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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.

Welcome to the latest edition of Indlela’s quarterly newsletter. Each quarter we share updates and announcements about Indlela’s activities as well as a collection of interesting reading materials related to behavioural economics and health. For more frequent updates, follow us on Twitter or visit the Indlela webpage. 

As we approach the holiday season at the end of a trying year, we wish you a safe and well-deserved time of rest with your loved ones. We look forward to connecting with you again in 2021!

  Project Updates
 Indlela Webinar - How to nudge  your HIV program to success

More than 60 participants joined our second webinar held on 13th October. We discussed behavioural economic principles and their application to HIV in South Africa, conducted a behaviourally informed “design sprint” to demonstrate how we will identify solutions during the upcoming workshops, and shared information about opportunities for collaboration with Indlela, including the upcoming BIT Development Virtual Workshop Series. You can view the webinar here and the presentation here.

Behavioural Insights Test (BIT) Development Virtual Workshop Series

Following the expression of interest, we selected more than 25 participants from 21 organisations to participate in the BIT Development Virtual Workshop Series that seeks to build behavioural economics capacity and supports the development of innovative solutions in HIV service delivery. Following a successful workshop launch on 3rd December, the workshops will continue into the first quarter of 2021. 

Getting to know the Indlela team
Harsha Thirumurthy: Indlela Co-Director
I am an Associate Professor of Health Policy at the University of Pennsylvania. At Penn I’m affiliated with the Center for Health Incentives and Behavioral Economics (CHIBE) and the Population Studies Center. I’ve also co-founded the Penn Development Research Initiative (PDRI), which brings together social scientists at Penn whose research focuses on low- and middle-income countries.

My research interests are at the intersection of economics and health in low- and middle-income countries. Working with researchers and public health practitioners in several countries in eastern and southern Africa, I have conducted studies of economic interventions and behavioural ‘nudges’ to promote various HIV-related behaviours. More recently I have studied policies and behaviours that are relevant to environmental health and non-communicable diseases.

Vision for Indlela: I’m excited about forming stronger ties with social scientists, health scientists, and practitioners who are interested in behavioural economics and are seeking to improve health outcomes. I am equally enthusiastic about the opportunity to embed behavioural science principles in the delivery of health services; this can result in meaningful progress in efforts to end HIV/AIDS.

Career Nudge: Between 2003 and 2005, in the early years of the scale-up of HIV treatment in Africa, I lived in western Kenya and conducted dissertation research on the socio-economic impacts of HIV treatment in rural settings. This sparked my interest in doing interdisciplinary research based on collaborations with local researchers and organizations. It also motivated me to do applied research that bridges the gap between economics and global health.

Biggest Achievements: Professionally, I take great pride in having formed research partnerships in Kenya and other countries that have led to co-authored papers and influenced health service delivery guidelines and practices. Personally, I’m grateful for my longevity (so far!) as a distance runner who is able to run competitively on the track and on the roads.

Sophie Pascoe: Indlela Co-Director 
I am a Principal Researcher and Epidemiologist at HE2RO since 2015 and the Co-Director for Indlela here in South Africa. I am also co-editor for the Journal of International AIDS Society and have a joint appointment with the University of Witwatersrand.

My research interests have focused on the implementation of differentiated models of care and their impact on resource utilization and health outcomes among HIV patients. More recently I have led studies exploring preferences of adolescents and men for accessing HIV services. Behavioural economics and the application of behavioural insights to develop nudges that might lead towards better health outcomes is a new area in my research portfolio and one that I am particularly excited about growing and developing!

Vision for Indlela: I am excited about the various Behavioural Insights Test (BIT) projects we are already exploring with stakeholders. It is so exciting to be building these interdisciplinary collaborations, to see BIT projects launched, and to see the impact these nudges might have on achieving the desired HIV health outcomes in South Africa (SA).

Career Nudge: I started my career as a data scientist in a veterinary epidemiology department in the UK. I was working with some amazing veterinary epidemiologists who nudged me to do my masters degree. My interest in the area of HIV epidemiology was sparked and that, coupled with my love of Southern Africa developed over years of travel, nudged me to take up an Epidemiologist post with LSHTM in Zimbabwe. The relationships and collaborations I built whilst there motivated my PhD and my move to SA, setting the scene for my research interests and work over the last decade.

Biggest Achievements: Professionally, 
being part of the Indlela team and co-leading the launch of this initiative is one of the things I am currently most proud of. I really believe this initiative can help SA make progress towards its goal of ending HIV/AIDS. Personally, and I know it sounds clichéd, but my beautiful daughter (and getting her safely to 9 years old!) has to be my biggest achievement.

 Achievements of the Indlela team 
Congratulations to Alison ButtenheimIndlela Co-Investigator, for being acknowledged in Forbes as one of the 10 Behavioral Scientists You Should Know
Sophie Pascoe is a Co-Chair for the Epidemiology and Public Health Track for the 10th SA AIDS Conference 2021. The closing date for abstract submissions is 23rd February 2021.
What have we published?

Brendan Maughan-Brown co-authored this manuscript in Social Science & Medicine describing a mixed methods discrete choice experiment targeting suboptimal ART adherence among adolescents in Cape Town, South Africa. The results showed that conditional economic incentives could help young persons living with HIV overcome barriers to treatment adherence. 

Harsha Thirumurthy and colleagues published an article in BMJ Global Health that reports the results of a randomized controlled trial of simple calendar “planning prompts” to promote HIV testing among men in rural Uganda. The planning prompts encouraged men to voluntarily make a plan for when they wanted to test at upcoming community health campaigns in their area. This study could serve as a model for how inexpensive nudges can be implemented and rapidly tested in the context of HIV service delivery.

What are we reading?
This article in Science magazine shows that an incredibly simple redesign of a criminal summons form that highlighted critical information and providing text message reminders increased the likelihood that defendants would show up to their appointed court date, thus reducing arrest warrants for failing to appear in court.
If you would like to know more about nudges, please access Rohit Kahul’s database of 100 nudge case studies and research reports that includes a title, category, description, type of nudge and citation of the research papers.
Cass Sunstein released his new book entitled Behavioral Science and Public Policy which covers a range of topics targeting those who are new to behavioural science and those who are familiar with this area of research. The full book is available for download at the above link. 
What are we listening to? 

In 2018, Janet Fleischman from the Center for Strategic & International Studies interviewed Quarraisha Abdool Karim. Although two years later, some of the social and economic risk factors driving the HIV epidemic are still relevant today. For more information listen to the CSIS podcast entitled "Take as directed": Drivers of the HIV Epidemic in South Africa

Craig Fox, behavioural scientist at UCLA, and author of “Details matter: predicting when nudging clinicians will succeed or fail” explains why he thinks nudging could work in medicine on the BMJ podcast entitled Nudge It.

What are we watching?
Sheena Lyengar is a leading expert on the psychology of choice. She explores the challenges humans face in a world where a multitude of choices are available in her recent talk at the University of Pennsylvania, entitled Re-thinking the Value of Choice.
Médecins Sans Frontières/Doctors Without Borders (MSF) is recognised as one of the pioneers of providing Antiretroviral Treatment (ART) in the public sector. In this video, MSF Looks Back on 20 Years of HIV Work in South Africa.  

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