Participatory prototyping of a tailored U=U (undetectable=untransmittable) message to increase HIV testing in men in Western Cape, South Africa

Introduction Taking daily ART eliminates sufficient virus so that HIV is undetectable via viral load (VL) testing within 24 weeks. HIV-positive individuals with an undetectable VL cannot transmit HIV to sexual partners or through giving birth, a message commonly referred to as U=U (undetectable equals untransmittable). Since South African men have poorer HIV outcomes than women, we used interactive human centred design co-creation workshops to ask men from high HIV burden communities in Cape Town, South Africa to create a U=U message aimed at increasing HIV testing and ART uptake in men. Methods Two facilitators explained the U=U message to the men (n =39) attending the workshop and asked them how to effectively communicate the message. Participants designed messages to assuage fears of testing HIV positive, explaining that ART enables HIV positive people to live normally and makes the virus “untransmittable” to their sexual partners. Results Participants developed three insights for the U=U message; 1) “Introduce” the modern antiretroviral pill, 2) positively redefine the man for whom the pill is intended, and 3) simplify the benefits of ART for men. Participants’ messages emphasised 1) “ you cannot spread the virus (HIV) to the other person ” 2) and “ (the pill) keeps on killing the virus so I can live a normal life for the rest of my life .” Discussion Men in the workshops co-created a simple U=U message to address fears of testing HIV positive, emphasising the pill’s positive effects. Co-created, tailored messaging may improve the uptake of HIV services for South African men. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The work presented was funded by the Bill and Melinda Gates Foundation (INV-008318). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the University of Cape Town Human Research Ethics Committee. All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The qusalitative data is available upon request.