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June 2022 

Hello Indlela community! Over this past quarter, we were delighted to host an in-person Indlela retreat and our first BIT Partners Collaborative meeting. In this edition, we also highlight findings from the CVACS project, and preliminary results from the PREDICT and FPD Behavioural Insight Tests. We share exciting news on team promotions and we are proud to announce that Indlela will be hosting a satellite symposium session at the AIDS 2022 conference. 

Join us on Whatsapp, follow us on Twitter, or visit our website for more frequent updates!

Indlela BIT Partner Collaboration Meeting

We are pleased to share that on March 24, the Indlela team hosted a Behavioural Insight Test (BIT) Partner Collaborative Meeting.

Our team and partners engaged in panel discussions around the different BIT projects and lessons learned, feedback for Indlela as well as ideas for the future and a discussion around the NUDGE design process.

We would like to extend our special thanks to all the BIT project partners for making this day a success: The Aurum Institute, The Foundation for Professional Development, Right to Care, Palindrome Data, Triggerise, Institute of Health Programmes and Systems, Anova Health Institute and Population Services International.
Project updates

The COVID-19 Vaccine Survey (CVACS) team led by Indlela Research Faculty, Dr. Brendan Maughan-Brown and Behavioural Design Lead, Dr. Alison Butteinheim shared key findings from the CVACS Survey 2, conducted in February-March. Here are the links to CVACS Survey 2 Policy Brief and CVACS Survey 2 Slide Deck. The data is also available on the DataFirst online open data portal

CVACS collected high quality, timely information on facilitators and barriers to COVID-19 vaccine uptake in South Africa to inform the development of campaigns and programmes to improve COVID-19 vaccination uptake. The policy brief and slide deck are based on findings from a sample of 3500 unvaccinated respondents and 386 CVACS Survey 1 respondents who were unvaccinated at Survey 1 but have reported being vaccinated in Survey 2. Key findings from CVACS 2 show that respondents had improved knowledge and awareness about the vaccine and that mandates were a common reason offered for getting vaccinated. In contrast, misconceptions about vaccine safety and effectiveness are cited among the main reasons for not vaccinating.

We are excited to share that enrolment for our Behavioural Insights Test (BIT) project with the Foundation for Professional Development (FPD) was completed in April. The aim of the project was to determine whether HIV testing services demand creation materials that leverage behavioural science principles might increase demand for HIV testing at GP practices within a GP Care Cell network. FPD distributed 11,982 invitation brochures and 565 individuals presented at their GP practice. We are in the process of data cleaning and analysis, results will be shared in due course. 

Read more about the FPD project here.

We completed the qualitative data collection for Indlela’s PREDICT BIT project in May. Read more about the PREDICT project here

We conducted seven interviews with health care providers to determine the fidelity, feasibility and acceptability of using the adherence scorecards and treatment referral plans on visit attendance for PLHIV. Preliminary results show that health care providers found the adherence scorecards and referral plans to be useful and acceptable, and felt that it encouraged communication with their care recipients. However, there were varying opinions about the feasibility of implementing the intervention, as the tool took time to learn how to use, but proved helpful after this initial learning curve. Look out for more detailed results.

Indlela team 

We were excited to have our first in-person Indlela team meeting since 2020 in Johannesburg this March with Indlela representatives from HE2RO, UCT UPenn and Boston University present. It was a productive time for our team to evaluate the progress on the BIT projects, evaluate our Indlela strategy and cast a vision for the future of Indlela.

Indlela team achievements

Congratulations to Indlela Co-director Harsha Thirumurthy, PhD, on his promotion to Professor of Medical Ethics and Health Policy, effective July 1, 2022.
Dr. Thirumurthy’s promotion recognizes his extensive and impactful scholarly contributions as an economist and behavioral scientist working to improve health outcomes for people in low- and middle-income countries.

We are proud to announce that Indlela Behavioural Design Lead and CHIBE Scientific Director, Alison Buttenheim, has been promoted to Professor of Nursing & Health Policy at the Department of Family and Community Health, School of Nursing, University of Pennsylvania. This well-deserved promotion reflects her significant scientific contributions in the areas of food access, vaccine hesitancy, large-scale vector control programs, childhood obesity, and global health.

Notice of Award: NIH R01 focusing on U=U messaging in South Africa

Dr. Alison Buttenheim and Dr. Andrew Medina-Marino (Desmond Tutu Health Foundation) have received a Notice of Award for an NIH-funded R01 grant entitled “Improving HIV testing, linkage, and retention in care for men through U=U messaging” that will build upon learnings from an earlier study in partnership with the Indlela team described in AIDS & Behavior and AIDS Patient Care and STDs, as well as this video.

In this trial, they will evaluate the effectiveness of “U=U” messaging for closing the gender gap in the HIV cascade. Building on their prior work on U=U messaging informed by behavioral economics and human-centered design, they will conduct two RCTs to evaluate the impact of U=U messages on men’s uptake of community-based HIV testing and treatment initiation, and achievement of viral suppression in Western and Eastern Cape, SA.

What have we published?

Dr. Candice Chetty-Makkan, Prof. Harsha Thirumurthy, Ms. Simamkele Bokolo, Dr. Lawrence Long, Dr. Brendan Maughan-Brown, Dr. Sophie Pascoe, Dr. Jacqui Miot and Dr. Alison Buttenheim with colleagues from the DG Murray Trust and Genesis Analytics released a preprint in medRxiv entitled A quasi-experimental cohort study evaluating a conditional economic incentive on first-dose COVID-19 vaccination rates among older adults in South Africa. The article showed that the Vooma Voucher program for COVID-19 vaccination led to a modest increase in first dose vaccinations among older adults in South Africa.

Dr. Lawrence Long, Dr. Jacqui Miot and Dr. Sydney Rosen published an article entitled Reduction in initiations of HIV treatment in South Africa during the COVID pandemic in BMC Health Service Research. Results show that due to the COVID pandemic and lockdown restrictions, there was a substantial decline in ART initiations, with numbers in 2020 remaining well below those seen in 2019. The authors note that this decline is likely a result of multiple factors, including fear of COVID infection and physical restrictions. In order to protect the health gains of the HIV response, policy makers need to place additional effort on helping people living with HIV engage with the healthcare system as well as identifying ways to protect the program from future shocks.

Indlela will be hosting a 60-minute in-person satellite session at the AIDS 2022 Conference on July 30, at 8am EDT (2pm SAST) entitled “Nudging our way to 95-95-95: a behavioural economics capacity building and implementation research initiative in SA”. 

Some other highlights to look out for at the conference featuring behavioural economics and service delivery models from the HE2RO team:

  • Virtual Satellite: Behavioral economics and conditional incentives to strengthen HIV treatment and prevention: Actioning the science on July, 30 at 17:45pm EDT (23:45pm SAST)

  • E-poster (EPE157): No differences in recipients of care perceived quality of care between differentiated service delivery models and conventional care in South Africa

  • E-poster (D6): Behavioral Economic Incentives to Support HIV Treatment Adherence (BEST): one-year results of a randomized controlled trial in Uganda

  • Poster exhibition (D13): Integrating human-centered design, public health, and behavioral science to improve access to HIV services among young men who have sex with men in Kenya

  • E-poster (EPE166): How do nurses spend their time? A time and motion analysis in the context of differentiated service delivery at primary public healthcare facilities in South Africa

  • E-poster (EPE157): No differences in recipients of care perceived quality of care between differentiated service delivery models and conventional care in South Africa

What are we reading?
The Ogilvy Behavioural Science Annual 2022 features social and behavioural initiatives undertaken by Ogilvy teams from around the world. Included in this interesting compendium are easy to read case studies of interventions addressing behavioural challenges ranging from low COVID-19 vaccination rates in Chicago youth, malnutrition and hidden hunger in Ecuador and West Africa respectively and hand washing with soap at schools in India, amongst others.

This editorial on Critical social and behavioral sciences perspectives on ending the HIV epidemic highlights various social and behavioural aspects integral to HIV prevention and treatment from nine papers in the March issue of Current opinion in HIV and AIDS. Topics include health and social inequalities, the impact of interpersonal and social processes, and importance of community engagement in designing interventions. 

What are we listening to?

In this podcast by Choiceology we learn about how Less is More. Katy Milkman interviews Gabriella Adams, an author of a book called, People Systematically Overlook Subtractive Changes. This podcast highlights the subtractive solution study, the subtraction neglect approach as a possible alternative to addition bias and a way to resolve design challenges to improve outcomes in a more cost-effective way.

In this podcast by Action Design Radio, Zarak and Erik interview Allison White, a Senior Behavioural Researcher at Duke University’s Centre for Advanced Hindsight. This podcast highlights behaviour mapping, journey mapping, structural versus psychological barriers, the importance of focusing on pain points, and methodologies in various fields of human-centred design.

What are we watching?
Dr. John Beshears presented on Nudging: Progress to Date and Future Directions at  the Norms and Behavioural Change (NoBec) Talks. He reflected on a decade of empirical research on nudging. Multi-disciplinary research on nudges have been published but there are still opportunities to draw lessons from current studies to inform future nudge research (est. viewing time 75 min).
Tackling Global Health Challenges With Behavioral Design is a video that summarises behavioural science and how it is applied in tackling persistent global health challenges. It covers key components of effectively using a behavioural design to address health challenges, starting from understanding human behaviour and the context of the behaviour to the rapid development of cost-effective solutions supported by data (est. viewing time 3 min).

Upcoming results from current BIT projects

New posts on Indlela’s Viewpoint

Updates on Indlela’s publications



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