About

Jacob Bor, ScD, is an Associate Professor in the Departments of Global Health and Epidemiology at Boston University School of Public Health. His research applies the analytical tools of economics and data science to the study of population health. His research interests include HIV treatment and prevention in southern Africa, structural causes of health disparities in the U.S, and intersections of health, politics, and development. Prior to his graduate training at Harvard School of Public Health, Dr. Bor worked with an HIV-prevention NGO in Botswana, Lesotho, and South Africa. He is a faculty affiliate of BU's Global Development Policy Center and Senior Research at the Health Economics and Epidemiology Research Office in South Africa.

Research topics

• Medicine
• Political Science
• Sociology
• Economics
• Environmental health
• Demography
• Demographic economics
• Public administration
• Economic growth
• Nursing
• Socioeconomics
• Geography
• Law

Selected publications

• Age at School Entry and Human Capital Development: Evidence from Lesotho

  American Economic Journal Applied Economics · 2026-03-27 · 1 citations

  articleSenior author

  Evidence on school-entry age impacts in lower-income countries is limited. We assess how school starting age affects human capital development in Lesotho, exploiting an enrollment age threshold. Children who start primary school at older ages overcome initial skill deficits as they progress. They are more likely to remain in school, spend less time on economic and household activities, and obtain substantially higher total years of schooling. In adulthood they are more likely to have professional occupations and less likely to be married or have children as teenagers, become HIV infected (men), and experience the death of a child (women). (JEL I12, I21, I25, I26, J13, J24, O15)

  PublisherDOI

• Initiation of dolutegravir vs efavirenz on 12- and 24-month weight, body mass index, blood pressure, and incident hypertension: A target trial emulation

  Annals of Epidemiology · 2026-03-10

  articleOpen access

  Using the Target Trial Emulation Framework, we evaluated the impact of initiating dolutegravir versus efavirenz on 12- and 24-month weight, body mass index (BMI), blood pressure (BP), and incident hypertension among treatment-naïve individuals in Johannesburg, South Africa from 2019-2022. We used linear models to estimate the mean difference in weight, BMI, BP and a log-binomial model to estimate the causal risk difference of incident hypertension, adjusting for patient characteristics via inverse probability weighting. Among 2,930 people initiating treatment from 2019-2022, 1,847 initiated dolutegravir and 1,083 initiated efavirenz. At 12-months, mean difference comparing dolutegravir to efavirenz in weight was 2.9 kilograms (95% Confidence Interval (CI): -0.3, 5.5), BMI was 0.8 kg/m 2 (95% CI: -0.3, 1.9), diastolic BP was 1.6 mmHg (95% CI: -0.7, 3.9) and systolic BP was 3.9 mmHg (95% CI: 1.2, 6.6). Risk of incident hypertension rose by 35% (95% CI: 0.04, 0.5). At 24-months, mean weight difference was 1.9 kilograms (95% CI: -1.3, 5.1), BMI was 0.6 kg/m 2 (95% CI: -0.6, 1.9), diastolic BP was -0.4 mmHg (95% CI: -1.8, 5.1) and systolic BP was 1.7 mmHg (95% CI: -1.8, 5.1). Risk of incident hypertension rose by 22% (95% CI: -0.1, 0.4). Dolutegravir was associated with greater increases in weight, systolic BP, and incident hypertension over 24-months, particularly in the first 12-months. Future research is needed to determine whether this reflects a direct effect of dolutegravir or the weight-suppressing effects of efavirenz.

  PublisherDOI

• Initiation of Dolutegravir Versus Efavirenz on Viral Suppression and Retention at 6 months: A Regression Discontinuity Design

  JAIDS Journal of Acquired Immune Deficiency Syndromes · 2025-02-06 · 1 citations

  articleOpen access

  BACKGROUND: In 2019, South Africa's Antiretroviral Therapy (ART) Treatment Guidelines replaced efavirenz with dolutegravir in first-line ART. SETTING: We assessed the impact of this national guideline change on retention and viral suppression in the Themba Lethu Clinical Cohort, Johannesburg, South Africa. We applied a regression discontinuity design in a prospective cohort study of 1654 adults living with HIV initiating first-line ART within 12 months (±12 months) of the guideline change. METHODS: We compared outcomes in individuals presenting just before and after the guideline change and estimated intention-to-treat effects on initiating a dolutegravir- vs efavirenz-based regimen. Primary outcomes were retention and viral suppression. Participants were defined as retained in care if a visit took place within ±3 months of the 6-month end point. Viral suppression was defined as having a viral load ≤1000 copies/mL 3 months before and up to 6 months after the 6-month end point. RESULTS: The 2019 guideline change led to an increase in uptake of dolutegravir. We noted a 26.6 percentage point increase in the proportion initiating dolutegravir [95% Confidence Interval (CI): 14.1 to 38.6]. We saw a small increase in viral suppression [Risk Difference (RD): 7.4 percentage points; 95% CI: -1.6 to 16.5] and no change in retention (RD: -1.7 percentage points; 95% CI: -13.9 to 10.5) at 6 months, though our findings were imprecise. CONCLUSIONS: Our estimates suggest early uptake of the revised treatment guidelines after implementation. Despite this, there was no meaningful change in viral suppression and retention rates at 6 months.

  PublisherDOI

• Timing of ART Initiation With Treatment Policy Changes in South Africa: A Cohort Study

  JAIDS Journal of Acquired Immune Deficiency Syndromes · 2025-11-18

  articleOpen accessSenior author

  BACKGROUND: Early antiretroviral therapy (ART) improves uptake, retention, and viral suppression. However, there is limited real-world data for high HIV burden settings, including South Africa. METHODS: We conducted a retrospective cohort study using linked clinical CD4 and viral load (VL) data from South Africa's HIV treatment database (TIER.Net) and National Health Laboratory Service (NHLS). Our analysis included ART non-naive individuals entering HIV care between January 2010 and March 2017 in 4 provinces (KwaZulu-Natal, Northern Cape, Limpopo, and Mpumalanga). We estimated days from entry into HIV care (same day, 2-6 days, 7-89 days, and ≥90 days). Outcome measures included retention, viral suppression (VL <50 copies/mL), and CD4 recovery at 12 months. A Poisson regression model with adjusted Risk Ratios (aRR) was used to identify factors associated with rapid ART initiation (<7 days) at 5% significance level. RESULTS: Among 1,211,966 individuals (median age 31 years, 69.6% female), 30% initiated ART on the day of diagnosis, 4.2% within 2-6 days, 26% within 7-89 days, and 39.8% after ≥90 days. Rapid ART initiation increased over time, with same-day initiations rising from 24.6% in 2010 to 60% in 2017. Factors associated with rapid ART initiation included female gender (aRR: 1.04; 95% CI: 1.03 to 1.04) and a lower CD4 count at entry. At 12 months, 77.6% of same-day initiators were retained, with 28.4% having a VL test and 61.2% achieving viral suppression. CONCLUSIONS: Rapid ART initiation has increased because of policy changes and healthcare worker efforts in South Africa, but addressing late entry into care and treatment nonadherence remains crucial.

  PublisherDOI

• Gaps in the Type 1 Diabetes Mellitus care cascade: a national perspective using South Africa’s National Health Laboratory Service (NHLS) database

  medRxiv · 2025-09-28

  preprintOpen access

  Objective: Type 1 diabetes mellitus (T1DM) requires lifelong management, yet access to insulin, specialized care, and education is limited in low- and middle-income countries (LMICs). While cascade-of-care analyses are well documented for type 2 diabetes (T2DM), to our knowledge no population-level estimates of the T1DM care cascade exist from LMICs. We therefore evaluated the T1DM care cascade nationally in South Africa and compared outcomes between youth living with HIV (YLWH) and youth living without HIV (YLWOH). Research Design and Methods: We analyzed South Africa's National Health Laboratory Service (NHLS) data for patients <20 years with a first glycated hemoglobin A1c (HbA1c) or plasma glucose [fasting (FPG), random (RPG)] between April 2004 and March 2015. Laboratory-diagnosed T1DM was defined as HbA1c ≥6.5%, FPG ≥7.0 mmol/L, or RPG ≥11.1 mmol/L. Cascade stages over 24 months were remaining in care and achieving glycemic control (HbA1c <7.0%, FPG <8.0 mmol/L, or RPG <10.0 mmol/L). Results: Of 256,449 youth tested for diabetes, 12.1% met criteria for laboratory-diagnosed T1DM. Among these, 15.9% remained in care and 7.2% achieved glycemic control by 24 months. Retention was similar between YLWH and YLWOH (16.8% vs. 15.8%), but glycemic control was higher among YLWH (72.5% vs. 43.4%). Conclusions: Four of five South African youth with T1DM lacked consistent care, and fewer than 10% achieved glycemic control within two years. Higher control rates among YLWH suggest lessons from HIV care models may strengthen T1DM services. These findings provide the first national estimates of the T1DM care cascade from sub-Saharan Africa and highlight the urgent need for targeted strategies to improve outcomes.

  PublisherOA PDFDOI

• Correction: The fall—And rise—In hospital-based care for people with HIV in South Africa: 2004–2017

  PLOS Global Public Health · 2025-09-08

  erratumOpen access

  [This corrects the article DOI: 10.1371/journal.pgph.0002127.].

  PublisherOA PDFDOI

• The risk of rifampicin-resistant TB after drug-susceptible TB treatment

  IJTLD OPEN · 2025-03-01

  articleOpen access
  PublisherDOI

• Correction: A Risk Prediction Model to Identify People Living with HIV Who are High-risk for Disengagement from Care after HIV Diagnosis in South Africa

  AIDS and Behavior · 2025-02-19

  erratumOpen access
  PublisherOA PDFDOI

• Life Expectancy of American Indian and Alaska Native Persons and Underreporting of Mortality in Vital Statistics

  JAMA · 2025-06-16 · 7 citations

  letter1st authorCorresponding

  Importance: Mortality of American Indian and Alaska Native (AI/AN) persons is known to be high but may be underreported in routine vital statistics. Objective: To estimate age-specific mortality rates and life expectancy for non-Hispanic AI/AN individuals and other racial and ethnic groups, using self-identified race and ethnicity data in a national cohort, circumventing errors due to racial misclassification on death certificates. Design, Setting, and Participants: This longitudinal cohort study used data from the Mortality Disparities in American Communities (MDAC) study, a nationally representative cohort created through the US Census Bureau's linkage of the 2008 American Community Survey (ACS) with death records from the National Vital Statistics System through 2019. The cohort included 4 135 000 ACS respondents, including 30 500 who self-identified as AI/AN (alone) and 58 000 who self-identified as AI/AN alone or in combination with another race (AI/AN-AiC). Exposure: Self-identified race and ethnicity. Main Outcomes and Measures: Age-specific mortality rates and life expectancy, estimated using continuous time, nonparametric period survival curves by self-identified race and ethnicity; comparisons to estimates from the US Centers for Disease Control and Prevention (CDC) WONDER database based on race and ethnicity reported on death certificates; and classification ratios for self-reported vs death certificate-recorded AI/AN race among decedents in the MDAC. Analyses were stratified by time period, sociodemographic factors, and cause of death. Results: Life expectancy of self-identified AI/AN individuals was 72.7 years (73.9 for AI/AN-AiC individuals), 6.5 years less than the US-wide average of 79.2 years. The AI/AN vs US average life expectancy gap widened from 4.1 years in 2008 to 2010 to 8.0 years in 2017 to 2019. Among self-identified AI/AN and AI/AN-AiC decedents, only 59.0% and 39.8% had AI/AN race reported on their death certificates, yielding classification ratios of 1.26 and 1.81, respectively. AI/AN race was most frequently underreported for heart disease and cancer deaths and less frequently for deaths from violence, drugs, and alcohol. In CDC WONDER data (based on race and ethnicity from death certificates), age-standardized mortality was 5% higher for AI/AN individuals than the US average (1067 vs 1016 deaths per 100 000). In MDAC data, mortality for self-identified AI/AN individuals was 42% higher (1420 vs 999 deaths per 100 000). The AI/AN life expectancy gap was 2.9 times larger in the MDAC than in unadjusted official statistics. Conclusions and Relevance: This longitudinal cohort study found that large life expectancy differences between AI/AN individuals and other US residents have been underestimated due to racial misclassification on death certificates, resulting in the statistical erasure of Indigenous people in routine vital statistics.

  PublisherDOI

• Initiation of dolutegravir vs. efavirenz on 12- and 24-month retention and viral suppression: a target trial emulation

  Infectious Diseases · 2025-09-22

  articleOpen access

  BACKGROUND: South Africa's antiretroviral therapy (ART) treatment guidelines in 2019 were revised to use dolutegravir as part of first-line ART instead of efavirenz due to recommendations from the World Health Organization and findings from clinical trials indicating noninferior efficacy and reduced side effects. Utilizing the target trial framework, we estimated the effect of initiating a dolutegravir-based regimen compared to an efavirenz-based regimen among treatment-naïve people living with HIV initiating treatment in Johannesburg, South Africa from 2019 to 2022 on retention and viral suppression. METHODS: We used linear regression to estimate causal risk differences on 12- and 24-month retention and viral suppression. Characteristics of those who initiated dolutegravir vs. efavirenz were balanced through inverse probability of treatment weighting. The covariates included: natal sex, age, year of initiation, education level, employment status, tuberculosis, WHO stage, smoking and alcohol use. RESULTS: Of the 2930 individuals initiating ART, 1847 initiated a dolutegravir-based regimen and 1083 initiated an efavirenz-based regimen. The median age was 45.1 years (IQR: 37.1, 53.0). Initiation of dolutegravir was associated with a 5-percentage point increase (95% confidence interval (CI): -0.02, 0.11) in retention and 4-percentage point increase (95% CI: -0.06, 0.16) in viral suppression at 12 months. At 24 months, dolutegravir was associated with a 10-percentage point (95% CI: 0.03, 0.16) increase in retention and a 14-percentage point (95% CI: -0.02, 0.30) increase in viral suppression. CONCLUSIONS: Initiation of dolutegravir led to an appreciable increase in retention and viral suppression over 24 months when compared to efavirenz. Dolutegravir may lead to increases in long-term retention.

  PublisherDOI

Recent grants

• Economic, health, and behavioral dimensions of HIV treatment scale-up

  NIH · $154k · 2015–2019

• Economic, health, and behavioral dimensions of HIV treatment scale-up

  NIH · $459k · 2015–2020

• Evaluating UTT with a National HIV Cohort to Optimize South Africa's HIV Response (ENCORE)

  NIH · $1.8M · 2020–2026

Frequent coauthors

• Till Bärnighausen

  University Hospital Heidelberg

  141 shared

• Matthew P. Fox

  University of the Witwatersrand

  115 shared

• Frank Tanser

  University of KwaZulu-Natal

  71 shared

• Karen R. Jacobson

  Boston University

  58 shared

• Sydney Rosen

  Boston University

  57 shared

• Helen E. Jenkins

  Boston University

  55 shared

• Robin M. Warren

  South African Medical Research Council

  52 shared

• Sarah V. Leavitt

  51 shared