Can personalized digital counseling improve consumer search for modern contraceptive methods?

This paper analyzes a randomized controlled trial of a personalized digital counseling intervention addressing informational constraints and choice architecture, cross-randomized with discounts for long-acting reversible contraceptives (LARCs), such as intrauterine devices (IUDs). The counseling intervention encourages shared decision-making (SDM) using a tablet-based app, which provides a tailored ranking of modern methods to each client according to their elicited needs and preferences. Take-up of LARCs in the status quo regime at full price was 11%, which increased to 28% with discounts. SDM roughly tripled the share of clients adopting a LARC at full price to 35%, and discounts had no incremental impact in this group. Neither intervention affected the take-up of short-acting methods, such as the pill. Consistent with theoretical models of consumer search, SDM clients discussed more methods in depth, which led to higher adoption rates for second- or lower-ranked LARCs. Our findings suggest that low-cost individualized recommendations can potentially be as effective in increasing unfamiliar technology adoption as providing large subsidies.

Girl Empower - A gender transformative mentoring and cash transfer intervention to promote adolescent wellbeing: Impact findings from a cluster-randomized controlled trial in Liberia

Background

We evaluated Girl Empower – an intervention that aimed to equip adolescent girls with the skills to make healthy, strategic life choices and to stay safe from sexual abuse using a cluster-randomized controlled trial with three arms: control, Girl Empower (GE), and GE+.

Methods

GE delivered a life skills curriculum to girls aged 13–14 in Liberia, facilitated by local female mentors. In the GE + variation, a cash incentive payment was offered to caregivers for girls’ participation in the program. We evaluated the impact of the program on seven pre-specified domains using standardized indices: sexual violence, schooling, sexual and reproductive health (SRH), psychosocial wellbeing, gender attitudes, life skills, and protective factors.

Findings

Participation rates in the program were high in both GE and GE+, with the average participant attending 28 out of 32 sessions. At 24 months, the standardized effects of both GE and GE+, compared to control, on sexual violence, schooling, psychosocial wellbeing, and protective factors were small (β, ≤ 0.11 standard deviations [SD]) and not statistically significant at the 95% level of confidence. However, we found positive standardized effects on Gender Attitudes (GE: β, 0.206 SD, p<0.05; GE+: β, 0.228 SD, p<0.05), Life Skills (GE: β, 0.224 SD, p<0.05; GE+: β, 0.289 SD, p<0.01), and SRH (GE: β, 0.244 SD, p<0.01; GE+: β, 0.372 SD, p<0.01; F-test for GE = GE+: p = 0.075).

Interpretation

Girl Empower led to sustained improvements in several important domains, including SRH, but did not reduce sexual violence among the target population.

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Violence against women and children are closely linked global epidemics that have lifelong impacts on human welfare.

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This study examines the impact of adding cash transfers to a mentoring intervention targeted to girls in early adolescence.

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Girl Empower has positive impacts on some important outcomes, but is ineffective in protecting girls from sexual violence.

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Cash transfers, tied to attendance, enhanced program impacts on child marriage, teen pregnancy, and risky sexual behavior.

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Future research is needed to understand whether cash affects these outcomes directly or through an interaction effect.

Simulations for designing and interpreting intervention trials in infectious diseases

BACKGROUND

Interventions in infectious diseases can have both direct effects on individuals who receive the intervention as well as indirect effects in the population. In addition, intervention combinations can have complex interactions at the population level, which are often difficult to adequately assess with standard study designs and analytical methods.

DISCUSSION

Herein, we urge the adoption of a new paradigm for the design and interpretation of intervention trials in infectious diseases, particularly with regard to emerging infectious diseases, one that more accurately reflects the dynamics of the transmission process. In an increasingly complex world, simulations can explicitly represent transmission dynamics, which are critical for proper trial design and interpretation. Certain ethical aspects of a trial can also be quantified using simulations. Further, after a trial has been conducted, simulations can be used to explore the possible explanations for the observed effects.

CONCLUSION

Much is to be gained through a multidisciplinary approach that builds collaborations among experts in infectious disease dynamics, epidemiology, statistical science, economics, simulation methods, and the conduct of clinical trials.

The heterogeneous effects of HIV testing

An extensive multi-disciplinary literature examines the effects of learning one's HIV status on subsequent risky sexual behaviors. However, many of these studies rely on non-experimental designs; use self-reported outcome measures; or both. In this study, we investigate the effects of a randomly assigned home based HIV testing and counseling (HTC) intervention on risky sexual behaviors and schooling investments among school-age females in Malawi. We find no overall effects on HIV, Herpes Simplex Virus (HSV-2), or achievement test scores at follow-up. However, among the small group of individuals who tested positive for HIV, we find a large increase in the probability of HSV-2 infection, with this effect being stronger among those surprised by their test results. Similarly, those surprised by HIV-negative test results have significantly higher achievement test scores at follow-up, consistent with increased returns to investments in human capital.