CHIBE To Establish First-of-its-Kind HIV ‘Nudge Unit’ in South Africa

Two CHIBE directors have received a grant from the Bill and Melinda Gates Foundation to establish a first-of-its-kind nudge unit focused on HIV prevention in South Africa.

With support from the Bill and Melinda Gates Foundation, the University of Witwatersrand’s Health Economics and Epidemiology Research Office (HE²RO) and CHIBE are launching Indlela: Behavioural Insights for Better Health. (“Indlela” means “the way” or “the path” in Zulu.) Harsha Thirumurthy, PhD, Associate Director of CHIBE, and Alison Buttenheim, PhD, MBA, Associate Director of CHIBE, will co-lead this three-year initiative with their colleagues at HE²RO.

In the past decade, a number of governments and health systems globally have used behavioral science and rapid-testing of interventions to improve the efficiency of programs by forming “nudge units” to help develop low-cost interventions that have successfully resulted in behavior change and improve health care delivery. The Indlela Unit is founded on the premise that there is plenty of potential for behavioral interventions to make a difference for HIV prevention in South Africa.

“I’ve seen nudge units be spectacularly successful at addressing behavioral barriers in multiple policy domains in high-income countries,” Dr. Buttenheim said. “It’s exciting to have the opportunity to partner with researchers and HIV service providers in South Africa in leveraging the same behavioral science strategies and toolkits to improve testing and treatment outcomes.”

In the Indlela Unit’s first 3 years, the focus will be on (a) building capacity to expand the use of behavioral economics within HIV prevention and treatment programs in South Africa, and (b) strengthening the ability of health service delivery providers and researchers to develop and test contextually appropriate interventions that are informed by behavioral science principles. In future years, the unit’s scope will expand beyond HIV to include other pressing public health issues in South Africa.

The main objectives of the Indlela Unit will be to:

1. Increase knowledge and application of key behavioral economics insights among organizations delivering or supporting the delivery of health and HIV services.
2. Strengthen the technical capacity of local institutions to support government and implementing partners in developing and testing behavioral economics solutions.

The Indlela Unit will initially focus on developing and testing behavioral solutions that increase uptake of HIV testing, linkage to HIV care, re-engagement in HIV care. Over time, the team sees significant potential for the focus to expand to other health-related problems that are influenced by human behavior. The Indlela Unit will begin by undertaking the following activities during the first 3 years beginning in 2020:

1. Workshops for researchers, HIV service delivery providers and those supporting implementation of the HIV program. These will introduce principles of behavioral economics with concrete examples of how they can be used to develop simple, low-cost interventions. The unit seeks to engage researchers, implementing organizations, and officials from provincial and national governments.
2. Supported pilot grants. This will support sustained engagement with workshop stakeholders and practical application of behavioral economics. We will oversee a pilot grant program in which researchers and implementers who participate in the workshops can test behavioral interventions in HIV testing and care.

“This grant from the Bill and Melinda Gates Foundation provides an opportunity to greatly enhance the use and impact of behavioral economics ideas in ongoing efforts to reduce the burden of HIV in South Africa. We look forward to working with colleagues at HE²RO and other organizations that lead HIV research and implementation,” Dr. Thirumurthy said.

In addition to serving as an Associate Director of CHIBE, Dr. Thirumurthy is also an Associate Professor of Medical Ethics and Health Policy at the University of Pennsylvania’s Perelman School of Medicine.

Dr. Buttenheim is the Patricia Bleznak Silverstein and Howard A. Silverstein Endowed Term Chair in Global Women’s Health, Associate Professor of Nursing in the Department of Family and Community Health at the University of Pennsylvania School of Nursing, Associate Professor of Health Policy in the Division of Health Policy in Perelman School of Medicine, and also Director of Engagement at the Leonard Davis Institute of Health Economics.