Lessons from the field: understanding the use of a youth tailored U = U tool by peer educators in Lesotho with adolescents and youth living with HIV

Adolescence is defined by significant socio-emotional changes and vulnerability. Adolescents and youth living with HIV (AYLHIV) experience worse clinical HIV outcomes—adherence, retention and viral load suppression—compared to adults [1]. Novel approaches to implement evidence-based interventions to address their unique needs and life-stage are needed.

Undetectable = Untransmittable (U = U) is important in the comprehensive care of AYLHIV [2, 3]. U = U is a community-driven, evidence-based movement embodying the message that a person living with HIV who has reached and sustained an undetectable viral load (<200 copies/ml) will not transmit HIV to a sexual partner [4, 5]. As AYLHIV navigate friendships, sexual and romantic relationships, and parenthood, U = U may be a powerful tool for safe relationships and motivation for maintaining viral suppression [6]. Limited U = U interventions exist for AYLHIV, especially in Eastern and Southern Africa, where nearly 80% of AYLHIV reside.

The experience of implementing this tool reveals the practicality and promise of a narrative, youth-friendly graphic novel tool on a topic like U = U.

The authors declare no competing interests.

CL, TR, ET, AT, MM and CAYA conceptualized the project. Data tools were designed by CL, TR and MM with inputs from CAYA, ET and AT. Data collection was facilitated by TR and MM. Data analysis was led by CL. The draft was jointly constructed by all authors and reviewed by all authors.

ET/AT were funded by the Fogarty International Center, National Institute on Mental Health, National Institutes of Health [K43TW011434] and UKRI GCRF Accelerating Achievement for Africa's Adolescents (Accelerate) Hub (ES/S008101/1).

The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health.