Marrying Empathy and Science to Spread Impact

Although our team specializes in rigorous evaluation of health programs, but we also love to design new interventions. Check out our Stanford Social Innovation Review article about the creation of more effective, equitable, and scalable sexual and reproductive health programs with design thinking and behavioral science: "Mapping design-thinking insights to evidence-based behavioral principles can reveal strengths and weaknesses in service design..... This worked well in our past work to drive HIV treatment adherence using patient-centered approaches, and we’ve continued to employ this approach to broader, market-blocking norms." Intrigued? Check out the full article to learn how to design for scale, thereby maximizing impact and access for vulnerable groups. Congrats to our amazing team that’s helped us build this model over many projects and years!

Malkia Klabu (“Queen Club”) is a loyalty program designed with and for young women (like this young woman from Shinyanga, who is on our Youth Advisory Board) to address multiple structural and psychological barriers to accessing sensitive health products. (Photo by Lauren Hunter)

Now Hiring!

Join our research team in California or Tanzania! Read below about two opportunities for doctoral-level scholars in our research group. 

1. We're hiring a full-time postdoctoral researcher at UC Berkeley to develop, lead, and collaborate on health-related projects in California and in sub-Saharan Africa. Learn more about the opportunity here. The ideal candidate loves exploring data, has a strong foundation in epidemiology and biostatistics, and has experience leading projects using techniques from causal inference, econometrics, or related disciplines. At the same time, the ideal candidate also has a passion for fieldwork and data collection, working in global settings (particularly in sub-Saharan Africa), collaborating with a diverse team, and applying new and innovative approaches to global health (e.g., human centered design, machine learning). Applicants with demonstrated research productivity are especially welcome. The specific duties of the position include: leading independent statistical analyses, writing peer-reviewed manuscripts, supervising observational and experimental epidemiological studies, and developing and contributing to research proposals.

2. The application cycle for the Global Health Equity Scholars Fellowship is now open! We welcome applications from both Tanzanian and U.S. scholars who want to conduct research at our research site in Shinyanga, Tanzania. The Global Health Equity Scholars (GHES) fellowship is 12-month mentored research fellowship sponsored by the Fogarty International Center (FIC) and several collaborating institutes and centers at the National Institutes of Health (NIH).  The GHES program brings together a consortium that includes the University of California, Berkeley,  Florida International University, Stanford University and Yale University, in collaboration with 37 partner institutions in low-and-middle-income countries (LMIC). Learn more about this exciting opportunity here. Applications will be accepted online from August 15 to November 15, 2018.

Launch of AmbassADDOrs for Health

PhD student Lauren Hunter

Dr. Sandra McCoy

Dr. Prosper Njau

Adolescent girls and young women (ages 15-24) in sub-Saharan Africa face the dual threats of HIV infection and unintended pregnancy that severely undermine their long-term wellbeing. However, despite the urgent need to reach young women with sexual and reproductive health services, health systems are often ill equipped to overcome the numerous barriers to health care services faced by young women. Our team, including Dr. Jenny Liu (UCSF), Dr. Sue Napierala (RTI International), and Dr. Prosper Njau (Health for a Prosperous Nation), is embarking on a new NIH-funded project to address this need in Tanzania. 

We will develop 'girl-friendly' drug shops (known as Accredited Drug Dispensing Outlets, or ADDOs, in Tanzania) as a venue where young women can access HIV prevention services and contraception. The motivation for this approach is the growing recognition that drug shops, which are widely located in urban and rural settings, can promote beneficial health behaviors, bridge gaps in health services, and mitigate health workforce shortages. Similar to our previous projects, we will use human centered design to select and refine the best solutions from behavioral economics to optimize the girl-friendly approach. 

We will evaluate these approaches in a pilot study in 20 drug girl-friendly drug shops.  We will measure whether there is demand for contraception and HIV self-tests and whether drug shops are a suitable venue for their distribution. We will also provide linkages to local health care providers in case a young woman requires a clinical evaluation (e.g., for HIV infection). Our long term goal is to provide guidance to the government and scientific community about whether community-based distribution of HIV testing at drug shops is an effective strategy for decreasing the incidence of HIV and unintended pregnancies among girls and young women. Read more about the NIH-funded project here. 

Launch of biometric mHealth system for patient tracking and distribution of cash transfers

Our research team reached an important milestone in May with the launch of an integrated mHealth system as part of our research study on the effectiveness of short-term cash assistance for people starting HIV treatment. Built by Rasello CS, the system was launched at four clinics in Shinyanga, Tanzania and includes a biometric patient tracking system, automatic delivery of cash transfers through all major mobile money providers (e.g., M-PESA), and collection of survey data. In a major departure from the paper- and cash-based methods of past research studies, when patients attend clinic visits for HIV care they now scan their fingerprint in the pharmacy and information about the visit date, antiretroviral therapy dispensing, and their next visit is digitally captured. Not only does this improve the accuracy of measures of retention in care and adherence, but it reduces the amount of missing data and ensures that patients receive cash transfers within 24 hours to their chosen mobile money account. Perhaps the most exciting feature is that it provides us with real-time data about patient behavior which can be used to improve the clinic experience and the effectiveness of our supportive programs. 

Next steps of our adherence research in Tanzania

We're very pleased to report that we've been given the opportunity by the U.S. National Institutes of Health to continue our work on HIV treatment adherence in Tanzania in collaboration with Health for a Prosperous Nation, the Ministry of Health, Community Development, Gender, Elderly, and Children, and Management and Development for Health. Over the next 5 years, we'll optimize the size and delivery of a short-term cash transfer and test its effectiveness for reducing HIV viral load in a cluster randomized trial. We'll use an innovative biometric delivery model linked to SMS and mobile banking developed by the communications firm Rasello. Read more about the new project here.

A week in Paris: The 9th International AIDS Society Conference on HIV Science

Sandi McCoy presenting on a Gates Grand Challenge Explorations project.

Jillian Kadota, Sandi McCoy, Carolyn Fahey, and Nancy Padian.

Carolyn Fahey presenting her work.

Jillian Kadota at one of her two posters.

This week our team traveled to Paris for the 9th International AIDS Society Conference on HIV Science where we presented our latest research findings. Doctoral student Carolyn Fahey presented her work on the effects of short-term cash and food assistance on food insecurity and labor force participation among HIV-infected adults in Tanzania (watch her presentation here and see her abstract #TUAD0204 in the abstract book). Recent MPH graduate Jillian Kadota presented an analysis that found that cash transfers do not increase the use of temptation goods like alcohol, a reassuring finding consistent with prior literature on cash transfers. She also presented an analysis which found that cash and food transfers work the best among those who were recently initiated on antiretroviral therapy and among the poorest patients, which may be related to the cost of transportation to the clinic. These data can be used to better design future cash transfer programs for people living with HIV infection in Tanzania and elsewhere. Lastly, we presented the results of our study that used human-centered design to develop an intervention using social norms and priming to improve adherence to antiretroviral therapy and retention in care among adults with HIV in Tanzania (watch the presentation here and read about the full study in PLoS One). We also published a two-part series on this study in the Stanford Social Innovation Review (see Part I and Part II). A very successful week for our research team and we are enthusiastic about incorporating the new ideas and perspectives we learned in Paris into our future work.

Can gamification improve global health?

See the post on Gamification and Global Health co-authored by Sandi McCoy and Dr. Raluca Buzdugan in the Berkeley Blog this month!

Congratulations Class of 2017!

Sandi and 2017 MPH graduate Ms. Jillian Kadota

Women in Shinyanga carrying firewood. Photo by J. Kadota.

Congratulations to the UC Berkeley School of Public Health Class of 2017! Our team's graduates will enter the workforce as newly minted epidemiologists and many will share their research this summer at national and international scientific meetings. Jillian Kadota is one such student. As part of her MPH summer internship, she spearheaded a multidisciplinary study in Tanzania to understand the effects of heavy load carrying on women's health. Jillian collected qualitative and quantitative information from women about how much water, wood, or other substances they carry every day and their self-reported health. She also weighed their loads, took pictures and videos to characterize their posture and gait, and asked a subset of women to wear personal devices to capture biometric data. With this information she plans to assess the potential health effects of heavy load carrying. This is an especially salient topic in East Africa where mechanized transportation is scarce and women and girls bear most of the carrying burden. Furthermore, musculoskeletal injuries - often related to carrying heavy loads - comprise the largest burden of disease globally; both the 1990 and 2013 Global Burden of Disease studies listed low back pain as the number one contributor to years lost to disability (YLD). You can read more about her work here and in an upcoming publication. 

More evidence on the benefits of incentives to improve health and welfare

Two of our former UC Berkeley students recently published new findings that describe how people in Tanzania use the incentives they receive in exchange for engaging in beneficial health behaviors. In a qualitative study led by Dr. Nancy Czaicki and published in AIDS Care, our team found that people living with HIV who received monthly cash or food assistance when they visited the HIV clinic reported myriad beneficial effects on household welfare. Participants reported that incentives were predominantly used for food, school fees, and investing in businesses. There were no reports of harmful events associated with the incentives. In a second qualitative study published in Social Science & Medicine, Dr. Jan Cooper examined how female sex workers in Dar es Salaam changed their behavior in order to receive a cash transfer conditional on staying free of sexually transmitted infections. Although many of the women had limited ability to insist on condom use with sexual partners, they reported substantial power over their work logistics, such as reducing the number of workdays and clients, that they leveraged to meet the conditions of the incentive program. This is an important new finding that adds to what we know about how incentives help women achieve health goals. Together, these studies add to the growing evidence base about the benefits of cash and other kinds of incentives for improving health and welfare in sub-Saharan Africa. 

Cash and food transfers improve adherence to HIV treatment and care

Our team is thrilled to announce the results of our randomized trial comparing the effectiveness of conditional cash and food transfers to improve adherence to antiretroviral therapy and retention in HIV care among adults in Tanzania. The study found that both food assistance and cash transfers increased adherence to treatment and reduced loss to follow-up, although cash transfers were more effective than food assistance after the incentive period was over. We also found that cash transfers cost less than food transfers, are easier to implement, and are often preferred by patients. The presentation at AIDS 2016 (Durban, South Africa) can be viewed here and the results are available starting January 2017 in the journal AIDS. The study was a collaboration between UC Berkeley, the Shinyanga Regional Medical Office, and the Ministry of Health, Community Development, Gender, Elderly, and Children. It was funded by the U.S. National Institutes of Health. 

The food basket evaluated in the study.