Increasing HIV treatment literacy among people living with HIV using a novel health communication aid: Evidence from KwaZulu Natal province, South Africa

IntroductionEffective health communication is important for promoting adherence to antiretroviral therapy (ART). During counselling sessions with people living with HIV (PLHIV) who are initiating or re-initiating ART, we assessed whether a simple visual aid using bead bottles to explain the concept of viral suppression resulted in changes in HIV treatment literacy. MethodsAt three public sector clinics in KwaZulu-Natal KZN) province, South Africa, we enrolled adults who tested HIV-positive and were newly initiating ART or re-engaging in HIV care. Trained HIV counsellors used bottles with coloured beads ("B-OK bottles") to explain concepts related to viral load, viral suppression, and undetectable=Untransmittable (U=U). We assessed participants knowledge, attitudes, and perceptions about ART before and after counselling. ResultsBetween November 2022 and January 2023, we enrolled 80 PLHIV. Participants median age was 32 years (IQR: 24-41) and 58% were male. After receiving counselling with the B-OK bottles, understanding of U=U increased from 6% to 99% and understanding of viral suppression increased from 20% to 99%. Confidence in the protective effects of ART increased (64% to 100% for ones own health; 58% to 94% for transmission to partners) and was observed among participants both initiating ART and re-engaging in care. The number of participants agreeing that viral suppression means their sexual partners are safe from HIV even without condoms increased from 14% to 93% p-value =0.0. However, 65% still expressed worry that ART does not completely eliminate the risk of sexually transmitting HIV. ConclusionsUse of B-OK bottles during ART counselling was acceptable and increased HIV treatment literacy. While there was no significant effect on level of confidence in complete elimination of transmission risk when virally suppressed, we observed a significant reduction in concern about transmitting HIV and an increase in confidence in the protective effects of ART. Clinical Trial Number (SANCTR)DOH-27-092022-8067