This piece originally ran in the PEPFAR Zimbabwe Newsletter in April 2023

   When John’s health started deteriorating in 2017, he went to get tested for HIV with his wife and received a positive result. Regardless of this knowledge, he refused to initiate HIV treatment. Eventually, John fell ill between 2021 and 2022 and it was during this time he interacted with a community health worker who explained to him how HIV was affecting him. The nurse explained this using bead bottles, developed through the Flip the Script (FtS) treatment literacy campaign to improve HIV treatment adherence. Today, John is on treatment and is looking forward to experiencing the full benefits of HIV treatment in his life.”

The bead bottles have been a game changer in reshaping the attitudes and perceptions of people living with HIV and the broader community towards HIV treatment by amplifying the concept of U=U (undetectable equals untransmittable). This concept conveys that a virally suppressed person with an undetectable viral load cannot transmit HIV to their partner. This challenges the narrative of an HIV-positive diagnosis as a death sentence which has been a huge barrier to HIV testing and consequently starting and/or continuing treatment for many people. The first of three bead bottles represents a body that has been taken over by HIV. The second bottle symbolizes a scenario where HIV treatment is gradually reducing the amount of HIV in the body. The last bottle represents a virally suppressed body which means the person cannot transmit HIV to their partner.

   Interacting with the ART Champions and their b-ok demonstration has changed my attitude towards HIV treatment,” said one client from Marange. “I sometimes skipped it, but now take it every day, at the same time, even when I attend a funeral or church event, I carry my ART medication.”

Through this innovation, people living with HIV have gained the confidence to continue living the lives they desire through taking their HIV medication. It also highlights the importance of a periodic viral load test for all recipients of care to determine adherence to and effectiveness of treatment and the associated achievement of viral suppression.

   … the red beads represent HIV in the body and the black beads represent the body’s immune system. Taking your HIV medication every day at the same time helps you reduce the amount of HIV in the body and gradually, we have less of the red beads and more black ones. In the last bottle, the amount of HIV is so little that we only have that one red bead and so many black ones. At this point, you have a low chance of falling sick due to HIV and you have reduced chances of passing on HIV,” according to FtS Expert Client, Nyabira.

The bead bottles have equipped clinicians and community healthcare workers with the confidence and skills to explain what a viral load test result means using simple language. It has also helped people living with HIV to understand the benefits of consistently taking their HIV treatment leading to viral load suppression and reduced chances of passing on HIV to your partner.

   We have seen these tools work and they simplify our ways of counseling and giving information,” said one healthcare provider in Nyabira.

Community health worker leads a group discussion on viral load suppression.

Population Solutions for Health (PSH) and Population Services International (PSI) are implementing the Flip the Script (FtS) program in partnership with the Ministry of Health and Child Care with support from the  Bill and Melinda Gates Foundation, PEPFAR and Johnson & Johnson.

To assess the impact of the FtS intervention, the program conducted a reflexive study, tracked digital and mass media campaign reach, tracked ART champions’ community level program outputs and compared treatment indicators before and after the campaign at intervention and control sites. More than 1.4 million social media users were reached through digital and mass media campaign, while 1,600 people were reached by 37 ART Champions trained under FtS.

ART Champions supported over 1.400 recipients of care to access HIV testing, ART (re)initiation, and/or viral load testing. The reflexive design showed significant improvement in ART adherence, improved perceived community and household level social support, and improved knowledge on the benefits of ART among PLHIV exposed to the campaign. Viral load tests done increased by 164% comparing periods before and after the FtS campaign in the intervention sites. Qualitative results corroborated these quantitative results.