Life Plans Intervention Study
Condition: HIV/AIDS; Chronic HIV Infection; Health Knowledge, Attitudes, Practice
MeSH terms: HIV Infections
Study type: Interventional

Summary: 
      The mass provision of HIV treatment in rural KwaZulu-Natal, South Africa has raised adult
      life expectancy by 18 years since 2003. We will conduct a population-based survey to assess
      young adults' beliefs about HIV, HIV treatment, and expectations for the future in the era of
      mass HIV treatment. Thh investigators will conduct a randomized evaluation to assess whether
      a short video providing young adults with information on longevity gains from HIV treatment
      affects young adults survival expectations, hope for the future, and health and educational
      behaviours, including uptake of HIV testing, the study's primary outcome.
    

Detailed description: 
      The proposed study will investigate survival expectations and health behaviours among young
      adults ages 18 to 25. Potential respondents will be sampled at random from a population
      listing from the demographic and health surveillance system of the Africa Health Research
      Institute (AHRI) in Somkhele, South Africa. Potential participants will be visited at home to
      be recruited for the study.

        1. Consent. The study will be described and participants will provide written informed
           consent to participate in the study, including the baseline visit, a follow-up survey,
           and permission to link with demographic surveillance data.

        2. Baseline interview (1.5 hours)

      2.a) Survey module. First, a survey questionnaire will be conducted with young adults ages 18
      to 25 to learn about their survival expectations, perceptions of HIV risks and treatment,
      future-oriented behaviours such as smoking, alcohol use, HIV risk behaviors, savings, locus
      of control, mental health, time and risk preference, and life satisfaction.

      2.b) Video intervention. After the survey module, study participants will be randomized into
      treatment and control groups. Both interview participants and interviewers will be blinded to
      treatment assignment prior to this stage. The treatment group will be shown a 10 minute video
      that provides information on the changes in HIV-related mortality and life expectancy in the
      Demographic Surveillance Area between 2003 and today (an increase of about 18 years in the
      average length of life). The video includes testimonials from community members who have
      lived long and fulfilling lives on HIV treatment. The goal of the video is to increase
      measured survival expectations, hope, locus of control, and future orientation. The control
      group will receive a 10-minute video clip on another topic. Participants will be asked
      briefly for an open-ended response to the video: "what did the video make you think about?"
      which will be transcribed or recorded.

      Details on randomization procedures: treatment assignment will be determined at the level of
      the household, such that if there are multiple respondents per household, they receive the
      same treatment. Households will be randomized to the intervention video or control ex ante.
      Though treatment assignment will occur ex ante, it will only be revealed - to both the field
      workers and the respondents - after completing the initial survey module. Ex ante
      randomization has two benefits. First, as a quality control, ex ante randomization limits the
      opportunity for violations of treatment assignment. Second, it increases power by enabling
      stratification on baseline variables. Because the study is nested in the AHRI population
      surveillance, treated and control households can be balanced on household size, wealth, and
      other characteristics. Treated and controls will be randomized at a 1:1 ratio, with controls
      further sub-randomized 1:1 to attention-placebo vs. pure control.

      2.c) Re-survey module. Immediately after the video intervention, all study participants will
      be asked a brief subset of the survey module questions to re-measure survival expectations,
      locus of control, and life satisfaction. This step will estimate the immediate impact of the
      video intervention on beliefs.

      2.d) Uptake of investment behaviors. 2.d.i) HIV Testing Voucher. Immediately after the
      re-survey module, participants will be offered a voucher for free HIV testing at a local
      pharmacy. Redeemed voucher numbers will be collected from the pharmacy to assess uptake of
      testing. No test results will be collected. This information will be stated clearly on the
      voucher.

      2.d.ii) Invitation to Job Search Skills Workshop. Participants will be invited to a job
      skills training workshop delivered in partnership with a local human resources consultant.
      The workshop will inform participants of the types of job opportunities that exist, what
      skills and qualifications employers are looking for, as well as what strategies can be used
      to increase chances of getting a job. (For example, recent research in South Africa finds
      that employers are 60% more likely to respond to job applicants that include a letter of
      reference.) The workshop will be held at a convenient location 1-3 weeks after the baseline
      interview and attendance of study participants will be recorded. R10 will be provided to
      attendees to assist with travel expenses. The goal is to measure differences in uptake across
      treated and control arms, which will provide short-run evidence of the impact of the video on
      human capital investment behaviours.

      2.d.iii) Savings choice. Immediately after the giving participants the HIV testing voucher,
      all participants will be offered the opportunity to save a portion of their participation
      compensation (R100) using a labelled box with a key that we will provide them. We provide
      this choice for study participants so that we can immediately measure intentions for
      future-oriented behaviour and to estimate the video's short-term effect based on differences
      in savings chosen between the treatment and control group.

      2.d.iv) Condom offer. Participants will be offered the opportunity to purchase discount
      condoms and the number purchased will be recorded.

      3. Follow-up interview at 2 months. Study participants will be contacted 2 months after their
      initial interview and provided with a follow-up survey that measures survival expectations,
      locus of control, and life satisfaction, mental health, savings, health behaviours, and (if
      applicable) schooling status. Participants will receive R50 in compensation for participation
      in the follow-up survey.

      4. Surveillance Follow-up. Data from this study will be linked at the individual level to the
      AHRI population surveillance, which contains data on HIV testing, schooling, and employment.
      Participants will be visited approximately six weeks after the baseline survey and offered
      HIV testing as part of the AHRI surveillance. Passive follow-up through the surveillance is
      anticipated in future years, although this is beyond the scope of the registered trial.
      Linkage will be conducted by AHRI staff with access to identifying information in the
      population surveillance. After the conclusion of data collection and linkage, the key linking
      identifying data collected in this study to survey responses will be destroyed and only the
      de-identified ID number used in the demographic surveillance will remain. Participant contact
      details (not linked to data) will be retained in order to disseminate findings.
    

Intervention name(s): A Beautiful Future Video; Active Control Video
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Video delivering information on the longevity gains due to HIV treatment in the area.; Video on another topic.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Other
Keywords: Population-based survey; HIV treatment; HIV testing; Survival expectations; Condom use; Life plans; South African young adults