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.