BACKGROUND: People living with HIV (PLHIV) who achieve an undetectable viral load by taking antiretroviral therapy (ART) as prescribed are unlikely to sexually transmit the virus, this message is commonly known as Undetectable = Untransmittable (U=U). There has been global movement to promote U=U to address HIV treatment as prevention, continuity of care, and reduce HIV-related stigma. U=U message has been implemented to varying degrees across selected regions in Tanzania but lack data on the reach of U=U messaging among PLHIV.
METHODS: A cross-sectional, facility-based survey was rapidly conducted between August- September 2022 in six regions in mainland Tanzania and Zanzibar. A total of 106 out of 703 health facilities were randomly selected. From these, 1,198 PLHIV aged 18 years and above were identified and participated in the structured exit-interviews to assess awareness (i.e., ever heard) of U=U message. Modified Poisson regression models accounting for facility clustering were used to assess correlates of awareness. We estimated prevalence ratios (PR) and their corresponding 95% confidence intervals (95% CI).
RESULTS: Overall, 31% of PLHIV had ever heard of the U=U message. The majority of PLHIV (75%) were exposed to U=U message through health facilities. The likelihood of U=U message awareness was higher in Kigoma compared to Dar es Salaam region [aPR: 1.76, CI:1.22-2.53] and among PLHIV aged 25-49 years [aPR:1.35, CI:1.08-1.67] compared to those aged 18-24 years. PLHIV with no formal education were less likely to be aware of U=U messaging [aPR: 0.45, CI:0.30-0.67].
CONCLUSIONS: Our results serve as a baseline to inform and evaluate the programmatic scale-up of U=U among PLHIV in Tanzania. This assessment demonstrated low exposure to U=U messaging among PLHIV especially among young adults and with no formal education which points to the need for stronger U=U promotion through diverse communication channels.

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