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March 2022 

Hello Indlela community! As we approach the second quarter of 2022, the battle of addressing the HIV and COVID-19 pandemics continues. This reinforces the importance of understanding human behaviour and applying behavioural insights to public health programmes.

Our Indlela team contributed to the field of HIV and COVID-19 through the CVACS project and developed a tipsheet on Behavioural interventions for HIV service delivery during the COVID pandemic. We have also made significant strides on our Behavioural Insights Test (BIT) Projects and continue to grow our team. Another highlight to look out for in this edition is a 3-minute video presenting results from the U=U study. Continue reading for more details and join us on Whatsapp, follow us on Twitter or visit the Indlela website for more frequent updates!

  New BIT Project

In collaboration with the Anova Health Institute, Indlela will test whether text messaging using a “fresh start” approach will increase ART re-initiation after treatment interruptions in Capricorn District, Limpopo Province. The “fresh start effect” leverages the importance that individuals may place on specific moments in time (temporal landmarks) that motivate changes in their behaviour or decision making in the pursuit of personal goals (Dai and Li, 2019; Beshears et al., 2021)

This BIT project will be a randomised control trial that includes three study arms: standard of care routine tracing with no SMS message, a standard SMS message and a standard SMS message with a “fresh start” date. The project will take place over approximately 15 months at primary health clinics. Read the full project summary on our website here.

Current  project updates

We are excited to share that enrollment for the Aurum Institute and PREDICT BIT projects were completed in February 2022. We also began enrollment for the FPD project and made available the results from the CVACS project. Read on for more details.

The goal of this study was to rapidly determine whether text messages framed according to behavioural economics principles increased clinic attendance among patients on ART. For this study the primary outcome was a clinic visit on or before the scheduled appointment date. The Aurum Institute enrolled 1,536 care recipients from three clinics into four study arms: 380 (24.7%) in the standard of care, 388 (25.3%) loss aversion, 376 (24.5%) social norms and 392 (25.2%) in altruism framing. We are in the process of data cleaning and analysis. Results are forthcoming.

Watch for more updates on the Aurum project here.

The objective of this BIT was to evaluate the fidelity, feasibility, acceptability, and effectiveness of adherence scorecards and a treatment referral plan focusing on the outcome of clinic visit attendance for people living with HIV (PLHIV).

Right to Care and Palindrome Data reached the recruitment target and enrolled 2,415 care recipients. The Indlela team also completed qualitative interviews with the providers who administered the adherence scorecards and referral plans. We aim to complete data collection for the follow-up visits by May 2022. Look out for more updates on the PREDICT project here.

Our BIT project in partnership with the Foundation for Professional Development (FPD) launched on February 1. The project aims to determine whether HTS demand creation material that leverages behavioural science principles will increase demand for HIV testing at GP practices. In preparation for the launch, we prototyped the marketing material in December and received feedback from care recipients on the content and structure of the brochures. We conducted training in January and piloted the tools over 5 days at all participating GP practices before beginning data collection. Read more about this BIT project here!

Indlela’s Research Faculty, Dr. Brendan Maughan-Brown and Behavioural Design Lead Dr. Alison Buttenheim shared key findings from the COVID-19 Vaccine Survey (CVACS) Survey 1 in February 2022. Here are the links to CVACS Survey 1 Policy Brief and CVACS Survey 1 Slide Deck.  

CVACS collects high quality, timely information to inform the development of campaigns and programmes to improve COVID-19 vaccination uptake in South Africa. The policy brief and slide deck are based on the full Survey 1 sample of 3,510, and thus update preliminary findings from the CVACS Survey 1 (December 2021). The anonymised CVACS Survey 1 data will be published in the coming weeks via Data First’s online open data portal.

Preethi Mistri discusses the use of conditional economic incentives (CEIs) to overcome present bias and motivate pre-exposure prophylaxis (PrEP) use. This post focuses on adolescent girls and young women (AGYW) as a priority group for HIV preventative interventions and debates whether CEIs are useful for decision making on PrEP use and sustaining behaviour change. We also explore if the use of CEIs are justifiable and under what circumstances. Our Tiko BIT that is in collaboration with Triggerise and the Institute of Health Programmes and Systems will test the use of CEIs in AGYWs.  Read the full post and leave your reply in the comments section!

Indlela Team 

Neo Ndlovu
I am a Nudge Associate, have a doctorate degree, and am also a registered nurse with the South African Nursing Council.


My research interests include learning more about behavioural economics principles, technical and operational management of BIT projects, and contributing to the dissemination of findings in the form of publications.

Career nudge: I developed an interest in human behaviour at a young age and continued to pursue a career in Social Sciences. This prompted me to study research psychology until I obtained my doctorate. When the opportunity to develop my skills in behavioural economics presented itself, I didn’t think twice to apply.

Vision for Indlela: I am excited to learn more about behavioural economics and be part of the Indlela team. I would like to see Indlela lead some of the public health training programmes in collaboration with tertiary institutions that mentor upcoming researchers. 


My biggest achievement is obtaining a PhD and working full-time in public health while raising my three children. This life experience has taught me to be hard-working and disciplined. 


Jacqui Miot
I am a Health Economist,  Division Director of 
HE2RO and the Strategic Advisor for Indlela.


My research interests include economic evaluations of public health interventions and programmes with a focus on HIV, TB and oncology. More recently I have become involved with various aspects of COVID-19 research and costing analyses.

Career Nudge:  After completing my pharmacy degree and internship, I was looking for a job as a research lab assistant in my gap year in the UK and my boss-to-be mistakenly thought I was applying for a PhD. He put my name forward and I received a scholarship for my doctoral studies in pharmacology at London University. Since then I’ve been passionate about academics and healthcare research.

Vision for Indlela: To be the go-to place for research and generating evidence in behavioural health economics in Africa, expanding beyond HIV and TB to other clinical areas. Indlela is recognised as a centre of excellence in training and mentorship for aspiring BE scientists.


My biggest achievement: Professionally, this includes appointment as division director and getting up to speed with the diverse, wide-ranging and fascinating research studies especially in HIV, and continuing to grow my own research interests that includes behavioural sciences. Personally, it is raising my two sons who have turned out to be smart, kind, funny and insightful young men. 


Averi Chakrabarthi
I am a Postdoctoral Researcher at the Department of Medical Ethics and Health Policy at the University of Pennsylvania.

My research interests include  health, nutrition, gender and poverty alleviation in low- and middle-income countries. My current projects are: 1) the linkages between health and poverty/financial equity, 2) the consequences of environmental degradation for the wellbeing of women, children and households, and 3) the patterns and drivers of malnutrition and overnutrition.  

Vision for Indlela: I am thrilled to be affiliated with Indlela and envisage that the unit can help build the efficacy of HIV service delivery in SA. Dissemination of the findings from Indlela’s BIT projects can also help inform the operations of health systems in comparable settings

Career Nudge: My interest in international health research was sparked while pursuing a Master’s degree in Public Policy at Johns Hopkins University, which has a fabulous public health school. I subsequently spent two years with the research organization J-PAL in India working on empirical research and primary data collection operations, which solidified my desire to work on policy-relevant and impactful research.

My biggest achievement: Professionally, being a part of great research teams such as the one in Indlela. Personally, staying super close with friends and family despite geographic distance and busy schedules.

Indlela team achievements

In South Africa, men are less likely than women to know their HIV status or take antiretroviral treatment and often experience higher mortality. This 3-minute animated video describes a study led by the Desmond Tutu Health Foundation and UPenn which found that peer-delivered messaging about HIV being untransmissable if undetectable when on treatment (U=U) increased men’s HIV testing uptake. 

The study showcases the hallmarks of a BIT project: a rapid, low-cost intervention built upon an existing program and utilising a rigorous study design. You can read more about the results in AIDS & Behavior and the methodology in AIDS Patient Care and STDs.

We are proud to report that Dr. Harsha Thirumurthy was featured on a broadcast by CNBC for a discussion on how Experts seriously doubt whether patent waivers on Covid-19 vaccines will ever come to be. 

Congratulations to Dr. Alison Buttenheim and Indlela’s EAB member Dr. Kevin Volpp who were recently appointed to serve on the US National Academies of Sciences, Engineering, and Medicine’s ad hoc committee reviewing the evidence for Future Directions for Applying Behavioral Economics to Policy.

What have we published?
Dr. Alison Buttenheim and colleagues co-authored a publication in The Lancet Health Policy entitled Promoting COVID-19 vaccine acceptance: recommendations from the Lancet Commission on Vaccine Refusal, Acceptance, and Demand in the USA. The article provides strategies to promote COVID-19 vaccine acceptance that could be applied across different contexts. The authors highlight that national communication and behavioural intervention campaigns are vital to promote COVID-19 vaccine coverage.
Dr. Candice Chetty-Makkan and colleagues from the Aurum Institute co-authored a publication in PLOS One entitled HIV-related stigma and uptake of antiretroviral treatment among incarcerated individuals living with HIV AIDS in South African correctional settings - A mixed methods analysis. Findings showed that despite a high reported prevalence of HIV-related stigma, anti-retroviral treatment (ART) uptake within correctional settings was high. Positive self-coping mechanisms, peer and staff support were some reasons for sustained engagement in HIV care.
Dr. Lawrence Long and colleagues co-authored a publication in JIAS on Getting resources to those who need them: The evidence we need to budget for underserved populations in sub‐Saharan Africa. The authors indicate that evidence-based budgeting (EBB) is a strong tool to achieve the transparent and efficient allocation of resources for HIV care. Yet, the evidence based for certain underserved populations is inadequate and we need further investment to make sure that sufficient data are available to appropriately apply EBB.
What are we reading?
The editorial of When pandemics collide highlights the negative impact of SARS-CoV-2 on HIV prevention programmes, reduced engagement in care of people living with HIV and on health systems in settings with high HIV burden.

Our team developed a tipsheet on Behavioural interventions for HIV service delivery during the COVID pandemic that we released last year and the guidelines remain relevant. This guide targets programs, policymakers, and researchers where we highlight a behavioural challenge and propose a potential solution informed by behavioural insights to address the challenge.

What are we listening to?

In this podcast by the Decision Lab, Dilip Soman talks about Bringing behavioural science to the real world. During this interview, we learn about the importance of taking context into account, how to translate nudges to specific context, how to scale up the nudges and challenges that could occur. (est. listening time 39 minutes) 


Matt Galloway from CBC Radio’s The Current interviewed Hombisa Ntsikanye, an implementer and developer of the HIV and AIDS program at Blue Roof Life Space in KwaZulu Natal and Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition on How the COVID-19 pandemic has affected the fight against HIV/AIDS? (est. listening time 18 min)

What are we watching?

ICAP and the Columbia Mailman School Public Health commemorated World AIDS Day 2021 with a discussion on HIV & COVID 19: When Pandemics Collide highlighting lessons learned from the global HIV response that could  inform the COVID-19 response, and how COVID-19 impacted HIV programs. (est. viewing time 94 min). 

In this youtube video on Coronavirus and Behavioural Economics by tutor2u, we learn about applying seven behavioural biases to the coronavirus crisis. These biases include the bandwagon effect, status quo bias, loss aversion, normalcy bias (ostrich effect), overconfidence bias, one-model thinking bias and zero-risk bias. This video also provides examples of behavioural nudges that can be applied to the coronavirus pandemic. (est. viewing time 17 min)

Announcing new BIT awards

Upcoming results from current BIT projects

New posts on Indlela’s Viewpoint

Updates on Indlela’s publications

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