Applying quantitative behavioral research methods in UPTAKE Stage 2
The UPTAKE study was initiated to accelerate access and facilitate adherence to effective and innovative biomedical sexual and reproductive health products for adolescent girls and young women (AGYW) and female sex workers (FSWs) in sub-Saharan Africa. By leveraging social-behavioural science, UPTAKE seeks to inform the development of long-acting (LA) HIV Pre-Exposure Prophylaxis (PrEP), including formulation, device, delivery, and packaging decisions, and to enable the licensure of HIV prevention products that are better suited to AGYW and FSWs. This four-stage research study is being conducted in Kenya (Nairobi) and Uganda (Kampala) over three years (October 2020 to October 2023), with stage 2, led by Busara Center for Behavioral Economics, beginning in October/November 2022.
Stage 1 involved formative research that included in-depth interviews (IDIs) with end users (30 AGYW and 30 FSW), and with key informants (10 health care professionals (HCPs) and 10 policymakers) to explore preferences in terms of feasibility and affordability. Stage 2, described in detail below, is exploring market segmentation and behavioural intervention design through the use of quantitative and qualitative social-behavioural research approaches. Stage 3 will be based on the design and evaluation of an intervention, while stage 4 will focus on cost-effectiveness modelling of products and the intervention. Importantly, the outcomes of stages 1 and 2 will inform the specific design of stages 3 and 4. You can learn more about the findings from the study so far in the Publications section.
The main objective of stage 2 is to use quantitative behavioral research methods to design interventions to influence the uptake of new biomedical HIV prevention products, including future LA HIV prevention and multipurpose prevention techniques (MPT) products, based on user demographics. Data collection is being carried out in two batches featuring three research activities: a quantitative survey, Discrete Choice Experiments (DCE), and behavioral lab experiments (henceforth lab experiments). A quantitative survey and DCE will be deployed in batch 1, followed by a DCE and lab experiments in batch 2. The expected outcome of stage 2 is to use quantitative behavioral research methods to design interventions that will be tested in stage 3 to influence the uptake of new biomedical HIV prevention products and multipurpose prevention techniques.
More specifically, stage 2 aims to answer the following questions:
Who are existing users of HIV prevention and family planning products? What are their choices and experiences with these products?
Who are potential users of future LA HIV prevention and MPT products?
What characteristics (e.g., individual, behavioral, interpersonal, social) predict current and future use of HIV prevention and contraceptive products? What are the behavioral patterns, levers, barriers, and cognitive biases around current and future use of HIV prevention and contraceptive products?
What is the strength of preferences for product and delivery attributes for HIV prevention and contraceptive products, including future LA HIV prevention and MPT products? How do preferences segment by individual, behavioral, and social profiles?
To answer the first three questions, a quantitative survey is being administered to a sample of 600 respondents (300 in Nairobi and 300 in Kampala). Descriptive statistics will be calculated to reveal the characteristics of existing users of HIV prevention and contraceptive products, their choice and usage of the products, and the behavioral mechanism behind their decision making. Inferential analysis will be employed to identify the influential characteristics (e.g., individual, behavioral, interpersonal, social) that help predict current and future use of HIV prevention and contraceptive products. In addition, a segmentation analysis using machine learning approaches will be conducted to identify and describe the featured user segments and their behaviours around the products.
To answer the fourth question on preference, a DCE is being implemented alongside the quantitative survey in batch 1, and later alongside the lab experiments in batch 2. The data collected from the DCE will be used to measure the strength of preferences for product and delivery attributes for HIV prevention and contraceptive products, including future LA HIV prevention and MPT products among AGYW and FSWs.
In batch 2, lab experiments will be conducted to test and explain behavioral phenomena observed or hypotheses drawn from stage 1 and batch 1 of stage 2, and to test the efficacy of potential behaviourally informed interventions. For example, if data from the quantitative survey suggests that FSWs tend to underestimate their risk of getting HIV even if they are behaviourally vulnerable to HIV, and that their decisions are likely to be influenced by peers, one potential experiment could be designed to test the effectiveness of different norms and messengers, such as HCPs or youth leaders, upon FSWs’ decision making. Typically, an experiment contains several treatment arms, each of which present a potential intervention to be tested, and study participants will be randomly assigned to the control and treatment arms.
Following the completion of stage 2 research activities, we will disseminate relevant findings in different forums and journals, including peer reviewed articles addressing the different research questions. In addition, the UPTAKE PhD and master’s students will use the stage 2 findings as part of their theses. Abstracts for oral and poster presentations will also be submitted by the study partners to key scientific conferences.