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 pro…

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)

Launch of AmbassADDOrs for Health

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. 

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

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.

Congratulations to 2015 Student Fellowship Recipients

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!

Research featured in the Stanford Social Innovation Review

This fictional persona represents a typical patient that belongs to the Courageous Fighter segment. Positive reinforcement and social support motivate these patients to adhere, despite the obstacles they face. See other personas and the accompanying…

This fictional persona represents a typical patient that belongs to the Courageous Fighter segment. Positive reinforcement and social support motivate these patients to adhere, despite the obstacles they face. See other personas and the accompanying "customer journeys" here. 

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. 

New project using behavioral priming to improve adherence to antiretroviral therapy

Our team recently received a Grand Challenge Explorations award, which funds individuals worldwide to explore ideas that can break the mold in how we solve persistent global health and development challenges. Our project is one of more than 60 Grand Challenges Explorations grants announced on November 4th by the Bill & Melinda Gates Foundation. We will explore whether behavioral priming, which involves using a stimulus to indirectly or subconsciously influence behavior, can promote adherence to HIV treatment in Tanzania. Our team includes Dr. Prosper Njau from the Ministry of Health and Social Work in Tanzania and Mr. Sergio Bautista-Arredondo from the National Institute of Public Health in Mexico. Read more about our project and the other Grand Challenge winners here. 

Is cash better than in-kind aid? Let's find out. →

In-kind Aid vs cash transfers. Source: Niehaus, presentation at Center for Global Development, 2014

In-kind Aid vs cash transfers. Source: Niehaus, presentation at Center for Global Development, 2014

Next time you donate money to buy a poor family a cow or give a seamstress a loan for starting a small business, ask yourself the following question: would it be more effective to simply give cash? Amanda Glassman, Director of Global Health Policy and Senior Fellow at the Center for Global Development, argues in this blog post that in many cases, cash is cheaper and more effective than in-kind aid. She suggests that funders should find out if their in-kind assistance does more good than cash at achieving their anti-poverty objectives, noting the success of charities like GiveDirectly. Whether the "cash is king" mantra holds in the HIV/AIDS context is the focus of our ongoing study in Tanzania.