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December 2022 

Hello Indlela community! As we reflect on this past year, we are so proud of all that Indlela has achieved. In commemoration of World AIDS Day 2022, please see a video by Prof. Linda Gail Bekker (an Indlela EAB member) on learnings and achievements in the last 40 years of responding to HIV. We bring the year to a close on a high note, with our very own Dr. Sophie Pascoe featured on BBC Health Check and Indlela’s NUDGE Handbook promoted in The Behavioral Design Database by Habit Weekly!

We are also proud of Ms. Simamkele Bokolo who achieved a first author publication. If you missed Ms. Caroline Govathson's Viewpoint, “Is there a place for behavioural science in South Africa’s TLD transition programme?”, here is a link to this interesting opinion piece. Activities as part of Indlela’s Behavioural Hub are progressing well and we share news on our exciting in-person design sessions that took place with Anova Health Institute and John Snow, Inc. (JSI). Please join us on WhatsApp, follow us on Twitter, or visit our website for more updates!

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 2023 and if you think there are others in your network who have not yet joined the Indlela community please do feel free to share our newsletter with them or on your social media posts!

Highlights from Indlela’s Behavioural Hub

What is Indlela’s Behavioural Hub?

Indlela’s Community Panel has a new name! We are excited to introduce Indlela’s Behavioural Hub (B-Hub). Activities within the B-Hub include obtaining rapid feedback on intervention design, testing interventions and assessing knowledge, attitudes, beliefs and intentions of potential users through A/B tests, rapid surveys and contextual inquiry. Importantly, the B-Hub is not a longitudinal cohort but rather draws on different participants at various time points to provide feedback on a range of projects. Participants will be invited at least once per year to take part in an activity and we will follow-up with B-Hub members regularly to ensure engagement and retention. Read more about the B-Hub here. Below are two examples of projects that are currently taking place within the B-Hub. 

BRAVO Booster Test

According to the National Department of Health Social Listening Reports on COVID-19 vaccines, we noticed that certain individuals misunderstood the purpose of COVID-19 vaccine boosters. Some people were motivated to take the vaccine booster even though they were not vaccinated, as the term “booster” appealed to them, as they perceived the term booster to mean strength or better immunity.

Building on this report we drew a sample of 100 vaccinated and unvaccinated participants from the B-Hub to explore their perceptions and understanding of COVID-19 vaccines and vaccine boosters. We completed enrolments and conducted telephone interviews in just less than  a month (6 September to 3 October 2022) - this rapid pace of data collection is a key advantage of the B-Hub tests. 

Detailed results from this test will be on our website and shared soon.

Focus groups on PrEP persistence

Through the B-Hub, we have access to a diverse sample. In our next test we will invite a sample of gay men and other men who have sex with men to take part in focus group discussions (FGD) to explore their perceptions of PrEP and the role of cognitive bias in the decision to request, accept and continue on PrEP. We have ethics approval and conducted the FGD on 12 December. Results will be coming soon!

How can you get involved?

Do you have a new HIV-focused intervention that would be useful to test in a group of users before it is scaled? Are you interested in leveraging an existing sample to learn more about user perspectives to help improve your program? Do you have a question you want to pose to the community through a phone or interview conversation? Working with the B-Hub can offer rapid feedback and support your work. Send us an email if you are interested! 

If you are working on a project and need rapid feedback from users on a particular HIV behavioural intervention or programme, please reach out to us - we would love to learn more about your project and how we can support testing of interventions through the B-Hub. Please send an email to indlela@heroza.org.   

Project updates

Leveraging behaviourally framed demand creation materials to increase demand for HIV testing 

We are pleased to share preliminary results from the FPD BIT project that evaluated whether behaviourally informed HIV testing services demand creation material  increased demand for HIV testing at GP practices. You will find an overview of the project here

We distributed 11,471 brochures across 3 study arms - the recipient of care voucher, healthy lifestyle brochure and standard of care. Of the distributed brochures, 448 (4%) individuals presented at the GP practice for HIV testing. There were no differences between the study arms however, there was an increase in HIV testing uptake among GP practices that were centrally located and had greater visibility. Consistent distribution of demand creation material is likely to increase HIV testing uptake when the GP practices are easily accessible. Results are coming soon!

Design sessions with Anova Health Institute and John Snow, Inc.

Over this last quarter it was exciting to have the entire Indlela team meet in-person, including members from the University of Pennsylvania, Boston University, University of Cape Town, and HE2RO. During this time we hosted design sessions with Anova and JSI. We used this opportunity to brainstorm ideas to build on the current Anova BIT project and understand gaps in HIV self-testing with JSI. 

Indlela team achievements

We are very proud of Dr. Sophie Pascoe who was interviewed on the BBC World Service Health Check and spoke about Psychological nudges for HIV treatment. The U=U study and the Anova Fresh Start BIT project.


We were honoured to have Dr. Sophie Pascoe also present as the keynote speaker at the WeMove Adolescent Health webinar on 29 November hosted by the Desmond Tutu Health Foundation (DTHF) and IAVI and focusing on the important issue of how behavioural economics can improve adolescent health and research within this space. The recording will be uploaded to the WeMove webinar series YouTube channel.

Another highlight was having Indlela’s NUDGE Handbook featured on The Behavioral Design Database by Habit Weekly  


 

 
If you missed Indlela’s satellite session on Nudging our way to 95-95-95: a behavioural economics capacity building and implementation research initiative in South Africa at AIDS 2022, click here to view the recording.

Is there a place for behavioural science in South Africa’s TLD transition programme?

In 2019, following recommendations by the World Health Organisation, South Africa began transitioning from Tenofovir/Emtricitabine/Efavirenz (TEE) to a Dolutegravir (DTG)-based regimen, TLD (Tenofovir/Emtricitabine/Dolutegravir). Because the dolutegravir based regimen is more efficacious, better tolerated and is cost effective, its use could go a long way towards achieving South Africa’s HIV goals for epidemic control. In our latest viewpoint, we discuss challenges with South Africa’s TLD transition and outline options on how behavioural science can add value to the TLD transition program. Read more in the latest Indlela Viewpoint by Senior Nudge Associate Caroline Govasthon Mandimika here

What have we published?
Ms. Simamkele Bokolo and her colleague published a paper on Educators' perceptions on the benefits and barriers of oral PrEP uptake among adolescent girls and young women in Vulindlela, KwaZulu-Natal in Communicare: Journal for Communication Studies in Africa. The article explores the perceptions of educators on the related benefits and barriers to oral PrEP uptake among school girls. The authors highlight the need for more contextual community-driven communication strategies around PrEP, and the value of a community-centred approach to further enhance PrEP communication.
Dr. Sophie Pascoe and her colleague published a commentary in the HIV Lancet on Home delivery of ART: could this be a reality in South Africa? This commentary responded to a trial conducted in KwaZulu Natal on the home or workplace delivery of ART and highlighted the advantages and concerns with sustainability of this approach. Overall, it seemed that tailoring this model of home ART delivery to those who are early in their ART journey or those with mobility constraints could  be feasible and beneficial.
Prof. Harsha Thirumurthy and colleagues published an article in Current HIV AIDS Reports on Using Behavioral Economics to Support PrEP Adherence for HIV Prevention. This review shows that there are limited studies on addressing present bias, salience bias and affect for decision-making related to PrEP adherence. Applying behavioural science concepts to PrEP dissemination programmes could help target key populations and tailor programmes to encourage PrEP adherence and prevent new HIV infections.

In collaboration with Ezintsha, Prof. Harsha Thirumurthy and Ms. Laura Schmucker co-authored a second study that tested an incentive for reporting HIV test results, showing that financial incentives and reminders were not effective in promoting engagement with HIV care and viral suppression in this setting. The results were published in Frontiers Reproductive Health in this article: Incentives to promote accessing HIV care and viral suppression among HIV self-screening test users who obtain a reactive result.

Prof. Alison Buttenheim, Ms.Laura Schmucker and Prof. Harsha Thirumurthy co-authored a PLOS Global Public Health article with Ezintsha entitled Planning and commitment prompts to encourage reporting of HIV self-test results: A cluster randomized pragmatic trial in Tshwane District, South Africa. This cluster randomised trial leveraged a simple commitment prompt to increase reporting of HIV self-test results. The study found that boosting the reporting of HIV self-test results can be done solely through increasing the salience of reporting and a clear explanation on steps to follow when reporting results.

 Behavioural Science and HIV Resources

USAID released an article on Nudging our programs to reach HIV Epidemic Control which highlights the potential of behavioural science in identifying innovative ways to reach and sustain HIV epidemic control. There is opportunity to intentionally incorporate behavioural nudges in HIV prevention and treatment programmes to make the last mile in reaching the 95-95-95 UNAIDS target and beyond


Habit Weekly released the Behavioural design 2022: State of the Field Report focusing on the building blocks of impactful behavioural design. The report includes thoughts, experiences and priorities of global industry leaders on what makes for good behavioural science teams, user research, and behaviour change interventions.


New to behavioural science or need a refresher? An important step in planning behavioural interventions, identifying and understanding health behaviours and the context in which they occur, is to map the client journey. The process helps clarify points in the journey at which more complex decisions can be simplified through choice architecture and behavioural science principles. In this blog by Jennifer Clinehens on How to apply behavioural science principles to journey mapping, you will find information on client journey mapping, and behavioural tools and frameworks to guide the design of improved client experiences. With great examples and simple explanations, this content is easy to follow and a useful reference.

In this Lancet HIV podcast, Peter Hayward interviews Dr. Kenneth Ngure from the Jomo Kenyatta University on PrEP roll-out in Kenya. Dr. Ngure also provides information on a trial that was aimed to establish the efficiency of semi-annual PrEP clinic visits supplemented with interim home-based HIV self-testing (HIVST) compared to standard of care for HIV testing, drug refilling, and adherence among PrEP users.The findings provide evidence for simplifying PrEP delivery and supports a differentiated model for PrEP delivery with interim HIV self testing. [est listening time 12 min]


Shame, failure, breaking points and demotivation in care recipients on medication for multiple comorbidities can lead to treatment interruptions and health deterioration. In this podcast on Solving Patient Care Challenges Using a Psychological Approach, Ada Lê from BE Works interviews Dan Ariely to share thoughts on these behavioural barriers and strategies to improve care recipients’ treatment uptake, consistent use and adherence to medication. [est listening time 18 minutes]

In this entertaining and educational webinar on Designing for scale Prof. John List speaks to the fundamentals of examining successful experiments for their viability at scale. Using simple language and easy to understand examples, he makes reference to specific criteria to consider when scaling lab or field experiments to real life settings, which also highlights pathways to integrating implementation science and behavioural economics concepts. The second part of the webinar is an interesting panel discussion with Prof. Rinad Beidas, Dr. Mitesh Patel, Dr. Srinath Adusumalli and Dr. Kit Delgado. [est watching time 85 minutes]
                                 


 In this video on PEPFAR's Flip the script: Mary Saizi the ART champion works for the PEPFAR-supported Flip the Script treatment literacy campaign. This visual tool using glass bottles and simple red and black beads is a mechanism to educate people living with HIV about antiretroviral treatment (ART). Even though ART is a life-long commitment, people on treatment can still live normal and healthy lives. [est watching time 2 minutes]

                                    

Coming soon!

Updates on Indlela's BIT projects
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Updates on tests from Indlela’s Behavioural Hub
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Release of Indlela’s NUDGE Handbook 2.0

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