By Shawn Malone, Project Director, The Mpilo Project, PSI, South Africa
In the public health sector, we sometimes forget that simpler can be better.
People living with HIV don’t really need to know the number of copies of the virus in their blood or understand what that means. They do need to understand how effective treatment can reduce HIV to such a low level that it can’t be detected or transmitted.
In South Africa, as part of PSI’s effort to deliver Consumer-Powered Healthcare, we’ve been leveraging user insights and human-centered design approaches to develop solutions that address barriers to treatment, including many patients’ limited familiarity with clinical terminology.
In 2021, the Mpilo Project developed the B-OK bottles, a simple visual aid to make it easier to explain concepts like viral suppression and non-transmissibility. It consists of three bottles, with red beads representing HIV and black beads representing healthy cells.
The mixed bottle represents someone upon diagnosis, facing the choice to start treatment or put it off. The predominantly red bottle represents the body in the absence of treatment, with HIV rapidly multiplying. The black bottle with one red bead represents viral suppression.
In collaboration with local partners Aurum Institute and MatCH, we initially tested the bottles with more than 500 health providers across 70 facilities. The response was overwhelmingly positive. Providers said the bottles were helpful in explaining how treatment works in the body and prompted greater curiosity and engagement among patients.
Earlier this year, the Mpilo Project and the Indlela Project followed up with a formal evaluation of the bottles, and we are excited to report that they dramatically increased understanding of adherence and viral suppression, confidence in the protective effects of HIV treatment, and overall HIV knowledge.
In addition to high scores for acceptability, the bottles increased understanding of the relationship between viral load and transmissibility from 6.5% to 98.8% and understanding of how HIV treatment works from 12.5% to 92.5%. There was also a significant increase in confidence in the protective effects of ART for oneself (from 63.7% to 100%) and one’s sexual partners (from 57.5% to 93.7%).
The World Health Organization recently launched a policy brief confirming what we’ve long known: individuals with an undetectable viral load have zero risk of transmitting the virus through sex as long as they continue to take their treatment as prescribed. This is often referred to as U=U, or undetectable = untransmissible. The B-OK bottles give healthcare workers a better way to communicate this game-changing fact to their patients.
The Mpilo/Indlela evaluation showed that this simple visual aid has the potential to increase HIV treatment literacy – and ultimately to help make the message of U=U a reality for all people living with HIV.
You can read more about the evaluation results here. And if you would like to try out the B-OK bottles in your own setting, please get in touch!
Funded by the Bill & Melinda Gates Foundation and led by PSI in partnership with Ipsos, Matchboxology, and the South African National Department of Health, the Mpilo Project aims to increase linkage to HIV treatment and prevention among men in South Africa by designing, testing, and scaling interventions that are informed by an understanding of men’s barriers and preferences.