{"doi":"10.1002/jia2.26267","title":"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","abstract":"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. Promoting U = U to address self-stigma and accurate knowledge sharing between sexual partners has the power to shape AYLHIV's ability to live full and healthy lives [3]. Despite global support and conclusive evidence for U = U, varying levels of awareness, reception and integration in standard clinical practice remain [7]. There is a critical gap in the literature and knowledge regarding how to message and use U = U to empower AYLHIV across sub-Saharan Africa (SSA). We embarked on creating a tool to address this gap and subsequently aimed to understand how this tool is being used and whether it is relevant to AYLHIV around U = U. The Elizabeth Glaser Pediatric AIDS Foundation's (EGPAF) Committee of African Youth Advisors (CAYA) developed an innovative U = U tool in partnership with researchers at the University of Cape Town. CAYA engages 15- to 29-year-old youth from 11 SSA countries. CAYA identified U = U as a priority in their 2022 prioritization survey. Members completed initial surveys on U = U knowledge and awareness, informing skill-building sessions. CAYA previously developed cartoon-based tools on HIV-treatment literacy, which are routinely used in AYLHIV programming and positively received [8]. In discussions on format, CAYA preferred the tool to be visually appealing, relevant, youth-friendly and use simple language. CAYA, therefore, decided to create a U = U graphic novel. Graphic novels and comic books can be effective in delivering clinical information to youth and can be integrated into individual/group-based programming [9]. A graphic novel, compared to a video, can be utilized in various ways—role plays, individual/group reads, play-acting and so on, for participatory-based learning [9]. Paper-based tools are useful as not all health facilities and adolescents have access to reliable technology or connectivity for standardized use of video-based learning. We conducted several discussions with CAYA to identify relevant U = U scenarios for youth. The three main scenarios identified included U = U in the context of romantic partnerships (heterosexual and same-sex) and pregnant young women. CAYA reflected on characters for each scenario and developed character profiles for each story. We iteratively developed the stories and worked with local African artists for illustration. Lira and Obi: A young man and woman in a new relationship navigating HIV disclosure Martha and Ibrahim: A sero-discordant married couple, Martha is newly pregnant Tambo and Junior: Two young men as a couple navigating disclosure and prevention of HIV EGPAF Lesotho implements youth-responsive HIV services supported by youth ambassadors (YA). U = U messaging is included in national guidelines on HIV treatment and prevention. YA are trained peers who facilitate all AYLHIV peer support groups (PSGs), conduct individual counselling and support health services at adolescent corners and other facilities. Utilizing YA to implement the tool was logical as the tool was designed f","journal":"Journal of the International AIDS Society","year":2024,"id":459575,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":4,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9587,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1287131,"name":"Thabelang Rabaholo","orcid":null,"position":1,"is_corresponding":false},{"id":1287132,"name":"Matsepo Mphafi","orcid":null,"position":2,"is_corresponding":false},{"id":1287133,"name":"Felleng Samonyane","orcid":null,"position":3,"is_corresponding":false},{"id":364590,"name":"Lauren Greenberg","orcid":"0000-0003-1554-0408","position":4,"is_corresponding":false},{"id":924066,"name":"Angelique Thomas","orcid":"0000-0002-7847-2126","position":5,"is_corresponding":false},{"id":299795,"name":"Elona Toska","orcid":"0000-0002-3800-3173","position":6,"is_corresponding":false},{"id":1286680,"name":"Cosima Lenz","orcid":"0000-0001-8041-6943","position":0,"is_corresponding":true}],"reference_count":6,"raw_metadata":null,"created_at":"2026-07-19T02:03:59.428859Z","pmid":"38801729","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}