#KnowMyViralLoad: how community-led demand creation holds a key to routine viral load testing scale-up in Africa

Viral load testing (VLT) is key to detecting treatment failure and is central to HIV management. However, low demand for routine VLT among people on antiretroviral treatment limits opportunities for evidence-based HIV management and transmission reduction. Demand generation for routine VLT can improve through empowering communities of people living with and affected by HIV with relevant, tailored and actionable information on VLT. We sought to identify the most appropriate and context-relevant media platforms and audiences for VLT-related demand generation campaigns in 6 African countries. Two-phase VLT-focused media communication campaigns were conducted in six African countries. We also evaluated the process and outcomes of these campaigns through an anonymized assessment. We tracked the platform-specific reach of the campaigns, where traditional media platforms like radio and digital media platforms like Facebook, Twitter and WhatsApp had the widest reach. Additionally, respondents to the post-campaign assessment identified how they learnt new information about VLT (Facebook, Twitter, WhatsApp, short messaging services, radio, television, virtual and in-person meetings or peer educators) and provided a rationale for their preferred communication channels. Of all responses (n = 558), the most popular reasons were ease of understanding (23%), interactive sharing (19%), fun and entertaining way of presenting (18%) and presentation by a peer (17%). Of 210 post-campaign assessment respondents, 82% credited the campaign for a better understanding of their HIV status, 73% reported getting a VLT, 82% told a friend about VLT, 77% received their results and 73% sought interpretation of their VLT results. Community-led communication campaigns can effectively generate demand and uptake of routine VLT. Digital platforms, suited to the local context, hold potential for disseminating health messages and improving health seeking action, provided a commensurate effort is made to address laboratory-side barriers to the delivery or uptake of VLT services.