Undetectable equals untransmittable (U = U): awareness and associations with health outcomes among people living with HIV in 25 countries.

Autor:	Okoli C; ViiV Healthcare, Brentford, UK Chinyere.x.okoli@viivhealthcare.com., Van de Velde N; ViiV Healthcare, Brentford, UK., Richman B; Prevention Access Campaign, New York City, New York, USA., Allan B; International Council of AIDS Service Organizations (ICASO), Toronto, Ontario, Canada., Castellanos E; Global Action for Trans* Equality (GATE), Belize City, Belize., Young B; ViiV Healthcare, Research Triangle Park, North Carolina, USA., Brough G; Positively UK, London, UK., Eremin A; AIDS Center Foundation, Moscow, Russia, Moscow, Russian Federation., Corbelli GM; European AIDS Treatment Group, Rome, Lazio, Italy, Rome, Italy., Mc Britton M; Instituto Cultural Barong, São Paulo, Brazil, São Paulo, Brazil., Hardy WD; Johns Hopkins School of Medicine, Baltimore, Maryland, USA., de Los Rios P; ViiV Healthcare, Research Triangle Park, North Carolina, USA.
Jazyk:	angličtina
Zdroj:	Sexually transmitted infections [Sex Transm Infect] 2021 Feb; Vol. 97 (1), pp. 18-26. Date of Electronic Publication: 2020 Jul 30.
DOI:	10.1136/sextrans-2020-054551
Abstrakt:	Objectives: 'Undetectable equals Untransmittable' (U=U) is an empowering message that may enable people living with HIV (PLHIV) to reach and maintain undetectability. We estimated the percentage of PLHIV who ever discussed U=U with their main HIV care provider, and measured associations with health-related outcomes. Secondarily, we evaluated whether the impact of the U=U message varied between those who heard it from their healthcare provider (HCP) vs from elsewhere. Methods: Data were from the 25-country 2019 Positive Perspectives Survey of PLHIV on treatment (n=2389). PLHIV were classified as having discussed U=U with their HCP if they indicated that their HCP had ever told them about U=U. Those who had not discussed U=U with their HCP but were nonetheless aware that 'My HIV medication prevents me from passing on HIV to others' were classified as being made aware of U=U from non-HCP sources. Multivariable logistic regression was used to measure associations between exposure to U=U messages and health outcomes. Results: Overall, 66.5% reported ever discussing U=U with their HCP, from 38.0% (South Korea) to 87.3% (Switzerland). Prevalence was lowest among heterosexual men (57.6%) and PLHIV in Asia (51.3%). Compared with those unaware of U=U, those reporting U=U discussions with their HCP had lower odds of suboptimal adherence (AOR=0.59, 95% CI 0.44 to 0.78) and higher odds of self-reported viral suppression (AOR=2.34, 95% CI 1.72 to 3.20), optimal sexual health (AOR=1.48, 95% CI 1.14 to 1.92) and reporting they 'always shared' their HIV status (AOR=2.99, 95% CI 1.42 to 6.28). While exposure to U=U information from non-HCP sources was beneficial too, the observed associations were attenuated relative to those seen with reported discussions with HCPs. Conclusion: HCP discussion of U=U with PLHIV was associated with favourable health outcomes. However, missed opportunities exist since a third of PLHIV reported not having any U=U discussion with their HCP. U=U discussions with PLHIV should be considered as a standard of care in clinical guidelines. Competing Interests: Competing interests: The following authors are employees of ViiV Healthcare: CO, PdlR, BY and NVdV. (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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