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The second quarter of 2021 has been an exciting time for Indlela. We awarded our first Behavioural Insights Test (BIT) projects and convened a successful Behavioural Science Expert meeting.

In this edition of our newsletter, we also share team and project updates, and provide links to interesting resources related to HIV and behavioural economics. For more frequent updates, join our Whatsapp group, follow us on Twitter or visit the Indlela website.

  Project Updates
Awarded Behavioural Insights Test (BIT) Projects
 
We are proud to announce that our first Behavioural Insights Test (BIT) projects were awarded to The Aurum Institute and Right to Care.

This BIT project will be an individually randomized controlled trial seeking to improve clinic visit attendance. The study will be conducted with care recipients registered to receive ART who have upcoming appointments or have missed an appointment. The study involves a control group, and three intervention groups that will receive voice call attempts and different one-way text messages framed using BE principles (loss aversion, social norms and altruism). A total of 3,200 care recipients will be recruited and the study will take place over 9 months. For more information on this BIT project please visit our website

This BIT project will use machine learning and medical record data to build a predictive model that generates a risk level score to help identify people living with HIV  who may be at risk of poor treatment outcomes. The scoring system has been developed into prototype tools - adherence scorecards - that alerts clinicians to the care recipients’ risk profile and allows them to tailor care. We will use a quasi-experimental design to evaluate the fidelity, feasibility, acceptability, and effectiveness of adherence scorecards and treatment referral plans on subsequent clinic visit attendance.

The following behavioural economics principles will be incorporated into the design of the adherence scorecards and treatment referral plan: present bias, choice overload, ostriching, optimism bias and ambiguity aversion. Approximately 2,400 care recipients and 15 health care providers will be enrolled. The study duration will be about 12 months. For more information on this BIT project please visit our website.

Behavioural Science Expert Meeting

On March 16th, we convened a Behavioural Science Expert meeting that brought together 11 leading behavioural economists and the Indlela team (including some members of our External Advisory Board and our Indlela Affiliates). The purpose of the meeting was to generate and discuss ideas and behavioural insights that have potential applications to the HIV response. During the meeting we successfully identified a number of innovative BIT project ideas that may be explored further.
Update on the Request for Proposals (RFP)
 

We received 13 RFP applications from 11 partner organizations. All applications have been reviewed and we are currently working with applicants to refine the most promising BIT projects. Look out for more updates on the BIT projects via our social media platforms. We look forward to implementing more projects in the near future!

Indlela Team 

Getting to know the Indlela team


Candice Chetty-Makkan
Indlela Senior Behavioural Scientist. I am a Senior Researcher at the Health Economics and Epidemiology Research Office (HE²RO) and have an honorary senior lecturer appointment at the University of Witwatersrand School of Public Health.

My research interests are on defining, diagnosing, designing and testing low-cost interventions among patients and providers to improve HIV care in South Africa. I also have a strong interest to build capacity in behavioural science among upcoming researchers and those who implement HIV programmes. 

Career Nudge: 
The concept of “Ubuntu”, a Zulu word translating into “I am because we are” guided me along my career path. Early in life, I learned the importance of valuing humanity and was drawn to a career in psychology and public health research.

Vision for Indlela: I am honored to be part of Indlela that encourages collaboration between multidisciplinary teams to design rapid interventions and maximise use of existing resources within HIV programmes. Since people affected by HIV remain hesitant to access HIV care, I would like to see the successful implementation of Indlela’s BIT projects that could lead to better health choices and inform current health policies.

Biggest Achievements: I am the first person in my family to have graduated with a doctorate degree. I also have a great opportunity to collaborate with a team of expert researchers and implementers who share my passion of contributing to the improvement of public health services in South Africa.

Lawrence Long
 
Indlela Research Faculty. I have been on the faculty at Boston University’s School of Public Health (USA) since 2017. I am a Research Associate Professor in the Department of Global Health and an affiliate of the Health Economics and Epidemiology Research Office (University of Witwatersrand, South Africa).
My research interests focus on the application of economic evaluation methods to improve the delivery of HIV care and treatment in resource limited settings. I am currently involved in projects examining the roll out of HIV pre-exposure prophylaxis (PrEP) in South Africa, with a specific focus on applying a behavioural economic lens to the issues of low uptake and persistence amongst PrEP clients.

Career Nudge: Coming out of a traditional undergraduate economics program I really struggled to find a way to link my passion for health with my existing training. I happened across an opportunity to work as a health economist while considering my options for medical school. Through this role as a health economist I got to work with a string of local and international mentors that showed me the power of economics to inform policy making and make a difference; I have not looked back.


Vision for Indlela: The massive gains in life expectancy that the South African government has realised with their national HIV response is phenomenal, but in the era of declining budgets and competing needs we need to be thinking of ways to fine tune the existing programs to improve efficiency. Behavioural insights provides a toolkit to reexamine the way we provide services to help both clients and providers make decisions that benefit their health; I hope that Indlela can be instrumental in providing this toolkit to government and partners in South Africa and a catalyst for reaching the 95-95-95 goals. 

Biggest Achievements: Being part of an inspirational, multidisciplinary team that continues to build the evidence needed to shape policy for HIV care and treatment for all.

Achievements of the Indlela team

Alison Buttenheim (Indlela’s Behavioural Design Lead), was featured in the Financial Times where she talks about the role of incentives for the COVID-19 vaccine roll-out.  

Harsha Thirumurthy (Indlela’s Co-director), was featured in the New York Times where he was quoted on "How to Nudge People into Getting Tested for the Coronavirus". 
What have we published?

Harsha Thirumurthy and colleagues published an article on Financial incentives and deposit contracts to promote HIV retesting in Uganda: A randomized trial in PLOS Medicine. Results showed that offering financial incentives to high-risk adults resulted in significantly higher HIV retesting, while deposit contracts did not increase HIV retesting overall.

Sydney Rosen (a member of Indlela’s EAB), Lawrence Long and colleagues published an article in the Lancet Global Health on Multimonth dispensing of up to 6 months of antiretroviral therapy in Malawi and Zambia (INTERVAL): a cluster-randomized, non-blinded, non-inferiority trial. This cluster randomized trial was conducted at 30 facilities in Malawi and Zambia. The results showed that 6-monthly ART dispensing was non-inferior to 3-monthly ART dispensing and standard of care. The 6-monthly ART dispensing could be a promising strategy for ART provision.

Sophie PascoeLawrence Long and Sydney Rosen published an article in the Global Health Science and Practice on Differentiated Service Delivery Models for HIV Treatment in Malawi, South Africa, and Zambia: A Landscape Analysis. The results showed that as of 2019 there was considerable diversity in differentiated service models being offered that varied by patient populations. 

Harsha Thirumurthy and colleagues published an article in BMC Public Health on the Role of temporal discounting in a conditional cash transfer (CCT) intervention to improve engagement in the prevention of mother-to-child transmission (PMTCT) cascade. This randomized control trial took place in the Democratic Republic of Congo. The results showed that among  pregnant women who are HIV positive, small, frequent incentives could motivate improved uptake of prevention of mother-to-child transmission (PMTCT) services, especially among women exhibiting high rates of temporal discounting.
 

What are we reading?
For a free copy of the Applied Behavioral Science: An introductory guide please Click here.

 

 

Impactually is a management consultancy with expertise in behavioural economics and social psychology. You can access an essential behavioural economics reading list from their website.

    

Harambee, we can beat COVID, beat HIV and beat INEQUALITY by Winnie Byanyima, UNAIDS Executive Director, was printed in The Namibia Economist and highlights progress that Namibia made toward reaching global HIV treatment targets.

What are we listening to?
Prioritizing Children and Adolescents in the fight against HIV is a podcast from AIDS 2021. Agnes Ronan Head of Programmes and Knowledge at Paediatric Adolescent Treatment Africa (PATA) talks about service delivery changes during the COVID-19 pandemic and how needs of children and their caregivers need to be prioritised in global strategies to address HIV/AIDS.

Inside the nudge unit is a podcast from The Behavioral Insights Team where Richard Thaler, Cass Sunstein, Maya Shankar and David Halpern discuss the evolution of “nudges” over the past 10 years and the future of human behaviour in science. 

What are we watching?
This video on Living Positively with HIV - Four remarkable stories shows how different people handle their HIV diagnosis.

In this recording, the 1001 Stories  Behavioural Science Club invited Cass Sunstein to discuss the origins of nudge and vaccine uptake. Cass Sunstein also talks about how the EAST framework needs to be updated to FEAST with “F” for fun.


Spotlight on Indlela’s awarded BITs
                                 --------------
Introducing Indlela’s newly appointed nudge
associates

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          The launch of our blog posts on the website
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