20 September 2010 12:00AM
“Even in my first year, I knew that AIDS in Africa would be a focus for me,” said Kristin Johnson, a Ph.D. student who double-majored in mathematics and economics as an undergraduate at the University of Colorado.
Now in the fourth year of her Ph.D. studies, Johnson has learned the research skills to help address the critical health situation in Sub-Saharan Africa. More than two-thirds of the approximately 39 million people living with HIV or AIDS in the world reside there.
While living and working in Denver after college, Johnson read “Banker to the Poor” by Muhammad Yunus, the Bangladeshi banker, economist and Nobel Peace Prize recipient.
“It was a key catalyst in getting me to go to graduate school,” Johnson said of the book that chronicles the birth of microcredit as a tool to help the poor help themselves.
Johnson has chosen to put her effort toward assisting those in Tanzania, whose government has paid for free HIV medication since 2004. However, it is common for people not to adhere fully to their prescribed medication regimen.
A research project called Coping with HIV/Aids in Tanzania (CHAT) has given Johnson the opportunity to apply what she has learned in her doctoral studies to examine the problem. The CHAT project, led by Center for Health Policy at Duke Director Kate Whetten and funded by the National Institute of Mental Health, aims to understand the critical factors that influence adherence to a medication therapy plan, which is critical for effective HIV treatment.
“Especially with HIV medication, it’s very important to take it at the right time every day,” Johnson emphasized. “If you miss by even an hour or miss one pill in the month, it can reduce the effectiveness of the medication therapy to essentially nothing.”
The CHAT project follows 1,500 individuals, some HIV positive and others HIV negative. Local care workers and researchers interview the patients every six months to determine the underlying psychosocial, sociodemographic and economic factors associated with poor adherence rates.
“What I’m bringing to the study is a more formal way of looking at how people make decisions,” Johnson said. “I’ll add a section of questions to the survey that has to do with individual, subjective expectations of the future.”
Johnson’s questions aim to determine the value the patients place on the drugs, what they think will work and what they think the side effects will be.
“I’ll be asking people questions like, ‘Suppose you were to take every one of your medication doses on time, what is the likelihood that you will die in the next six months, one year, five years?'” she explained. “Then I’ll ask, ‘If you miss two days of doses, what do you think will happen then?’"
This summer Johnson spent two weeks in Moshi,Tanzania, spending time with locals in focus groups to hone the survey questions and ensure they are culturally specific.
“When asking these types of questions anywhere, unless you set it up in a precise way, the questions may be interpreted differently than intended,’’ Johnson said. “It’s up to me to set up the situation well, so that the data is meaningful in the end.”
Working on other international research projects, such as one in India with her primary economic adviser and development specialist Alessandro Tarozzi, has offered Johnson the chance to learn directly from leading experts in the field. Tarozzi has been guiding Johnson since her second year of doctoral studies.
"Kristin's Tanzania work will contribute to a growing and exciting literature that tries to use information directly elicited from survey respondents to improve our understanding of why people in developing countries make decisions which, from the outside, may look surprisingly bad," Tarozzi said. "What Kristin is doing has the potential to be both methodologically innovative and substantively important."
Johnson, who is also advised by economics faculty members Charles Becker and Duncan Thomas, will return to Tanzania this November to incorporate her questions into the broader CHAT survey.
“I predict that expectations have a big influence in people’s adherence to the medication regimen.” Johnson stated. “Any information we gain from this study is going to increase our understanding of how these patients look at their mortality and events in the future.”
Learn more about the CHAT project and the Center for Health Policy.
Learn more about the Ph.D. program at Duke Economics.
Economics Department