CASH TRANSFERS AND HIV EPIDEMIC CONTROL

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It is increasingly recognized that financial incentives can motivate behavior change and improve outcomes along the HIV care continuum. Under the right circumstances, financial incentives can increase the demand for HIV testing, change short-term sexual behavior, enhance linkage to care after HIV diagnosis, and promote antiretroviral therapy (ART) adherence. However, there are few studies of cash transfers’ effect on adherence and/or retention among people living with HIV infection (PLHIV) in Sub-Saharan Africa, which has the greatest burden of HIV and faces persistent challenges with poverty and food insecurity. Our team is leading a five year study to rigorously evaluate short-term cash support during the vulnerable period of HIV treatment initiation, support the development of good adherence habits, and protect individual and household welfare.

Cash and food assistance for people living with HIV infection

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Innovative Strategies for Behavior Change

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What’s the best way to encourage people to adopt healthy behaviors? From HIV and sexually transmitted disease testing to contraception, our team draws on innovative methods from behavioral economics and psychology to increase utilization of sexual and reproductive health services and to help people make more informed choices about their health behavior. We’re particularly interested in interventions that incorporate cash and in-kind incentives, social networks, social norms, gamification, and behavioral priming. 

Ongoing study (NCT02946164) of Stick To It, an intervention for men who have sex with men that uses gamification to encourage HIV and STI screening.

Recent study about patient-centered design and ART adherence, featured in the Stanford Social Innovation Review

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Human centered design for global health 

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Human-centered design is a creative, empathetic methodological approach from business and marketing. It draws on ethnographic methods and is characterized by rapid prototyping and testing of candidate solutions. The strength of human-centered design lies in its ability to reveal how individual motivations, preferences, and behaviors are shaped by everyday dynamic and often fleeting influences. Our team uses human-centered design to match innovative behavior change tools from behavioral economics and psychology with behavioral barriers, like suboptimal adherence to HIV treatment or poor demand for contraception. Especially when coupled with rigorous evaluation, we believe that the combination of design thinking and behavioral science is a powerful tool to rapidly identify, refine, and evaluate solutions to the major behavioral challenges in global health.

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Prevention of Mother-to-Child HIV Transmission

Although the number of infants born each year with HIV infection has declined dramatically over the past three decades, in 2015, between 110,000 and 190,000 children were newly infected with HIV. Our research team is leading the impact evaluation of Zimbabwe’s Accelerated National PMTCT Program, which is being implemented by the Zimbabwe Ministry of Health and Child Care. The evaluation (PIs: Nancy Padian and Frances Cowan) consists of serial cross-sectional community surveys of mother/caregiver-infant pairs residing in five of Zimbabwe’s ten provinces. We collect data about mother-to-child transmission, unmet need for contraception, and gaps in the “cascade” of PMTCT services in order to evaluate the effect and cost-effectiveness of the accelerated program. 

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