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September 2022 

Hello Indlela community!

Before we dive into the milestones that Indlela has reached over the past quarter, we would like to highlight the significant contributions made by the Indlela team during the AIDS 2022 conference. We were proud to launch Indlela’s Nudge Handbook, host a satellite session, and present at a session hosted by NIMH. During discussions, the importance of using behavioural insights to inform interventions that makes decision-making easier for people living with HIV and designing nudges that expand beyond incentives were reinforced and the team returned home with new ideas and energy for future work! 

Other highlights in this edition include a new BIT project aimed at evaluating use of the B-OK bead bottles and launch of three other Indlela projects. We were also proud to see one of our nudge associates, Ms. Preethi Mistri, join part of the panel of experts in a webinar titled Adolescents and Non-Communicable Diseases (NCDs) hosted by the Desmond Tutu Health Foundation. For more information on what the team has been up to please join us on Whatsapp, follow us on Twitter, or visit our website!

AIDS 2022 Conference

Ahead of the AIDS 2022 conference, we compiled a BE RoadMap that summarised the behavioural economics research presented during the conference. For those who missed the sessions at the AIDS 2022 conference, the recordings will be publicly available on  the conference website from October. 

Indlela’s satellite session at AIDS 2022, Nudging our way to 95-95-95: a behavioural economics capacity building and research initiative in South Africa had a large in-person audience as well as virtual participants from 16 different countries. After the Indlela team’s presentations about our approach and some of our projects, an esteemed panel of experts engaged the audience in a multifaceted discussion about applying behavioural science, engaging communities, leveraging technology, and expanding beyond HIV.

For those who missed this exciting session you can access it here.

It was great to meet some of our Indlela BIT partners at the conference from PSI and Anova Health Institute.

Prof. Harsha Thirumurthy, Dr. Sophie Pascoe and Dr. Candice Chetty-Makkan also participated in a satellite session entitled Behavioral Economics and Conditional Incentives to Strengthen HIV Treatment and Prevention: Actioning the Science that was led by CGHS and the National Institute of Mental Health’s Division of AIDS Research.
New project
This BIT project is a collaboration between Indlela, Population Services International (PSI), Matchboxology and HE2RO and aims to evaluate the acceptability of the B-OK bead bottles among people living with HIV (PLHIV). It also seeks to explore if there are any changes in knowledge, attitudes, perceptions, and intentions in ART linkage to care, initiation or re-engagement in care. We will use a mixed methods approach to collect data from approximately 80 adults who are newly diagnosed with HIV or are re-engaging on ART. This study will take place in the iLembe district, Kwa-Zulu Natal (KZN) province. Read more about the study here.
Project updates

In partnership with Anova Health Institute, the “fresh start” BIT project to promote re-engagement in HIV care kicked off ahead of the two chosen temporal landmarks: 16 June (Youth Day) and 18 July (Mandela Day). A temporal landmark is a specific time when people may be most motivated to engage in a specific behaviour to achieve personal goals. Text messages were sent five days before and one day after each temporal landmark. In total 12,780 text messages were sent with an average delivery rate of about 54%. We are monitoring return to care from our sample, so look out for more results! Read more about the study here.

We are excited to announce that the Right to Care (Moya) BIT project launched on 8 August. Individuals registering for voluntary medical male circumcision will be exposed to either a standard of care or one of four different registration forms that use behavioural economics principles to promote further engagement with VMMC services. These forms will be rotated weekly until 21 November and we will be assessing which forms are most effective in generating demand for VMMC. Read more about the study here, and look out for results in our December edition!

Another big highlight for us is that our amazing team reached the enrollment target of 550 healthcare workers, care recipients and community members to our Indlela Community Panel. The aim of the Community Panel is to assemble a cohort of individuals who can be contacted for different studies and surveys to assess the likely effectiveness of behavioural nudges or elicit opinions about nudges before they are implemented on a larger scale. We will share more information on the Community Panel projects in the next newsletter. Read more about the Indlela Community Panel here.

To our field team: Portia Ngwenya, William Magolego, Nonhlanhla Tshabalala, Hazel Tau and Michael Mothapo, thanks for making each and every enrollment a success.
Indlela team achievements
Indlela Nudge Associate Ms. Preethi Mistri participated as a panelist together with Dr. Monika Kamkuemah in a webinar titled Adolescents and Non-Communicable Diseases (NCDs) hosted by the Desmond Tutu Health Foundation. This episode featured talks by Prof. Mary Barker on engaging adolescents in improving health and well-being and Prof. Nasheeta Peer and Dr. Theo Adom on risk factors for and prevention of NCDs in adolescents. 
Yesterday, we released our latest Viewpoint that covers the launch of the Indlela Behavioural Insights Test (BIT) Indlela Community Panel. We adapt the traditional model of a consumer panel used in marketing to creating relevant products, and apply this in the context of creating behaviourally informed interventions in the HIV service delivery space. Read more about our rationale for creating this group, our vision for how we hope to use it, and opportunities to partner with us in the latest Viewpoint.
What have we published?

Prof. Harsha Thirumurthy and Aaron Richterman published an article in Nature Human Behavior on The effects of cash transfer programmes on HIV-related outcomes in 42 countries from 1996 to 2019. This article uses secondary data from 42 countries and a difference-in-differences approach to estimate the effect of cash transfer programmes on various HIV outcomes. The article finds that the introduction of cash transfer programmes was associated with higher HIV testing, fewer sexually transmitted infections among females, reductions in new HIV infections and AIDS-related deaths, and improvements in antiretroviral coverage. The results suggest that anti-poverty programmes can play a greater role in achieving global targets for HIV prevention and treatment.

Dr. Jacqui Miot and colleagues published an article on Health technology assessment (HTA) in support of National Health Insurance in South Africa in the International Journal of Technology Assessment in Health Care.  The paper argues that a credible, successful and sustainable HTA process will require ongoing investment in personnel with a range of competencies. NHI represents an opportunity for all South Africans to realize their constitutional right of progressive access to quality healthcare under a UHC system. The experiences of other countries which have applied HTA systems and processes in support of UHC are instructive; however, the practical structures of the South African HTA process will need to be “homegrown,” tailored to the local context, and built on existing approaches.

Prof. Alison Buttenheim and colleagues published an article in The Lancet on the Effectiveness of vaccination mandates in improving uptake of COVID-19 vaccines in the USA. The authors outline five considerations for the role of mandates for promoting the uptake of vaccines. Effective messaging to overcome vaccine hesitancy is still important to consider when implementing mandates.

Dr. Candice Chetty-Makkan and colleagues from the Aurum Institute published an article in the American Journal of Men’s Health on Attitudes Toward Gender-Based  Violence Among Sexually Active Adult Men at High Risk for HIV in Rustenburg, South Africa. South African HIV-uninfected men reported permissive attitudes towards GBV and these attitudes were associated with HIV risk behaviour. These results highlight the need to integrate GBV and HIV programmes. 

Dr. Sophie Pascoe, Ms. Caroline Govathson, Dr. Lawrence Long and colleagues from HE2RO published a pre-print on MedRxiv entitled School-going learners are more likely to access HIV and contraceptive care at locations with friendly providers, Wi-Fi and other value-added services: Findings from a discrete choice experiment among learners in Gauteng, South Africa. The study showed that health care staff attitude and confidentiality are key issues affecting student decisions to access HIV and contraceptive services. Addressing how healthcare providers respond to young people seeking sexual and reproductive health services is critical for improving adolescent uptake of services.

What are we reading?

The Behavioural Scientist’s Summer Book List 2022 features books published from January to August 2022 and they have 26 interesting titles thus far. These books illuminate new research and those that investigate complex social issues.

The Behavioural Economics Guide 2022 is the leading annual publication dedicated to behavioural economics and behavioural insights. Each edition features contributions from renowned scholars in behavioural sciences and practitioners from around the globe. 

Michael Hallsworth of the Behavioural Insights Team (BIT) weighed in on the “Do nudges work” debate. He argues that this debate is complex and the impact of nudges is shadowed by the misclassification of what constitutes a nudge.
The Journal of International AIDS Society (JIAS), released a supplement on the oral and late breaker abstracts from the AIDS 2022 conference. Use this link on Abstracts from AIDS2022 to access a full range of topics.
What are we listening to?
In this podcast by Let's Talk about Health in Africa - Africa's war on women is driving the HIV pandemic: ending it begins with each of us, Lenias Hwenda interviews Prof. Quarraisha Abdool Karim. This podcast highlights the trajectories to ending Africa’s war on the AIDS pandemic among adolescent girls and young women.
What are we watching?

We attended Nudgestock 2022 and wanted to highlight three of our favorite talks.

Prof. Katy Milkman talks about nudging flu vaccinations using text messages in two mega-studies. Find out which behavioural economics principles and strategies were most effective at Can text messages save lives?: Nudging vaccinations [Start listening from 18:40]

In a presentation described as “flawsome”, Dr. Chaning Jang, speaks about 9 lessons from failures, successes and the subsequent learning from BE experiments in the Global South. Hear insights from 9 years’ of experience on Open secrets, lessons, and failures from working in the global south [Start listening from 25:30]

“All choices have a hidden partner…the environment designer”. Prof. Eric Johnson, talks about Designing Better Choices. Choice architecture is often understood as defaults, however, could include other elements, ranging from the number and order of options, to choice attributes and descriptions of choices. Listen to Prof. Johnson’s views on The elements of choice [Start listening from 18:08]

Upcoming results from current BIT projects

New posts on Indlela’s Viewpoint

Updates on Indlela’s publications

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