Project Title

Developing “U=U” communication messages in Malawi: Establishing evidence on feasibility and acceptability

EDCTP Project Call

Career Development Fellowship (CDF)

Project Objectives

The project aimed to address the information gap on treatment as prevention (TasP) through developing contextually relevant TasP messaging materials that emphasise “U=U” information targeting HIV discordant couples in order to optimise adherence to ART, reduce new HIV infections in sero-discordant couples and increase male partner engagement in HIV self-testing, prevention and care. Specific objectives included: 1. Identify policy gap around treatment as prevention, explore end-user understanding about “U=U” and map effective approaches for identifying HIV sero-discordant couples within secondary distribution of self-testing offered through ANC clinics. 2. Develop and refine culturally relevant communication materials (pictorial, video, audio and written) that optimise user comprehension of “U=U” concepts targeting HIV sero-discordant heterosexuals identified through the secondary distribution HIVST model in Malawi. 3. Pilot test communication materials within a pragmatic context and carry out a hypothesis generation Phase 2 exploratory trial to test feasibility and acceptability of “U=U” intervention.

Study Design

ACCEPTU2U is a qualitative and quantitative mixed-methods study that will develop and pilot “U=U” communication materials delivered through ANC clinics in an urban primary health centre in Blantyre, Malawi.

Project Summary

A description of the work performed from the beginning of the action to the end of the period covered by the report, and the main results achieved so far. Following the development of U=U materials in year 1, and the optimization of the materials in Year 2, we conducted a small pilot study in 3 health facilities (Limbe Health Centre, Madziabango Health Centres and Mpemba Health Centre) to optimise these materials. We failed to collect data from one facility because the facility in-charge stated that the letter of support provided by the District Health Office was said to be outdated. This was surprising to the study team and the District Health Office considering that letters of support are only provided at the point when the study submits the protocol for ethical clearance. There are no restrictions of the amount of time that the study should last as long as ethical clearance is active. Following refinement of the materials, we hosted a stakeholder participatory workshop that included representatives from the Ministry of Health Department of HIV and AIDS, Civil Society Organisations and Implementing Partners to discuss suitability within the Malawian contexts. We also registered the trial on ISRCTN during this reporting period. See ISRCTN - ISRCTN31351715: Acceptability of treatment as prevention messages in Malawi. The immediate impact of the of this study is that the policy makers have acknowledged that the study addresses a known policy gap and implementation challenge within the Malawi HIV programme. Within the programme, People Who are Living with HIV are not given the information about the role of suppressed viral load in prevention of sexual. transmission of HIV. We have already shared the materials with members of the National AIDS Commission. The study participants also obtained important information which they would have otherwise not received within the national HIV programme. Descriptive results show a dramatic improvement in ARV use in the intervention arm from 70% (Baseline) to 100% (follow-up). ARV use in the standard of care arm was 70% (Baseline) and 69% (Follow-up). Complete trust that ARVs prevent transmission of HIV sexually also improved among study participants in the intervention arm between baseline (Standard of care – 57%; Intervention – 61%) and follow-up (Standard of care – 40%; Intervention – 98%) During the study, we also observed enormous interest from health facilities to have access to the study resources and use them to provide information to recipients of care.

Host Organisation

Sites

Current Organisation

Malawi Liverpool Wellcome Programme

Current Job Title

Social Scientist

Biography

Publications