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Building capacity to design and test nudges and other behavioural solutions to improve the effectiveness of health services and achieve better health outcomes in South Africa.

Hello again!

We are excited to share updates on the ‘Indlela: Behavioural Insights for Better Health’ project. Indlela is a collaboration between the University of Witwatersrand’s Health Economics and Epidemiology Research Office (HE2RO) and the University of Pennsylvania Center for Health Incentives and Behavioural Economics (CHIBE). Funded by the Bill & Melinda Gates Foundation, Indlela is a first-of-its-kind unit that seeks to build capacity of South African researchers and organizations that deliver health services to design and test behavioural interventions and nudges that can improve the effectiveness of the public sector in achieving better health outcomes. If you are unfamiliar with our work at Indlela, please click here to learn more; or if you missed our first newsletter, please click here.

As the COVID-19 pandemic has altered routines for all of us, in the past quarter we have adapted Indlela to develop new ways to build behavioural economics capacity in programs and research institutions in South Africa. Read on to learn more about our upcoming webinars and workshops, and opportunities to develop and test low-cost behavioural interventions that can increase utilization of HIV services.
Indlela Team Updates
We are very pleased to announce that we have recently hired Candice Chetty-Makkan as our Indlela Senior Behavioural Scientist. She joins us after a long tenure at the Aurum Institute. Candice will focus on establishing Indlela through advocacy, networking, demand creation and facilitating capacity-building workshops. View Candice’s profile description here.

Congratulations to Ammaarah Martinus, Indlela External Advisory Board member, for being appointed to the World Health Organization’s (WHO) recently formed Technical Advisory Group on Behavioural Insights and Sciences for Health. This group will provide behavioural perspectives across three levels of the WHO; providing technical assistance, incorporating behavioural insights for health policies and programme planning; and contributing to a strategic road map for the behavioural insights initiative. Find more information about the technical working group here.
Event announcement 
Indlela Webinar: How to nudge your HIV programme to success

Date: Tuesday, 13 October

Time: 15:00-16:30 (SAST)

Interested? Register here

This webinar will include an introduction to and an interactive discussion of Indlela’s approach to integrating behavioural economics in HIV programs. We will also introduce a new opportunity to partner with Indlela through an upcoming virtual workshop series to support HIV service delivery organizations in building their behavioural economics toolkit and collaborate with Indlela to design and implement behavioural interventions through an Indlela Behavioural Insight Test (BIT). We will conclude with a Q&A session for participants and discuss next steps for engaging with Indlela.
Highlights from AIDS 2020 Virtual
The AIDS 2020 Virtual conference in July 2020 included several presentations by Indlela investigators Harsha Thirumurthy and Sophie Pascoe about behavioural interventions to promote use of HIV prevention and treatment services in South Africa and beyond. 
A late breaker presentation on the use of HIV self-testing to promote male partner testing and safer sexual behaviour. 
Harsha Thirumurthy presented results from a cluster randomized trial of an HIV self-testing intervention to promote partner testing and safer sexual behavior among women at high risk of HIV infection in Kenya. The trial found larger increases in partner and couples testing due to the intervention but no reduction in HIV incidence among women. 

Please click here to view the presentation.
e-Posters by Sophie Pascoe

Patient costs and satisfaction associated with differentiated models of service delivery for HIV treatment in sub-Saharan Africa

How do we tailor services to meet young people’s needs? A discrete choice experiment to determine preferences of high students in Gauteng for accessing HIV and contraceptive services
Reflections from the AIDS 2020: Virtual Conference
The COVID-19 pandemic has led to heightened levels of fear, panic and changes in behaviour among populations across the globe. During these uncertain times, people living with HIV may have prioritised safety precautions against contracting the coronavirus over HIV care. At the opening session of the AIDS 2020: Virtual conference, US Speaker of the House of Representatives Nancy Pelosi and US Congresswoman Barbara Lee emphasised resilience when fighting epidemics and many of the presentations focussed on how HIV service provision could be adapted to “nudge” people back toward HIV care in the context of the COVID pandemic. These included creating enabling environments for optimal HIV responses (2929; 2930); and reframing the community demand narratives for engaging key populations into HIV care (763; 3542; 167).

AIDS 2020: Virtual highlighted various behavioural approaches ranging from brief counselling, use of short videos, reminders and health tips as potential interventions for improving HIV indicators  (395; 240; 2750; 2356). Interesting presentations on patient-centred approaches (264; 397; 2371), community involvement (2074; 419; 2142; 161), peer support (2382; 1688; 168; 2615), use of incentives (297;  1601; 2524; 4234), clear messaging (2323; 181; 1728) and collaborative efforts by key decision-makers (295; 2445) highlighted the importance of designing customised targeted interventions to engage HIV patients back in care. Articles by Anna Grimsrud and Ruanne Barnabas published in the Journal of International AIDS Society Special Issue further encouraged shifting the community demand narratives and noted the benefits of lottery incentives to reach neglected, yet vulnerable populations for HIV services. It was clear that these behavioural insights could highlight the way to move meaningfully beyond just listening to patient needs to addressing behavioural challenges that currently impact the effectiveness of existing health and HIV services and achievement of better health outcomes. 
 The Journal of International AIDS Special Issue (JIAS): Men & HIV: insights from Sub-Saharan Africa
The JIAS released a Special Issue focused on Men & HIV during the AIDS 2020 Virtual. Guest Editors included Indlela EAB member, Anna Grimsrud, from the International AIDS Society and Tanya Shewchuk from the Bill & Melinda Gates Foundation. You can download an open access copy of the publication here.



 

The following article from the JIAS Special Issue  is of special interest as it tested a behavioural economics intervention to promote linkage to care in South Africa.

Does the provision of lottery-based incentives promote linkage to ART among men? The Lotto to Link study sought to find the answer in a randomized trial conducted in rural KwaZulu-Natal, South Africa. Compared to motivational text messages, they found that lottery incentives shortened the time to ART initiation among men by almost half. You can access the article here.
What have we published? 
You can access a copy of the article by Harsha Thirumurthy here.
You can access a copy of the article by Sophie Pascoe here.
You can access a copy of the article by Alison Buttenheim here.
What are we reading and watching? 
  • The article on Behavioral Welfare Economics by Cass Sunstein discusses whether people’s choices promote their welfare. You can access the article here.
  • The Atlantic: The Role of Cognitive Dissonance in the Pandemic (16 July 2020). Please click here to access the article.
  • Nudgestock 2020 is a global initiative and a world leading festival of behavioural science and creativity that took place on the 12 June. We recommend viewing the following videos that feature interesting insights from behavioural science:

INDLELA WEBSITE: Launch planned in the upcoming months 

NUDGE ASSOCIATES: Hiring posts to be advertised
Interested in learning more?
Send us an email at: Indlela@heroza.org
Follow us on Twitter at: @Indlela_SA
Connect with us on LinkedIn
Join us on Facebook
 

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