aids 2014 ilovelife satellite presentation
DESCRIPTION
This is loveLife's new behaviour change product, iloveLife. Please contact [email protected] for more information on how it worksTRANSCRIPT
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loveLife’s Mobile Conditional Incentive Programme:
iloveLife
23 July 2014
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4 Introduction to loveLife
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loveLife
• Driven by youth volunteers called groundBREAKERs and mpintshis
• Footprint in South Africa:
8000schools
900sites
532 government
clinics
>300 franchised
community-based
organisations22
YouthCentres
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Risk Construct
Individual
• LOW SELF-ESTEEM• NO SENSE OF FUTURE• UNCERTAIN IDENTITY
Helplessness in the face of challenges
Social
• COERCION• PEER PRESSURE• LACK OF PARENTAL
COMMUNICATION• EXPECTATIONS OF
WOMANHOOD• MALE SENSE OF ENTITLEMENT
Pressure to acquiesce
Perception of scant opportunity
HIGH RISK TOLERANCE
Structural
• POVERTY• LOW EDUCATION• MARGINALIZATION• INEQUALITY
Sense of constrained choices
EARLY SEXUAL DEBUTUNSAFE SEXMULTIPLE SEXUAL PARTNERS
RISKY SEXUAL BEHAVIOUR
Possible HIV INFECTION
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loveLife Evidence
RHRU (2011) now WRHI HSRC (2012)
loveLife awareness amongst 12-19 year olds : 85%
loveLife awareness amongst 12-19 year olds : 90%
Reach of loveLife face-to-face programmes to 12-19 year olds : 20%
Reach of loveLife face-to-face programmes to 12-19 year olds: 33,5%
Studies1 show adjusted odds ratio for HIV infection amongst those that participated in a loveLife programme:- 0.61 for young women- 0.60 for young men
1- Pettifor et al., AIDS 19 (2005)
Significant links with participation: - Self-reported HIV negative status- Male circumcision- Male contraceptive use- Self esteem- Decreased stigma- Greater sense of future and self-
efficacy
97% of youths reached say ALL youth should participate in loveLife programmes
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4 Rationale for iloveLife
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HIV and Social Determinants
• Two-year experiment in Zomba, Southern Malawi, using cash incentives in households with schoolgirls aged 13-22
HIV prevalence
Control Group Incentivised Group
3.0% 1.2%
Marriage40% lower
Sexual Activity38% lower
Pregnancy30% lower
Conditional cash transfer results:
• Improve school attendance• Reduce sexual activity• Reduce teenage pregnancy• Reduce early marriage
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Rationale
• Similar approaches conducted in other countries:
• Offered conditional cash, grocery vouchers, nutritional supplements, educational subsidies
• Conditional reward successfully applied worldwide across education, social welfare, and health care with South Africa as a forerunner
2-The impact of conditional in-kind subsidies on preventative health behaviours: Evidence from Western Kenya. July 2005. Pascalis Dupas, EHESS-PSE.
• Study in Kenya2 incentivised visits to healthcare facilities • 117% increase in prenatal care services• 84% increase in HIV testing• 58% increase in follow-up visits to prenatal clinics
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Rationale
• Discovery Health (SA’s largest private health insurer) launched Vitality in 1998
• Incentive and reward based wellness program with statistically significant effects:3
• Lower costs per patient• Shorter hospital stays• Lower admission rates for engaged members• Lower chronic disease costs amongst engaged members
Bottom Line
Three consecutive impact sessions shared a clear association between increased vitality engagement
and lower health care costs
3-Discovery Vitality Journal: Reducing the cost of healthcare through lifestyle intervention. 2008
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• Group identity formation around the concept of a “crew” or “posse.• Girls in crew affirm each other, reinforce positive and negative
behaviours.• Sexually very assertive (e.g. “Foxy Chix”; “Pussy Gals”).• Celebration of femininity and group solidarity.
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Underlying iloveLife Design Principles
Premise for change
• Interrelated individual, social, biological and structural factors associated with high HIV infections amongst young women
• Prevention intervention to address different drivers of sexual risk
• iloveLife design must provide content and activities that address these drivers
Research
• Qualitative and Quantitative research conducted by McPhail et al. (2013) indicated young women found transfer incentives acceptable and feasible
Key Consideration
• Decrease immediate implications of risky sexual behaviour by increasing future reward
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Underlying iloveLife Design Principles
I
Focus on specific age
group
Achieving scale rapidly
Individual, social &
structural drivers of
HIV
New gains to be captured
by doing things
differently
Best evidence & models of
projected impact
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Audience demands
ENGAGEMENTRECOGNITION
REWARDSCONTENT
ENTERTAINMENTSTIMULATIONINFORMATION
SEAMLESS SYSTEMS
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4 Programme Design
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Introducing iloveLife
OverallGoal
Reduce new HIV infections among youth
by 15% over 3 years
• Incentivise young people to engage in healthy behaviours and responsible lifestyle choices
• Increase knowledge and understanding on HIV / AIDS and sexual reproductive health
• Develop self-efficacy among participants to seek helpful services:• Voluntary medical male circumcision (VMMC)• HIV counseling and testing (HCT)• Contraceptives• STI treatment
Main objectives:
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User Journey
• Implemented on mobile phones:– Through USSD technology via subscription – Or sign up via ilovelife.mobi
• Simple sign up process • Create a profile • Access to all content
Sign up
• User rewarded for 2 types of behaviour:• 1. Online activities • 2. Real World activities
Points
• Receive e-voucher from points earned• Redeem e-voucher at store Reward
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Online and Real World Activities
• On site / online activities include:• Reading, commenting on and sharing articles and videos • Taking part in online quizzes and polls • View memes such as bitstrips and images
Online Activities Example Activities Points
Mod 1: Promotion of delayed sexual debut
and condom use at first sex
Reading and sharing/commenting on compelling content that promotes delaying sexual debut
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Online quizzes 5
Participation in campaigns and competitions 10
loveLife programme participation and activations (i.e., loveLifestyle and games)
25
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Online and Real World Activities
• Real world activities include:• Clinic visits • HIV status check ups • Participation in loveLife events games
• Unique codes are generated for specific real world activities
Real World Activity Example Indicator Expected Outcome Reward Frequency Evidence/
Verification Reward Rating
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4 Programme’s M&E
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Expected Results
Increased sense of access to
things young people
Reduced transactional
sex relationships
Reduced age differences in
sexual
Reduced HIV incidence
among young people
Increased access to Healthcare
services (i.e. HCT, STI etc.)
Increased sense of purpose
among young people
Reduced levels of school drop-
out’s
Increased school
attendanceIncreased number of
young people who complete
Grade 12
Increased self-esteem and positive self-
image
Increased awareness of
riskDelayed sexual
debut
Increased condom use at
first sex
Increased uptake of
VMMC services
Increased consistent
condom use
Results
loveLife contact centre and online-media services
Online Content-messages/interact
ionIncentives
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Theory of Change
Delayed sexual debut
Reduction of sexual partners
Increased VMMC
Increased condom use
Suppressed viral load
Increased uptake of ART
Increase VCT
Reduced HIV incidence in young people (12-19)
Reduced inter-generational and transactional sex Increased school attendance
Impact
Behaviour change
(outcomes)
Predictors of behaviour (outputs)
Increased SRHR
knowledge
Increased awareness of
risk
Changes in attitudes (e.g. shared
responsibility)
Increased self-esteem
Increased self-efficacy to seek help
Increased sense of purpose
Increased sense of access to resources
Key Activities
Provide links to opportunities
Provide self-assessments
Provide forums and facilitate
interactions between users
Provide motivational messages and
motivational talks
Provide online quizzes
Provide content on SRHR
Provide special campaigns and competitions
Providing incentives for HCT and VMMC
Providing incentives for online
participation
Providing incentives for school attendance and school performance
Providing incentives for participation in clinical committees
and health talks
Providing incentives for real world programme participation
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Indicators at Output Level
Intervention Logic Indicators
Increased SRHR knowledge
% of young people (12-19) who both correctly identify ways of preventing sexual transmission of HIV and who reject major misconceptions about HIV transmission (in correlation to time and level of engagement with iloveLIfe)
Change in attitudes regarding discrimination of people living with HIV
% of young people (12-19) who agree with the statement “if a teacher has HIV but is not sick, he or she should be allowed to continue teaching” (in correlation to time and level of engagement with iloveLife)
Increased self-esteem Average score of young people on the Rosenberg Self-Esteem Scale (selected questions) (in correlation to time and level of engagement with the iloveLife)
Increased sense of purpose % of young people who report that they have many opportunities in life and that they have a good idea where they are heading in the future (in correlation to time and level of engagement with iloveLife)
Increased self-efficiency to seek help
% of young people who report that they know where to go if they need advice on SRH (formulation to be tested – in correlation to time and level of engagement with iloveLife)
% of young people who report that they have the confidence to test for HIV (formulation to be tested/defined) (in correlation to time and engagement with iloveLife)
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Indicators at Outcome Level
Intervention Logic Indicators
Condom use
% of young people (12-19) who report that iloveLife motivated them to use condoms more consistently
% of young people (12-19) who report that they always used a condom during sex in the last 12 month (intervention compared to control group)
Increased of HCT
No. of awarded rewards for HCT
% of users of rewards who report that the reward was important to motivate them to test
% of young people who report that they have tested for HIV in the last 12 month (intervention compared to control group or in correlation to engagement with iloveLife )
Reduction of sexual partners
% of young people (12-19) who report that iloveLife motivated them to use condoms more consistently
Self-reported number of sexual partners in the last 12 month (intervention compared to control group or in correlation to engagement with iloveLife)
Reduced transactional sex % of young people who report to have had transactional sex in the last 6 month (intervention compared to control group)
Increase school attendance
No. of awarded rewards
No. of young people who report that the reward motivated them to go to school
Additional indicator to be defined in coordination with the Department of Education
Live Demonstration
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Tel +27 (0)11 523 1000 Fax +27 (0)11 523 1001
48 wierda rd west, wierda valley, sandton, 2196P O Box 45 parklands 2121 south africa
[email protected] www.lovelife.org.za
Thank-you.