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Socio-Behavioural Research Division

Dr Millicent AtujunaSocio-behavioural Scientist

Thola BennieSocio-behavioural Scientist

Philip SmithProgramme Manager

Key Personnel: Linda-Gail Bekker, Millicent Atujuna, Thola Bennie, 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. As such, the socio-behavioural division is an essential part of the DTHF.

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 behaviours and community engagement in general.

Recent trial results confirm potential for new oral pre-exposure prophylaxis to prevent HIV-infection. New studies including injectable PrEP and PrEP plus cash incentives are now in progress. Qualitative and quantitative research work to better understand acceptability of and adherence to biomedical ARV-based prevention strategies (oral PrEP and microbicides) is taking place alongside large biomedical trials including HPTN 067 (oral PrEP), HPTN 076 (injectable PrEP), HOPE (and open label extension of ASPIRE MTN 020 (vaginal ring) and VOICE (oral PrEP and vaginal gel), involving subsets of participants from these trials. The 3P’s for Prevention and Power studies

Some of these new studies are conducted as formative work and will inform product developers of what people really want in an HIV prevention method.

PhD Research

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?

Thola Bennie is currently investigating adherence to study regimen among a key target population group of young women and men between the ages of 15 – 24, to help uncover some of the challenges of PrEP use. Her PhD topic is therefore an investigation into both barriers and facilitators of uptake and use of oral PrEP amongst youth who are participating in adolescent PrEP studies in and around Cape Town. Her PhD will highlight adolescent preferences for methods of HIV prevention and inform future dosing strategies that are suitable for young men and women. Thola is not only interested in investigating ways in which optimal levels of adherence can be achieved and maintained in clinical trials, but on finding strategies that will work post-licensure of PrEP, in real world settings.