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.
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.
I was very honored to participate in the 2015 UC Berkeley Center for Global Public Health Annual Symposium entitled “Making Cents, Making Change.” The one day workshop focused on economic innovations for adolescent health and wellbeing. The distinguished guest list included Fred Ssewamala, Associate Professor of Social Work and Director of the Columbia University International Center for Child Health and Asset Development, Dr. Lousie Fox, former Lead Economist at the World Bank (Africa Region), and UC Berkeley faculty members Dr. Ndola Prata, Dr. Doug Jutte, Dr. Ali Minnis, and Dr. Colette (Coco) Auerswald. One of the key discussions during the day addressed whether economic interventions are most likely to be effective and sustainable when delivered at the individual, community, or policy level.
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.
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.
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.
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!
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?
Very pleased to share two new papers from our research group that were published this month. The first, published in AIDS & Behavior, was led by Amanda Wheeler Singer about the detrimental relationship between food insecurity and adherence to HIV antiretroviral therapy. The second, published in PloS One, describes the unmet need for family planning among women with a recent birth in Zimbabwe.
A great World Bank blog post by Senior Economist David Evans on whether cash transfers given to the poor are wasted on alcohol and cigarettes. After reviewing 44 estimates of spending on alcohol and tobacco from 19 studies and 13 interventions (including Oportunidades/PROGRESA), David finds that the vast majority of estimates (82%) are negative. He concludes: "We should stop worrying that the poor are going to spend (or “waste”) their transfer income on alcohol and tobacco. They aren’t." This is good news for those of us interested in the overwhelmingly positive effects of cash transfers on health and welfare, including their potential for HIV prevention. However, this analysis was limited to alcohol and tobacco expenditures among households who were beneficiaries of government-run anti-poverty programs. In the HIV/AIDS realm, a study by Kohler and Thornton (2012) found that Malawian men given cash transfers were more likely to engage in risky sex shortly after receiving the transfer, although this finding has luckily not been replicated in other studies.