Wilson Nicholas
Department of Economics, Reed College, Portland, OR 97202, United States.
Econ Hum Biol. 2016 May;21:221-40. doi: 10.1016/j.ehb.2016.02.003. Epub 2016 Feb 20.
This paper examines the effects of antiretroviral therapy (ART) on demand for HIV testing and of ART-induced testing on demand for risky sexual behavior. I provide a model of sexual behavior decision-making under uncertainty and estimate the structural parameters of the model using nationally representative survey data from Zambia on HIV testing decisions before and after the introduction of ART. The empirical results indicate that although the introduction of ART appears to have increased HIV testing rates by upwards of 50 percent, the ART allocation process may have limited the prevention benefit of ART-induced testing. Simulation results show that eliminating this prevention inefficiency while holding the supply of ART constant would increase the prevention impact of ART-induced testing more than four-fold. More generally, the analysis indicates that existing studies which examine "universal" testing or quasi-experimental testing programs understate the efficacy of standard voluntary counseling and testing programs.
本文研究了抗逆转录病毒疗法（ART）对HIV检测需求的影响，以及ART引发的检测对危险性行为需求的影响。我构建了一个不确定性下性行为决策的模型，并利用赞比亚具有全国代表性的调查数据估计该模型的结构参数，这些数据涉及ART引入前后的HIV检测决策。实证结果表明，虽然ART的引入似乎使HIV检测率提高了50%以上，但ART的分配过程可能限制了ART引发的检测的预防效益。模拟结果显示，在保持ART供应不变的情况下消除这种预防效率低下的情况，将使ART引发的检测的预防影响提高四倍以上。更普遍地说，分析表明，现有研究在考察“普遍”检测或准实验检测项目时，低估了标准自愿咨询和检测项目的效果。
