The Trustees of the University of Pennsylvania

Behavioral solutions to end the world’s largest HIV epidemic Highly Ranked

Lead Organization

The Trustees of the University of Pennsylvania

Philadelphia, Pennsylvania, United States

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Project Summary

We seek to end the world’s largest HIV epidemic. We will scale up evidence-based behavioral interventions to increase uptake of HIV prevention and treatment services by a high-risk generation of 15-34 year-olds in South Africa. Major scientific breakthroughs in recent years have finally made it possible to imagine a world without HIV/AIDS. Highly effective, life-saving prevention and treatment services are widely available, but their success in reducing new HIV infections is hindered by the “last mile” challenge of human behavior: about 50% of individuals do not consistently use available HIV services. Proven, low-cost behavioral interventions to close this gap already exist but are not being implemented at scale. Our academic-public-private sector partnership will embed these interventions inside innovative service delivery models to durably increase HIV service coverage for the hardest-to-reach individuals. With strategic action now, we can end HIV in South Africa and create a pathway for global epidemic control.

Problem Statement

South Africa has the world’s largest HIV epidemic, with 7.2 million HIV-positive people and 19% HIV prevalence. An epidemic of this scale threatens not only population health but also economic well-being and gender equality. An end to the epidemic, however, is within reach. Following major scientific advances and an unprecedented mobilization of resources, there is now a biological path to eliminating new HIV infections. Treatment with antiretroviral medications, which protects the health of HIV-positive people and completely eliminates transmission risk, is widely available. So are HIV testing and highly-effective prevention services like medical male circumcision and prophylactic medicines. Despite these breakthroughs, South Africa is facing an HIV prevention crisis. Each day, 740 South Africans become newly infected. Young women face the greatest risk: each year, one out of 20 young South African women becomes infected. While HIV prevention efforts historically focused on reducing risky sexual behavior, ending the HIV epidemic now requires solving an altogether different problem. Due to common psychological barriers, decision-making factors, and information gaps, people do not seek available HIV prevention and treatment services. Nearly one in three HIV-positive people are unaware of their status or not taking treatment regularly. The hardest-to-reach persons are men and young people, who seek HIV services too late or not at all. Behavioral insights point to several bold, disruptive, and durable solutions that will motivate people to use HIV prevention and treatment services. If we deploy these low-cost solutions now, at scale, we can end the world’s largest HIV epidemic.

Solution Overview

We will scale up highly-feasible, evidence-based interventions to increase people’s use of existing HIV testing, prevention, and treatment services. Our three-pronged solution addresses key barriers to stopping new infections among young South Africans. First, we know that even when the benefits of a behavior are understood, people do not always act in their own best interest. We have demonstrated 5-fold increases in uptake of prevention services by offering small rewards that tackle inertia and other psychological barriers. Building on Discovery’s successful Vitality Health program, we will strategically deploy rewards to sustainably increase use of HIV services in priority populations. Second, we know that social influence is powerful. With easy-to-use HIV self-tests, we pioneered a social network-based distribution approach that achieved 90% testing in hard-to-reach, high-risk persons. We will scale this WHO-recommended approach that we have already deployed to 150,000 people.Third, we know that HIV services must meet people “where they are”. Hard-to-reach persons have little interaction with clinic-based services and are not persuaded by existing HIV-related messages. We will scale disruptive service delivery channels like pharmacies and mobile campaigns, while reframing HIV messages to showcase the transformative potential of treatment and prevention.We will monitor whether our solution increases coverage of essential HIV services among 15-34 year-old South Africans who face the highest HIV risk. After five years of scaling our solution, we expect HIV incidence will fall below 0.5% annually, a 60% reduction that will put South Africa firmly on the path to disease elimination by 2030.

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