an option from the following:

  • Not being contacted by the HIV fieldworker (including cases of always being outside, or being a migrant, or avoiding the fieldworker)
  • Being contacted but refusing the test
  • Accepting the test but not getting the result from the facility
  • Accepting the test and getting the result 

Therefore, the above research question can be addressed more specifically as follows: Out of all eligible population, what are the attributes of those who were contacted by the field workers? Among those who were contacted, what are the attributes of those who accepted testing? Among those who accepted testing, what are the attributes of those who came back for test results? Are there any potential selection biases associated as individuals proceed with the testing? If we assume that the HIV positive probit model derived from the population that accepted HIV testing applies to the non-tested population, what is the simulated HIV prevalence estimate for those without testing?



Till Barnighausen

Doctor of Science degree in Population and International Health, candidate
Harvard School of Public Health  

It has been estimated that 4.1 million people in Sub-Saharan countries are currently in need of antiretroviral treatment (ART). One major obstacle to treating these patients with ART is the lack of sufficient number of physicians and nurses in Sub-Saharan Africa. As an alternative to the physician and nurse-based traditional ART delivery model, treatment models have been proposed that rely on community AIDS workers to provide routine treatment and monitoring in community health centers. While such an approach seems to offer a number of advantages (community AIDS workers can be more quickly trained and need to be paid lower salaries than nurses and physicians; patients would not need to spend time and money on traveling to urban health care centers), it is unclear whether they will be able to deliver ART effectively and cost-effectively (community AIDS workers may lack sufficient clinical skills, managerial experience, or motivation; the model may have higher fixed costs than the traditional model).

To date, only a few studies have examined the effectiveness and cost-effectiveness (CE) of ART in sub-Saharan Africa. None of these studies investigated an ART delivery model in which community health workers delivered routine ART and monitored treatment success. Knowledge of the effectiveness and CE of a community AIDS worker-based ART scale-up, however, will be needed for future decision making about the most appropriate delivery model in the international efforts to bring ART to underserved populations, including WHO’s 3 by 5 initiative.

This study aims to investigate the effectiveness and CE of community AIDS workers who are trained by the Africa Centre of Health and Population Studies to provide ART in the Hlabisa sub-District of KwaZulu-Natal. These health workers screen patients for the indication of ART, provide maintenance therapy to patients who are stable on ART, screen for opportunistic infections and counsel HIV-infected persons who do not yet need ART. Measures of effectiveness will include mortality, morbidity from opportunistic infections and adverse events, CD4 count, viral load and adherence. Capital expenditures that need to be assessed include spending on training manuals, clinical equipment and non-clinical equipment and central support costs. Recurrent expenditures that need to be assessed include wages, costs of antiretrovirals, costs of non-antiretroviral drugs, laboratory costs, and transport costs.

The Travel Fellowship will be used to assess the feasibility of conducting the proposed study, to establish relationships with community AIDS workers, nurses and physicians who provide ART, and to make decisions on the design of the study, including the choice of a comparator group and the perspective of the analysis.




Iris G. Boutros

Doctor of Science degree in International Health Economics, candidate
Harvard School of Public Health

The AIDS epidemic is proving to be a significant challenge to healthy aging. Directly, the elderly are among those infected with HIV that will eventually succumb to AIDS. Indirectly, the illness and death of adults and children due to AIDS affects older-age parents and others in notable ways, such as a possible change in living arrangements, caregiving responsibilities, costs of treatment and care, exposure to infections, and caring for orphaned children. These changes present direct risks to the mortality and quality of life of the elderly and the effect from these risks could differ by socioeconomic status. In this way, the AIDS epidemic may also alter the association between socioeconomic status and mortality (“mortality gradient”) among the affected elderly. This study will examine the mortality gradient among the elderly in the Kwa-Zulu Natal Province of South Africa using demographic surveillance system data collected by the Africa Centre for Health and Population Studies. Additionally, the study will explore the impact of changes to household structure, related to an HIV-positive adult, on the mortality gradient. Research from other developing countries shows that HIV-positive adults return to an elderly parent or other’s household to receive care when terminally ill. With a mature epidemic, high HIV-related adult mortality, and one of the highest levels of inequality in the world, South Africa is particularly well suited to explore the impact of AIDS on the mortality gradient among the elderly.

Mtubatuba Rural Site Mtubatuba Rural Site
Mtubatuba Rural Site Mtubatuba Rural Site
Voluntary Counseling Center Voluntary Counseling Project
Voluntary Counseling Center Affiliated with Africa Centre Voluntary Counseling Project



Exploratory Investigation into Three Projects
in the Mississippi Delta Region

Diana Bowser

Doctor of Science degree in Population and International Health, candidate
Harvard School of Public Health  

Bowser's proposal explore three possible topics for future research, analysis and collaboration in the Mississippi River Delta Region. This exploratory phase of the research took place January 16-22, 2006 in coordination with Dr. Arthur Cosby, the Director of the Social Science Research Center at the Mississippi State University. The three research topics explored were 1) Health Effects from the Tunica Casino, 2) The Jackson, Mississippi Heart Study, and 3) A Natural Experiment with TennCare. All three topics incorporated a research arm examining the effects on the elderly. This is an exploratory trip in order to determine the type and level of data available. This trip helped determine if the research questions and/or methodology were appropriate. These three topics will become possible dissertation topics.



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