Socio-Behavioural Research Division
Key Personnel: Linda-Gail Bekker, Millicent Atujuna, Rebecca Marcus, Laura Myers, Philip Smith, Tiarney Ritchwood
While DTHF is a largely biomedical research organisation, it recognises the intrinsic value of socio-behavioural research and input in every facet of its work. Understanding the complex drivers of human behaviour is an essential requirement for successful implementation of any biomedical, behavioural or structural intervention promoting HIV prevention or treatment. Socio-behavioural research reveals critical insight and contextual understanding that other methods can fail to attain. Sexual behaviour, relationship patterns and the variable uptake of health services are, after all, situated within gendered, cultured and economic experience. The provision of support interventions to patients and engagement with the communities in which we work is also enhanced by socio-behavioural input. The social behavioural division seeks to understand the complex drivers of human behaviour underlying successful HIV treatment and prevention.
The division is currently exploring a number of issues relating to: treatment adherence, decision making in prevention, acceptability of emerging prevention technologies, community understanding of partially effective prevention, behavioural economics in HIV prevention, and community engagement.
A significant achievement has been the steady increase in the number of projects the division has secured. Some of these projects are conducted as formative work and will inform product developers of what people really want in an HIV prevention method. The core socio-behavioural team is increasing its contribution to published work through a greater focus on writing up project findings than conducting fieldwork. The division is working to establish a network of scientists and collaborators in the field with whom we are beginning to plan and develop new research proposals.
Current Projects and Initiatives
The division is also involved in implementation science with studies like Girl Power, which investigates the feasibility and effectiveness of providing different combination HIV prevention and sexual reproductive health packages. Retention in empowerment workshops is assessed with and without cash transfers . This centres around young women attending four public health clinics in the Klipfontein/Mitchells Plain sub-district. In 2017, this pilot study will be scaled-up to reach 10’000 young women through Women of Worth, a component of The Zimele Project.
DTHF partnered with IAS and the Children’s Radio Foundation in facilitating a series of focus groups and participatory media workshops with youth in South Africa, Zambia, and Tanzania to document youth perceptions of HIV prevention and treatment programs. These workshops yielded media content for a digital social media campaign called Youth Voices which advanced a youth voice to speak directly to policy makers and funders in advance of and at the AIDS 2016 conference.
The DTHF runs mobile diagnostic units: the Tutu Tester and the Tutu Teen Tester, which provides free comprehensive healthcare and counselling services to youth in the underserviced health sub-district of Klipfontein/Mitchells Plain. Services include HIV, TB and STI screening, as well as a wellness package that includes assessment for diabetes, hypertension, obesity, cervical, breast and testicular cancer. Health advice and treatment referral is additionally provided where appropriate. Studies are being conducted to assess the impact of economic incentives and/or text messages on linkage to HIV/TB care following mobile HIV and TB screening. Additionally, the feasibility and acceptability of HIV self-testing kits among adolescents and young adults is being accessed.
Currently, there is an STI test-and-treat study that aims to investigate the feasibility of point-of-care testing for STIs at youth friendly clinics
There is also an intervention programme to assist the transition to and retention of HIV positive youth in adult health care is scheduled for 2017.
Behavioural and decision making
Behavioural studies research how people make decisions around HIV and TB. whether that be treatment or testing. They explore the social determinants of adolescent engagement in HIV care post HIV testing and counselling
The department conducts interviews and surveys in the first phase of the Power Study, to develop a ‘mental model’ of what influences young men and women’s decisions on how to prevent HIV. These findings will inform the next phase of the Power Study in which up to 1,000 young women will receive PrEP via the Tutu Teen Truck in an open label demonstration project.
The division conducted critical formative research in both:
- The 3P’s for Prevention study (Push for funding, Pull in adherence with incentives and Pool data) is a program that is developing affordable, effective new drug regimens to treat TB.
- CHAMP (Tuberculosis child multidrug-resistant preventive therapy) is a study that accesses a child’s risk of developing TB while living with someone who has recently had MDR-TB.
The division is also involved in a number of HPTN (HIV Prevention Trials Network) and MTN (Microbicide Trials Network) studies, whereby qualitative assessment of adherence to biomedical HIV prevention tools, such as PrEP, are evaluated. Cognitive interviewing is used here to assess the validity of behavioural measures used in clinical trials. The Target User Product Preferences (TUPP) aims to aid preparations for new biomedical HIV prevention technology implementation amongst target user groups (including heterosexual adults, adolescents, and MSM) in South Africa by assessing different possible delivery systems for prevention products and gathering context-specific marketing expertise from country leaders. Similarly, the iPrevent study is identifying factors to optimise adherence to injectable HIV prevention products, which are currently in the early stages of development and clinical testing.
Philip Smith is currently investigating behavioural economics towards a PhD in behavioural medicine. In South Africa, many potential healthcare service users do not engage with lifesaving healthcare services until they are ill and symptomatic, and in need of complex interventions (van Schaik, Kranzer, Wood, & Bekker, 2010). Health services need to improve by bridging the gap between healthcare facilities and services users. The doctoral work investigates small changes in service provision which increase the uptake of health behaviours, such as early detection behaviours and linkage to care. Through the use of salutogenic and behavioural economic frameworks this doctoral work investigates: What do adolescent service users want from a healthcare service? Is an automated follow-up text message service to communicate with patients post-visit based on their medical feasible and acceptable? Will a text message follow-up increase linkage to care? How do incentives influence linkage to care?