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.
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.
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.
We are proud to announce the launch of a new project to determine whether gamification, the use of game elements in non-game settings, can improve the sexual health of gay and bisexual men in California. The project is funded by the U.S. National Institutes of Health and is a collaboration between UC Berkeley, AIDS Healthcare Foundation, and UCLA. Our goal is to to encourage young high-risk gay and bisexual men to be regularly screened for HIV and other sexually transmitted infections (STIs) and to adopt safer sexual behaviors. The results from the study will provide guidance about whether interventions using gamification can reduce high-risk behavior and decrease the incidence of HIV and STIs among young MSM. Read more about the project in the UC Berkeley newsroom.
Congratulations to UC Berkeley students Nerissa Nance and Anna Najor for receiving prestigious summer research fellowships. Nerissa, a graduate student in the School of Public Health, received a Center for Global Public Health summer research fellowship to evaluate an intervention to enhance PMTCT services in Tanzania using community health workers. She presented her findings on Friday at the 2015 Global Health Research Fall Student Symposium; her talk was "Catalyzing Community Health Workers to Improve the Health of Mothers with HIV and their Infants." Anna Najor is an undergraduate student who was selected as a 2015 Minority Health/Global Health Disparities Research Fellow. Anna's research goal was to understand what motivates communty health workers in Tanzania, and how to leverage their skills and commitment to their communities in order to improve global health. She also presented the results of her research on Friday; her talk was entitled "What Makes Community Health Work Worthwhile?" Bravo, Ladies!
We are very pleased that our innovative research using patient-centered design and behavioral priming was featured in the Stanford Social Innovation Review over the summer. In an article led by Aarthi Rao, we describe how a patient-centered approach together with tools from the private sector can greatly enhance global health programs that require changes in attitudes or behavior. We apply this strategy to the problem of antiretroviral therapy adherence among HIV-infected adults in Tanzania. The patient personas and customer journeys featured in the article can be found here.
Congratulations to Ms. Lauren Ralph, former UC Berkeley doctoral student and epidemiologist at the University of California, San Francisco, who published a study today in the Lancet Infectious Diseases summarizing the association between women's use of hormonal contraception and HIV infection. Her meta-analysis of 12 observational studies from sub-Saharan Africa involving 39,560 women suggest that use of the injectable contraceptive DMPA increases a woman’s chance of becoming infected with HIV by 40% compared with women using other contraceptive methods or no method. No increased risk was noted for users of oral contraceptive pills, combined oral contraceptives, or norethisterone enanthate. “The moderate elevation in risk observed in our study is not enough to justify a complete withdrawal of DMPA for women in the general population”, cautions Ms. Ralph. “Banning DMPA would leave many women without immediate access to alternative, effective contraceptive options. This is likely to lead to more unintended pregnancies, and because childbirth remains life-threatening in many developing countries, could increase overall deaths among women.” She adds, “Further evidence regarding the magnitude and mechanisms of the DMPA and HIV link among high risk women, such as commercial sex workers and women in serodiscordant partnerships (where one partner is HIV-positive and the other is not), is urgently needed.” A remaining question is whether a randomized trial is warranted; you can read about our group's opinion on the proposed trial here.
Congratulations to graduate students Nancy Czaicki and Chris Andersen, UC Berkeley Center for Global Public Health Fellows. Nancy and Chris presented their research this Thursday at the 2014 Global Health Research Fall Student Symposium; Nancy's talk was "Incentives for ART adherence among people living with HIV in Tanzania: mechanisms of action," and Chris presented "Loss to follow-up among Option B+ patients in Shinyanga, Tanzania." Bravo!
Suneetha Kadiyala, a Senior Lecturer at the London School of Hygiene & Tropical Medicine, and Rahul Rawat, a Research Fellow at the International Food Policy Research Institute (IFPRI), describe the dangerous interaction between food insecurity and HIV/AIDS in this excellent Scientific American article. Suneetha and Rahul highlight their research on food insecurity among people living with HIV infection in Uganda, including an analysis we conducted demonstrating that poor diet quality is associated with low CD4 count and predicts mortality among antiretroviral therapy-naive HIV-positive adults. They also argue for livelihood programs which have the potential to sustainably support care and treatment programs and mitigate the negative household and community-level impacts of HIV/AIDS.
Read a short report about nutritional support provided by the World Food Programme (WFP) to AIDS-affected and other vulnerable families in Zimbabwe. After nutritional assessment, clients at local clinics meeting the criteria for assistance are referred to WFP and their implementing partners and receive Super Cereal, a nutritious fortified blend of maize meal, soya protein and micronutrients. They also get a monthly household ration of maize meal, vegetable oil and pulses. Some types of food assistance programs, similar to this one in Zimbabwe, have been shown to increase adherence to antiretroviral therapy among people living with HIV infection. Read more about WFP's HIV/AIDS-related programs here.