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

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

CTC staff instructing a  a patient about pill box.jpg

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.

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. 

The food basket evaluated in the study. 

Can gamification help prevent HIV infection?

The UC Berkeley, AIDS Healthcare Foundation, and UCLA team. 

The UC Berkeley, AIDS Healthcare Foundation, and UCLA team. 

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 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 "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

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.