Regional Medical Office, Shinyanga Regional Hospital
UC Berkeley, School of Public Health
U.S. based mentor
Sandra I. McCoy PhD, MPH
Assistant Adjunct Professor of Epidemiology
Ntuli A. Kapologwe MD, MPH, MBA
Regional Medical Officer /Assistant Administrative Secretary, Shinyanga, Tanzania
Prosper Njau, MD, MP
Programme Officer, Ministry of Health and Social Welfare
Sexual and reproductive health, HIV/AIDS, adherence, maternal and child health, behavior change
Site and Background
The collaboration between the Division of Epidemiology at UC Berkeley and the Shinyanga Regional Medical Office is recent but has already proved to be fertile ground for training, exchange of research ideas, and the design and evaluation of innovative interventions to promote health. The Regional Medical Office, led by Dr. Ntuli Kapologwe, is charged with implementing the activities and health programs of the Ministry of Health and Social Welfare and the National AIDS Control Programme. Through our partnership, we are able to identify critical health issues faced by the region (e.g., non-adherence to antiretroviral therapy, poor coverage of early infant HIV diagnosis, increasing facility delivery) and subsequently develop and evaluate locally relevant and theoretically based interventions to remove barriers and improve access to health services. Furthermore, the strong connection to the Ministry of Health and Social Welfare through Dr. Njau ensures that our interventions are policy relevant and have the potential for scale. Our approach is non-traditional, combining traditional approaches from health promotion and epidemiology with behavioral economics and psychology. The success of the young partnership is evident: for the past two summers five UC Berkeley students were hosted in Shinyanga for field epidemiology experiences and the collaboration has three ongoing intervention studies underway with a research staff of more than 15 individuals. Together, UC Berkeley, the Shinyanga Regional Medical Office, and our local research team are well positioned to tackle the most challenging sexual and reproductive health issues faced by men and women in this part of northern Tanzania.
The underlying goal of our research is to identify effective, cost-effective, and scalable interventions using innovative approaches to improve the demand for sexual and reproductive health services, with an emphasis on HIV treatment and care. To achieve this, we are currently working in more than 30 clinics in Shinyanga Region that provide HIV and maternal and child health services. The first and largest of our projects is “Comparing Food and Cash Assistance for HIV-Positive Men and Women on Antiretroviral Therapy in Tanzania,” a 3-arm randomized controlled trial (K01MH094246 McCoy) to compare the effects of three delivery models for short-term support for food insecure people living with HIV infection who are on antiretroviral therapy: nutrition assessment and counseling (NAC) alone, NAC plus food assistance, and NAC plus cash transfers. We will examine the effect of this assistance on HIV-related outcomes such as adherence to treatment and retention in care. A second project focused on improving HIV treatment adherence is funded by the Gates Foundation (McCoy) and aims to develop and pilot an intervention using behavioral priming. Based on theories from psychology and behavioral economics, we hypothesize that a simple, innovative, and inexpensive strategy using behavioral priming may be equally effective at improving treatment adherence and more cost-effective than other approaches.
We have extended our work on antiretroviral adherence to pregnant and postpartum women, with the goal to motivate women to stay in care and on treatment after delivery. Funded by the International Initiate for Impact Evaluation (3ie), we are currently conducting a cluster-randomized trial in 30 facilities to evaluate a multi-pronged community health worker program with Amref Health Africa. The intervention is designed to integrate community-based maternal, newborn, and child health services with HIV prevention, treatment, and care, bridge the gap between community and facility through the use of community health workers, and enhance the potential benefits of “Option B+”, a prevention of mother-to-child HIV infection strategy whereby HIV-infected pregnant and breastfeeding women are immediately initiated on lifelong ART after diagnosis. Together, the collaboration provides ample opportunity for student training and the infrastructure for new projects focusing on sexual and reproductive health.