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December 2021

Hello Indlela community! We are pleased to share another edition of our newsletter, including an exciting announcement that Indlela will be expanding our work to COVID-19 vaccine research through the COVID-19 Vaccine Survey (CVACS) and Behavioural Research for Advancing VacciNatiOn (BRAVO) projects. We also awarded our fifth Behavioural Insights Test (BIT) project and released the second Indlela Viewpoint

In this edition, we share news about Indlela’s new Consumer Panel, 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

As we approach the holiday season, we wish you a safe and well-deserved time of rest with your loved ones. We look forward to connecting with you again in 2022!

  Project Updates

Indlela has awarded a fifth BIT project to Right to Care.  

Right to Care will leverage behavioural framing on a mobile app to encourage men to sign up for circumcisions. RTC has launched a new platform called Moya, a novel data free mobile phone application available nationally in South Africa. The health section of the Moya app includes a voluntary medical male circumcision (VMMC) sign up form. The purpose of this BIT is to investigate how forms and tools on the Moya platform can be leveraged to enhance demand creation and encourage men to sign up for VMMC. The messaging and visual design will be framed to make sign up feel easy, salient, attractive, and encourage timeliness. The BIT will evaluate four study arms - a standard of care form and three different intervention forms. The project will take place at RTC supported sites across different provinces over approximately 15 months, including a 2-month co-creation period. Read the full project summary on our website here.

 Consumer Panel

Incorporating perspectives of consumers including care recipients and healthcare workers can be vital for designing effective interventions for HIV service delivery such as health messages and other behavioural interventions. The Indlela team is planning to form a Behavioural Insights Test (BIT) Consumer Panel - a group of individuals assembled to obtain rapid feedback on behavioural interventions that may improve HIV outcomes. The views of the consumer panel will be vital for quickly assessing whether proposed interventions may succeed before they are deployed in clinic settings. 

Prototyping is an essential step to the development of our BIT projects. The consumer panel will include a group of approximately 50 healthcare workers and 500 care recipients to provide feedback on interventions. Phase 1 will include the recruitment, enrollment and set up of an operational structure for the consumer panel and will also explore participant understanding of HIV care and which aspects of care delivery to improve. Phase 2 will explore knowledge, attitudes and beliefs of healthcare workers and care recipients on proposed behavioural interventions. Participants will provide feedback on the usability and relevance of BIT interventions prior to implementation. We will collaborate with existing partners to recruit individuals for the consumer panel. For more information read here.

We’re excited to announce the release of Indlela’s second Viewpoint. The Indlela Viewpoint is a platform that gives our team the opportunity to share views, insights and information on behavioural economics and its use for better health.  

In this post, we tackle considerations around demand creation for HIV testing services and discuss an alternative to traditional HIV marketing approaches centred around promoting “Free HIV testing”. We are evaluating whether a voucher highlighting the monetary value of a “free” HIV test (worth ZAR 100) that can be redeemed at local GPs, might be more effective in motivating people to test as it  leverages loss aversion and the endowment effect and appeals to a sense of ownership. We test this approach in our FPD BIT project and discuss this more in the Viewpoint - read the full post to learn more!

Indlela Team 

Laura SchmuckerI am the Indlela Senior Programme Manager and I have been with Indlela since its launch in early 2020, and at the UPenn the Center for Health Incentives & Behavioral Economics (CHIBE) since 2019.

My research interests are at the intersection of behavioural science and public health, especially infectious disease (HIV, COVID-19, malaria, TB). I have also focused some of my past research on health and resilience within refugees and displaced persons in East Africa. I have also focused on health systems strengthening and supporting local government research efforts. 

Vision for Indlela: I would like Indlela to become a renowned centre where behavioural interventions can be easily, rapidly, nimbly tested and scaled. I would like to see this model expand beyond HIV and regionally beyond South Africa. Finally, I would like to see Indlela continue to support and invest in South Africa’s research community to support the growth of local behavioural scientists.

Career nudge: Early in my career I planned to become a clinician until I attended a global health conference and learned about preventative, population-level health and have never looked back. I was drawn to research in the pursuit of applying more systematic approaches to poverty reduction and health promotion and have since worked and lived in a number of countries in East and South Africa. 

My biggest achievement: My inquisitive nature has drawn me to research, outdoor sports and other pursuits. Several years ago, it also led me to plan a trip with two other women to ride my motorbike 7,000 kilometres from Kampala to Cape Town over 40 days. The preparation needed and the endurance required to finish the journey still reminds me to persevere, even when encountering challenges.  

Lungisile Vezi: Indlela Project Coordinator
I am a Study Coordinator at the Health Economics and Epidemiology Research Office (HE2RO) and have been working as a Project Coordinator for Indlela since 2020. I am part of HE2RO’s communication team and actively involved in managing Indlela’s website and social media platforms.

My research interests include testing interventions to improve the quality of patient care and treatment outcomes. I have a desire to learn more about behavioural science and how implementation can improve service delivery, awareness and treatment outcomes for health programmes in South Africa.

Career Nudge: I was raised in a society where HIV and TB compounded our daily struggles. I took it as a personal challenge to work in public health to help people understand the importance of prevention, treatment and breaking stereotypes that continue to negatively affect our communities.

Vision for Indlela: I am honored to be part of a group that not only applies behavioural insights to improve our health systems but also invests in building capacity. I think capacity building is the most crucial aspect for developing BIT projects and a good strategy to get buy-in from Indlela partners. 

My biggest achievement is the opportunity to learn about behavioural science. Seeing the interest and willingness of our research and implementing partners to be part of the BIT projects, increases my confidence that using behavioural insights for interventions will improve and move South Africa’s health system to a better platform.

Indlela team achievements 

We are proud to announce that the Indlela team recently received two new awards from the Bill and Melinda Gates Foundation.

Indlela Research Faculty, Dr. Brendan Maughan-Brown and Behavioural Design Lead Dr. Alison Buttenheim received funding to conduct three rapid, longitudinal, phone-based surveys to understand public perception and demand for COVID-19 vaccination in South Africa. The COVID-19 Vaccine Survey (CVACS) will (1) Engage with stakeholders to co-create questionnaires; (2) Rapidly synthesize and share findings; and (3) Rapidly share results and data. For more information read here.  

Register here to join a webinar where the CVACS team will share results from Survey 1, which  will take place on 14 December 2021.

Indlela received funding from the Gates Foundation to use behavioural insights to rapidly determine whether removing hassle factors, re-framing available choices, leveraging social norms and using incentives can increase COVID-19 vaccine registrations and uptake. The team spearheading BRAVO is led by Indlela Senior Behavioural Scientist Dr. Candice Chetty-Makkan, Behavioural Design Lead Dr. Alison Buttenheim, Research Faculty Dr. Brendan Maughan-Brown, Co-director Dr. Sophie Pascoe, Strategic Advisor Dr. Jacqui Miot and Primary Nudge Associate Ms. Simamkele Bokolo.

Indlela is providing technical support to the National Department of Health (NDoH), the DG Murray Trust and existing partners in the COVID-19 national vaccine programme to co-design interventions using behavioural economics to promote the adoption and sustainability of contextually relevant interventions. The project will also provide evidence for the selection and scalability of the approaches that show the greatest impact for vaccine registration and vaccine uptake in South Africa. Read more on our website here

Indlela’s Co-director, Dr. Sophie Pascoe presented at the International Association of Providers of AIDS Care 2021 Conference. Sophie’s presentation, which was part of a panel on the HIV Continuum of Care, focussed on ‘Models of Care: Enhancing Multi-disciplinary Patient-Centered Collaboration’. The presentation highlighted how we have successfully enhanced HIV treatment models through multi-disciplinary collaboration through task shifting and integration of data and services, but structural changes are still needed to support a workforce committed to patient centred care. Results from work done under the AMBIT study showed the breadth and scope of differentiated service delivery models for HIV treatment that are implemented across the region and it is clear that there are now a number of models that successfully support recipients of care who are doing well on treatment. Our collaborative efforts now, though, need to focus on enhancing models for those groups that are struggling to access services or adhere to treatment if we are to achieve the 95-95-95 targets.
What have we published?

Indlela’s Co-director Dr. Harsha Thirumurthy and colleagues from Impact Research & Development Organisation in Kenya, RTI International and UNC Chapel Hill recently published results from a cluster randomized trial of sustained access to HIV self-tests in Kenya. Women who participated in the study were HIV-negative at baseline and self-reported multiple partners. The results of the study, published in The Lancet HIV, found that access to self-tests led to significantly higher rates of partner and couples testing as well as higher numbers of HIV-positive partners identified, but had no effect on HIV incidence.

Indlela’s Co-director Dr. Harsha Thirumurthy and colleagues from the HIV Prevention Trials Network co-authored a commentary in Global Public Health entitled Mitigating the COVID-19 challenges to HIV prevention efforts in Africa: A socio-behavioral perspective. The authors outline the COVID-19 pandemic’s potential negative consequences for HIV prevention. They also highlight the importance of integrating social and behavioural science perspectives when developing interventions to offset the pandemic’s negative impact on HIV prevention outcomes.

Indlela's  Behavioural Design Lead Dr. Alison Buttenheim, Senior Programme Manager Ms. Laura Schmucker and Co-Director Dr. Harsha Thirumurthy co-authored this paper in AIDS Patient Care and STDS describing how this study engaged men from high HIV burden communities in Cape Town in two interactive Human-Centered Design (HCD) co-creation workshops to develop simple local U=U (Undetectable Equals Untransmittable) messages to address fears of testing HIV positive and emphasize the positive effects of using ART. Messaging improved the uptake of HIV testing (see Smith, et al. in AIDS & Behavior) and may reduce stigma among South African men living with HIV. Read more about this methodology.

Indlela’s Co-Director, Dr. Harsha Thirumurthy and Behavioural Science Lead, Dr. Alison Buttenheim with colleagues co-authored Association between statewide financial incentive programs and COVID-19 vaccination rates. Many US states introduced financial incentives in the form of guaranteed rewards and lotteries to encourage vaccination uptake. However, statewide incentive programmes and data on daily vaccine doses administered per 100 000 individuals in each state showed no significant difference in vaccination trends between states with and without incentives. There is a need for substantial incentives or mandates to raise vaccination rates. 

Indlela's Strategic Advisor Dr. Jacqui Miot and Research Faculty Dr. Lawrence Long with colleagues from HE2RO published an article Primary healthcare seeking behaviour of low-income patients across the public and private health sectors in South Africa in BMC Public Health that investigated health seeking behaviours and characteristics of low-income patients accessing private and public primary healthcare (PHC) and factors influencing their choice of facility. The majority of participants, while economically active (63%), did not have health insurance (91%) and earned less than R9,500 ($621) a month. Just under a third of participants accessing services at private facilities and a tenth of those at public facilities indicated using a mix of services. The most important reasons for choosing public facilities were affordability and convenience, while convenience and quality of care ranked highest for choosing private providers.

Profiling publications from the Bulletin of the World Health Organisation

A commentary on Behavioural science to improve effectiveness of HIV programmes, South Africa, by Indlela’s Co-Director Dr. Harsha Thirumurthy, Research Faculty Dr. Brendan Maughan-Brown, and Indlela affiliate Dr. Gavin George was featured in the Bulletin of the World Health Organisation. This publication highlights how cognitive biases and mental shortcuts frequently influence decision-making and reduce utilization of HIV prevention and treatment services. It also describes how behavioural nudges have been used to overcome status quo bias, present bias, hassle factors and social stigma in HIV programmes.  

Indlela’s Behavioural Design Lead, Dr. Alison Buttenheim and colleagues published a Behavioural intervention for adolescent uptake of family planning: a randomized controlled trial in Uganda in the WHO Bulletin. This randomized controlled trial at 126 social franchise clinics in Uganda evaluated a peer referral intervention on uptake of family planning services by young women aged 15-19 years. The intervention was designed to reduce stigma about contraceptive use, formalize word-of-mouth as a means to advocate for family planning and normalize peer information sharing using a “refer-a-friend” card. The study found that the intervention led to an increase in the monthly clinic visits and in the proportion of adolescents attending family planning visits.

In this editorial Using behavioural science for better health, Dr. Tedros Ghebreyesus, WHO Director-General, emphasizes the importance of  integrating behavioural science into the daily practice of public health work and the need for increased application of behavioural insights when designing policies and delivering public health services. 


What are we reading?

Thinking fast and slow is an international best seller by Daniel Kahneman where he aptly describes the “dual function” of the brain. This book explains how System 1 and System 2 cognitive functions drive the way we think, why we make certain choices and the influence of self-delusions on our decisions.

What are we listening to?
In this podcast from Behavioral Grooves on A reminder to nudge, Christina Gravert talks about the use of nudges and the effectiveness of using reminders referring to a study that took place in South Africa. She also talks about the difference between moral and pure nudges. (est listening time 60 minutes)

Interested in learning about infusing design thinking with behavioural science principles? Then listen to this Decision Corner podcast by The Decision Lab where Sandi McCoy and Aarthi Rao talk about Improving trust to create better health outcomes. They discuss the design of behaviourally informed interventions for HIV self-testing and ART adherence. (est listening time 60 minutes)

What are we watching?

Evan Nesterak Editor-in-Chief at the Behavioural Scientist interviewed Prof Richard Thaler on Nudge: The Final Edition about his current research, a commentary on applying behavioural science principles and a new chapter on Sludge (anti-nudge). They discussed the importance of prompted choice as opposed to presumed consent, using default nudges, nudging for good while encouraging the removal of Sludge and contextualising nudges as part of solutions to larger problems. (est viewing time 60 minutes)

The SESI Fellowship and Skill Hub, created this video: Young Woman Living with HIV in South Africa | Dikarabo’s Story || Hear Her Out. Here we see the multi-layered contextual and personal challenges experienced by young women in HIV testing, accepting an HIV positive status and the decision to initiate on ART and remain on treatment. (est viewing time 5 minutes)

Look out for details on a multiple nudge study

Announcing new BIT awards

New posts on Indlela’s Viewpoint

New posts on Indlela’s publications

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