Improving HIV testing, linkage, and retention in care for men through U=U messaging

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PROJECT ABSTRACT Increasing the coverage of HIV testing and treatment among people living with HIV (PLHIV) is essential for ending the global AIDS epidemic. Unfortunately, compared to women, men living with HIV (MLHIV) are less likely to know their HIV status, start anti-retroviral treatment, or achieve viral suppression. Given that new HIV infections among women are driven, in part, by men’s testing and treatment gaps, reducing the gender gap in testing uptake, treatment initiation and achievement of viral suppression by men must be prioritized in order to accelerate the decline in HIV incidence among women, improve men’s HIV-related health outcomes and achieve the UNAIDS 95-95-95 goals by 2030. In this study, we evaluate the effectiveness of Undetectable Equals Untransmittable or “U=U” messaging for closing the gender gap in the HIV cascade. The U=U message communicates the compelling idea that PLHIV who take ART and have an undetectable viral load (<200 copies/mL) cannot sexually transmit HIV. Particularly for men, the U=U message has the potential to accelerate progress towards the 95-95-95 targets by: 1) reducing anxiety associated with HIV testing (1st 95); 2) encouraging people who test HIV-positive to initiate ART (2nd 95); and 3) reducing fear of transmitting HIV to sexual partners by promoting treatment adherence to achieve viral suppression (3rd 95). While there is a growing knowledge of Treatment as Prevention (TasP)/U=U among PLWH in Western countries, the reach and penetration of the U=U message in sub-Saharan Africa has been limited and few studies have tested the impacted of accessible U=U messages on ART uptake and adherence in sub-Saharan Africa. Building on our prior work on U=U messaging informed by behavioral economics and human-centered design, we propose to conduct two hybrid type 1 effectiveness-implementation randomized controlled trials to evaluate the impact of U=U messages on men’s uptake of community-based HIV testing and treatment initiation (Aim 1), and achievement of viral suppression (Aim 2). We will also conduct a multi-method evaluation to inform future implementation of U=U messaging interventions. To improve the generalizability of our findings, we will conduct our study in two provinces in South Africa (Western and Eastern Cape). If effective, our intervention can shape global HIV testing and treatment counselling guidelines and practices. Our expert, multi-institutional collaborations will allow us to apply previous research findings, leverage unique implementation platforms and resources, and rapidly disseminate our findings.