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 "customer journeys" here. 

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

Time to play? Members of our team present on gamification and HIV/AIDS

This week I attended the yth live conference in San Francisco. It was an phenomenal opportunity to learn about innovative applications of technology to improve the health of adolescents and young adults. One of the highlights was watching our team members Dr. Raluca Buzdugan and Reva Grimball present their sexual health promotion game for men who have sex with men in Mexico City, a project in collaboration with Mr. Sergio Bautista-Arredondo of the National Institute of Public Health in Mexico. Gamification's application to health was also demonstrated by Goalpost, a smoking cessation app that uses the power of social networks, game mechanics and medical research to help people achieve their goal of being smoke-free. Together the two applications are on the forefront of tools that combine game elements with education, behavioral economics, and psychology to improve health.
 

New study summarizing the link between hormonal contraception and HIV risk

Lauren Ralph

Lauren Ralph

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.

Can Sayana Press revolutionize injectable hormonal contraception?

The health group PATH is training health workers in Uganda to administer the contraceptive. Credit: Will Boase/Path

The health group PATH is training health workers in Uganda to administer the contraceptive. Credit: Will Boase/Path

Today The New York Times published an article about Sayana Press, a lower dose version of Depo-Provera, an injectable hormonal contraceptive given once every three months. Sayana Press is a single-use syringe designed to be portable and easy to use. It combines the drug and needle in one device that is easy to transport and use with minimal training. Globally, 41 million women worldwide use injectable hormonal contraception, and Depo-Provera is the most common injectable method. However, many women are late for their quarterly dose or miss it entirely. Sayana Press might help women receive doses on time by facilitating community-based distribution of the product (obviating the need to visit a health clinic) and because of its potential for women to administer themselves through self-injection. Although pilot studies are in their infancy, implementation research is needed to understand the demand for the product and whether it fulfills its promise to improve adherence. In addition, it will need to be monitored to determine whether it increases women's risk of HIV infection

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

Using incentives to increase demand for influenza vaccine

Although the Centers for Disease Control (CDC) recommends that everyone 6 months of age and older gets a flu vaccine every season, many people don't get vaccinated. Here's what Safeway is doing about it: offering a coupon for 10% off of your next shopping trip in exchange for getting vaccinated. From a public health viewpoint, this might be a very effective strategy to nudge people to get a vaccine for a disease they think they aren't susceptible to or can easily recover from, especially because the influenza vaccine best protects a population when a critical proportion of people are vaccinated (a concept called "herd immunity", explained in this nice video from Upworthy). The AARP speculates that retailers are willing to offer incentives like this one because of attractive profit margins combined with the increased likelihood that you'll buy other items in the store. Financial incentives such as these are known to increase the demand for a variety of health services, including vaccination, but the jury is still out about whether this strategy can achieve real impact on influenza transmission rates. What do you think?