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September 2021

June to August has been a great three months for Indlela. We awarded two additional Behavioural Insights Test (BIT) projects, bringing our total now to four active projects, and we continued engagement with other potential partners. Indlela’s Nudge Associates are part of our core team and we are proud to introduce Caroline, Preethi and Simamkele here. They will provide technical and operational support for all of our BIT projects. 

In this edition, we also share project updates, an opportunity for further collaboration and 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 Indlela has awarded two more BIT projects to the Foundation for Professional Development (FPD) and Triggerise.

This BIT project will be a randomised controlled trial that tests whether HTS demand creation material leveraging behavioural science principles increases demand for HIV testing at clinics operated by general practitioners. The project will compare two-low cost interventions: 1) Brochures that advertise the availability of comprehensive and free health screening; and 2) vouchers that emphasize the value of HIV testing services that can be obtained for free. These will be compared to the standard of care promotional materials for HTS. The interventions tested in this project seek to leverage behavioural economics principles like the endowment effect and loss aversion

The project will be conducted with several GP practices in the Johannesburg Health District that are part of the Your Care Network. Read more about the project here.

The purpose of this BIT project is to evaluate the effectiveness of discreet pre-exposure prophylaxis (PrEP) packaging and a lottery reward incentive to increase PrEP initiation and persistence at three months. The target group includes adolescent girls and young women who test negative for HIV. This randomized controlled trial will take place at 16 PrEP-dispensing sites in Mbombela, Mpumalanga Province. 

Behavioural economics  principles leveraged in this project include present bias, social norms and stereotype threats. The project will take place over approximately 15 months, including a 2-month co-creation period. Read more here.

Collaboration opportunity 
Following our Behavioural Science Expert Convening, (see June 2021 newsletter), the Indlela team identified several behavioural intervention ideas that could be used to address challenges across the HIV care continuum. If you are interested in collaborating and testing any of these interventions then please email us at

We are pleased to announce the launch of Indlela’s Viewpoint! The goal of this is to share views, news and information about behavioural economics and its use in healthcare. In our first post we present a perspective on combining predictive analytics and behavioural economics to personalise delivery of nudges in HIV service delivery. We use this approach in the PREDICT BIT project where Palindrome Data, Right to Care, HE2RO and Indlela developed a predictive loss to follow-up (LTFU) “risk score” tool to help healthcare providers triage recipients of care. Read the full post on our website!

Introducing the Indlela Nudge Associates 

Caroline Govathson: Senior Nudge Associate
I am a Researcher at the Health Economics and Epidemiology Research Office (HE2RO) and have been working at Indlela since 2020.

My research interests include multidisciplinary approaches to improving HIV outcomes in developing countries. I have over nine years’ of research experience spanning across Zimbabwe and South Africa. Specifically, my focus is on using insights from health economics, epidemiology and BE to inform the development of cost-effective, person-centred, differentiated models of care for HIV. I have worked on costing of different health delivery models, exploring the preferences of different groups for accessing and utilizing HIV services and various epidemiological studies on HIV/AIDS and TB.

Career nudge: I started my career as a pharmacist, working on HIV/AIDS prevention clinical trials and was struck by the contribution of human behaviour to the success of interventions. We need a paradigm shift towards including a behavioural science lens in all approaches. Working with Indlela allows me to be a part of shifting the behaviour of others, and applying these principles to my work.

Vision for Indlela: I believe that in order to reap the full benefits of BE as we try to close the gap in HIV goals, context matters. Although insights from behavioural economics are universal, the application needs to be culturally and ethnographically informed. I am excited to see Indlela be part of building the evidence base for applying BE in our context. I believe in our vision of building expertise and capacity amongst African researchers and practitioners. I look forward to seeing the results from our work translate into practice and government policy. I am confident that this will bring us closer to achieving HIV goals.

Biggest Achievements: My parents instilled in my sisters and I that education is the key to upward social mobility and to contribute meaningfully to matters that we are passionate about. I am proud that I am able to sit at tables where conversations by thought leaders in public health take place and I can contribute. I always lend my voice, even if it shakes.

Preethi Mistri: Nudge Associate
I am a Researcher at the Health Economics and Epidemiology Research Office (HE2RO) who recently joined the team in July 2021.

My research interests include evaluating the effectiveness of interventions that address behavioural barriers in improving health outcomes. I have a strong desire to learn more about behavioural science and how it can be applied to existing health programming and promoting positive public health behaviours.

Career Nudge: I have worked in the public and private sectors. Over the years, I developed a passion to understand the influences of health behaviour in public health settings and opportunities to help enable engagement in behaviours to improve health outcomes.

Vision for Indlela: I am energized and excited to be a part of growing research that is based on behavioural insights and aims to improve HIV outcomes. I would like to see the positive findings from our research included in the Department of Health programmes and systems that could help achieve HIV prevention and control.

Biggest Achievements: My biggest achievement is this wonderful opportunity to work and engage with behavioural research experts and be a part of this dynamic and inspiring team working toward improving public health outcomes.

Simamkele Bokolo: Nudge Associate
I am a Researcher at the Health Economics and Epidemiology Research Office (HE2RO) who recently joined the team in July 2021. I am currently enrolled for a PhD in Cultural and Media Studies focusing on the localisation of Covid-19 prevention messages in eThekwini communities.

My research interests include understanding behavioural change within socio-cultural contexts. I am interested in exploring how these contexts influence behaviour change and the adoption of health interventions within communities. Over the years, I developed interest in this field and completed a postgraduate research degree focussing on HIV prevention for adolescent girls and young women. 

Career Nudge: Starting my career in a HIV burdened community with high rates of unemployment and substance abuse made me appreciate the social and behavioural realities within communities. I am keen to work in the HIV prevention space, hoping to make a contribution. 

Vision for Indlela: The stubborn HIV infection rates among particular sub-groups of the population require targeted prevention interventions that consider the social contexts that influence behaviour change. I hope that the implementation of Indlela’s BIT projects could lead to a compilation of contextually relevant nudges that can be integrated in the Department of Health HIV agenda and scaled up nationally.

Biggest Achievements: My shift from programme implementation venturing into the field of behavioural research is a milestone in my professional journey. I am grateful for the opportunity to work with a team of well seasoned behavioral science researchers.  

A successful nudge spotlight


Members of the Indlela team teamed up with the Desmond Tutu Health Foundation (DTHF) to test a light-touch, low-cost, rapidly implemented nudge and have published the results. 

The study investigated the impact of a peer-delivered U=U (undetectable equals untransmittable) message on men's HIV testing uptake through a cluster randomised trial. Results showed that men that received U=U messaging explaining the benefits of HIV treatment in reducing HIV transmission had greater odds of taking an HIV test. 

Philip Smith, Dvora Joseph Davey and Linda-Gail Bekker from DTHF co-authored the article alongside Indlela Programme Manager Laura Schmucker, Behavioural Design Lead Alison Buttenheim and Co-Director Harsha Thirumurthy

Read the full article in AIDS & Behavior here: U = U Messaging Increases Uptake of HIV Testing Among Men: Results from a Pilot Cluster Randomized Trial.

Achievements of the Indlela team
From Now On: A video-based intervention to promote HIV treatment among men

Brendan Maughan-Brown, Alison Buttenheim, Harsha Thirumurthy and Laura Schmucker completed the development of a video-based intervention titled From Now On, which aims to encourage South African men living with HIV to initiate treatment and remain in HIV care. The 4-minute video weaves together the stories of three men from Cape Town communities as they share how they were able to carry on with their lives and achieve personal goals after HIV diagnosis. From Now On addresses psychosocial barriers and uses affect-based messaging to promote HIV treatment uptake and adherence.

Watch the video and learn more about the project here.

International AIDS Society Conference 2021

Indlela’s Co-director Sophie Pascoe, Senior Nudge Associate Caroline Govathson and Research Faculty Lawrence Long from the Indlela team attended the virtual 11th International AIDS Society (IAS) Conference on HIV Science over 18-21 July 2021. Members from the Indlela team presented 4 abstracts (3 posters and 1 oral) throughout the conference, and participated in one panel discussion.

Commentary on IAS 2021 by Caroline Govathson 
In July 2021, I attended the 11th IAS Conference on HIV Science. Despite my scepticism of attending a virtual conference, I enjoyed myself.

Many discussions centred around how the COVID-19 pandemic impacted HIV services. Speakers, including John Stover spoke on Managing overlapping pandemics, the disruption caused by COVID19 on HIV testing and treatment in different settings and the various adaptive measures taken to mitigate the impact. From evidence on annual clinic visits and extended ART refills to integrated DSD service delivery, we saw how the new WHO recommendations have been translated to reality.

There was also emphasis on the need for an integrated, person-centred response to HIV/AIDS. I found the session on implementing population-based interventions particularly crowd-sourcing for implementation of HIV testing interesting, that highlighted the need to prioritize community-led participatory research. This approach was echoed in various presentations on developing interventions that are not only “acceptable but desirable”. There were presentations on disparities in HIV and the impact of COVID on social determinants of health and on the new UNAIDS targets, the "10's". Speaking of disparities, it wouldn’t be an HIV conference without conversations about hard to reach key populations. I attended an interesting session on men and HIV in sub-Saharan Africa.

The last year has seen an accelerated change in choice architecture for HIV care. We have changed methods of service provision, eligibility criteria for different models of care and delivery of care. Behavioural economics offers an approach to maximise the impact of these changes. I was excited to see the work from our team: The main focus of work by Pascoe et al was to understand men’s preferences for HIV services while Govathson et al presented on cost effective, preference based models of care for adolescents. We also feature the publication by Smith et al’s work on Co-creation of a tailored U=U message to increase HIV testing in men.

Participating in this conference was a very rich experience. I found myself flipping through channels and speed reading in an effort to keep up. You will find my review is biased towards my interests, I can assure you however, there was something for everyone.

What have we published?
Indlela’s Behavioural Design Lead Alison Buttenheim and her colleagues published a systematic review of clinician-directed nudges in healthcare contexts in BMJ Open to determine the types of nudges that are most studied and effective in improving clinical decision-making compared with other nudges. Thirty-nine papers were included in the review with the majority of studies conducted in the US. Default options or nudges that enabled choice and framing information were effective. However, nudges providing information to clinicians through reminders and prompting were less effective in changing clinician behaviour.

Indlela’s Programme Manager Noora Marcus and Indlela Co-Director Harsha Thirumurthy co-authored an article Health and Economic Outcomes Associated With COVID-19 in Women at High Risk of HIV Infection in Rural Kenya in JAMA Network Open exploring how COVID-19 lockdowns influenced the economic well-being, food security, and sexual behavior of vulnerable populations in Kenya. Findings from their surveys show large declines in employment, income, and numbers of sexual partners, suggesting negative economic impacts and temporarily reduced HIV risk in vulnerable populations. 

Indlela Research Faculty Lawrence Long and Indlela EAB member Sydney Rosen co-authored Getting resources to those who need them: the evidence we need to budget for underserved populations in sub-Saharan Africa in the Journal of the International AIDS Society special issue entitled: “Key populations: the Future of the African HIV/AIDS pandemic?” The paper examines the role of evidence-based budgeting in making sure resources get to those who need them most.

Indlela’s Senior Behavioural Scientist Candice Chetty-Makkan and colleagues co-authored High risk sexual behaviours associated with traditional beliefs about gender roles among men interested in medical male circumcision in South Africa in AIDS Research and Therapy. Beliefs about gender roles and high-risk sexual behaviours underlie the HIV epidemic in South Africa. Yet, there is limited information on the relationships between beliefs about gender roles and risky sexual behaviours. Results from this implementation science study in the Ekurhuleni district showed that young men with traditional beliefs on gender roles are likely to engage in high-risk sexual behaviour and are good candidates for HIV prevention programmes.

What are we reading?
Here are some interesting resources to help you learn more about BE principles. Happy reading!

The UNAIDS Global AIDS Update 2021, highlights the importance of implementing innovative research together with a rights-based approach in diverse settings to achieve HIV health outcomes. 

What are we listening to?

In this Unbeatable mind podcast, Katy Milkman talks about temptation bundling, creating habits to propagate change, how to make plans, avoid forgetting, avoid procrastination and how the social environment promotes change. Some concepts  from her book How to change can be applied to a public health setting. (Est. listening time 40 minutes).



In this podcast HIV unmuted: AIDS and the elusive vaccine, Dr Anthony Fauci talks about the history of AIDS and his personal journey in AIDS research.
(Est. listening time 20 minutes).
What are we watching?

Mary MacLennan from the UN Behavioural Science Group conducted an interview with  Prof Thaler during the 2021 UN Behavioural Science Week where he talked about choice architecture, nudging, and the role of behavioral science. (Est. viewing time 60 minutes).

In a presentation by Neela Saldhana and Sakshi Ghai on Covid vs Global South, they highlight the concept that context matters when developing interventions. Three key takeaways from this presentation were the importance of socio-cultural contexts when developing interventions, how context shapes risk perception and the importance of testing behavioural interventions in local contexts before implementation. Ammaarah Martinus, a member of Indlela’s External Advisory Board, was one of the participants who represented South Africa in this study. (Est. viewing time 11 minutes).

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