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School & Program Updates

School & Program Updates

mHealth Tools and Incentives Based on Behavioral Economics Empower UNC Researchers to Help Reduce Risk of HIV Acquisition and Transmission

More than five billion people worldwide have smartphones, about three-fourths of the world’s adults. UNC Gillings School of Global Public Health researchers are harnessing these and other mobile devices to collect data and deliver interventions to help prevent HIV/AIDS.

muessig_pettifor_thirumurthy_smartphone pic by pabak sarkar
[Photo: (L-R) UNC’s Drs. Kate Muessig, Audrey Pettifor and Harsha Thirumurthy use mobile health tools or incentives based on behavioral economics to lower risk of acquiring or transmitting HIV. mHealth Platforms can build stronger social support among those who face stigma related to their sexual preference or HIV status. Smartphone photo by Mr. Pabak Sarkar.]

Dr. Kate Muessig, assistant professor of health behavior at the Gillings School, uses mobile health (mHealth) tools to reduce risk of HIV in North Carolina and in China and other countries. She also works on the development a peer-support and mHealth-enabled intervention for men who have sex with men (MSM) in China. The intervention aims to help those who are HIV-positive connect with medical care, including HIV treatment and other supportive services, such as substance use treatment or mental health services.

“Young, black MSM bear a disproportionate buden of HIV in the U.S. and are one of the only subgroups who continue to experience an increase in HIV transmission,” Dr. Muessig says. “The stigma they face poses added barriers to health-positive behaviors and deters access to health care and services. The use of Web- and cellphone-based platforms to build stronger social support among these young people offers a highly accessible and familiar medium for intervention. More than 90 percent have access to the Web and/or a smartphone.”

Dr. Muessig says her research aims to reach people where they are, using a technology and mode of interaction (e.g., social networking) with which they are already familiar.

UNC’s MEASURE Evaluation, based at the Carolina Population Center and staffed by a number of UNC Gillings School faculty members, leads an mHealth project, “Priorities for Local AIDS Control Efforts” (PLACE) study in the Dominican Republic. In the project, mobile tablets are loaded with the Open Data Kit, a mobile data-collection platform, to identify populations at high risk of HIV, common points of transmission and whether HIV services are available in high-risk areas. Mobile tables also were used to collect data for an organizational network analysis in Homa Bay, Kenya. That study aimed to strengthen the HIV referral network to ensure that patients who test positive will receive appropriate treatment.

Why do some people choose not to take actions that they know would protect or improve their health? Behavioral economics research provides one of the answers – people tend to focus upon immediate costs and benefits of taking certain actions, rather than on long-term benefits. Research increasingly has shown that relatively small rewards can spur action.

Two UNC Gillings School researchers are among those using behavioral economics to investigate whether people in sub-Saharan Africa will adopt behaviors that prevent acquisition or transmission of HIV.

Dr. Harsha Thirumurthy, associate professor of health policy and management, conducted two studies to assess the effect of providing different types of low-cost incentives to Kenyan men who undergo medical circumcision, an intervention proven to reduce the men’s risk of acquiring HIV. Dr. Audrey Pettifor, associate professor of epidemiology, conducted a six-year study examining the effect of cash transfers, conditional upon high school attendance, on young South African women’s risk of HIV acquisition.

Dr. Thirumurthy tested two types of incentives – a lottery-style incentive, through which study participants had the chance to win big prizes (from a $2.50 food voucher to a bicycle or smartphone), and a fixed compensation incentive, through which participants would receive a $12.50 food voucher if they were circumcised within three months. Although the hope of winning a prize (the lottery) was not as attractive as in some Western countries, the fixed incentive spurred 8.4 percent of the participating men to undergo circumcision, as compared to only 1.3 percent of the control group, which were offered no incentive other than being told it was preventive for HIV acquisition.

Five percent of South African girls have acquired HIV at age 15, and the infection rate climbs to 25 percent by the time the young women are in their early 20s. Ensuring that the girls attend high school regularly – and graduate – is one intervention that consistently reduces HIV infection risk.

“They can’t afford school fees, school uniforms and transportation costs,” Dr. Pettifor says. “They may be responsible for caring for family members or have certain household duties, so girls may be required to stay home while boys attend school.”

Dr. Pettifor found that cash transfers of $10 per month to the girls and $20 per month to their families reduced some risk behaviors and had an impact upon the girls’ having unprotected sex and experiencing intimate partner violence.  As Dr. Pettifor and colleagues had hypothesized, staying in school was protective for HIV infection. Young women who attended less than 80 percent of the time were three times more likely to acquire HIV during the study period.