Can Undetectable (viral load) = Untransmissible (virus) change the life course of adolescents living the HIV in Africa? (CUUA)

Rationale: Adolescents living with HIV (ALHIV) have the worst outcomes of all ages because of sub-optimal adherence driven by structural factors associated with poverty.

This is exacerbated for adolescents by the limited opportunities to address mental health problems arising from the intersection of growing up in poverty and with HIV.

The scientific breakthrough related to Undetectable (viral load) = Untransmissible (virus) have shown that there is no sexual transmission of HIV when the virus is suppressed in people with HIV. The convincing evidence shows tha ART not only supress but also prevents the sexual transmission of HIV infection.

This scientific breakthough has had a major impact on motivation to take up and adhere to antiretroviral therapy among people living with HIV all over the world. However, the discussion remains remarkably silent in high burden, low income countries (LIC).

Very few ALHIV in LIC are aware that having an undetectable viral load (VL) substantially reduces the risk of transmitting HIV to their sexual partners and children.

Aims: The aim of the study is to work with MoHCC and other stakeholders to explore whether routine VL testing using Dried Blood Spot (DBS) can provide sufficiently robust evidence of ‘undetectability’ to support introduction of U=U messaging in ALHIV.

The specific objectives are to: determine viral load fluctuation between routine annual VL testing and the extent to which annual VL using DBS reflects short term fluctuations that occur in the interim. determine what proportion of ALHIV with VL