Agreement of and discussion with clients about Undetectable equals Untransmissible among general practitioners in Australia: a cross-sectional survey

Abstract

Background The message of undetectable HIV viral load equals untransmissible (U=U) is important to reduce HIV stigma. We examined Australian general practitioner (GP)s’ agreement of and discussion with clients about U=U. Methods We conducted an online survey through GP networks from April to October 2022. All GPs working within Australia were eligible. Univariable and multivariable logistic regression analyses were performed to identify factors associated with: (1) agreement of U=U; and (2) discussing U=U with clients. Results Of 703 surveys, 407 were included in the final analysis. Mean age was 39.7 years (s.d.: 8.4). Most GPs (74.2%, n = 302) agreed with U=U, but only 33.9% (n = 138) had ever discussed U=U with clients. Key barriers to discussing U=U were lack of relevant client presentations (48.7%), lack of understanding about U=U (39.9%), and difficulty identifying those who would benefit from U=U (6.6%). Agreement with U=U was associated with greater odds of discussing U=U (adjusted odds ratio (AOR) 4.75, 95% confidence interval (CI): 2.33–9.68), younger age (AOR 0.96 per additional year of age, 95%CI: 0.94–0.99), and extra training in sexual health (AOR 1.96, 95%CI: 1.11–3.45). Discussing U=U was associated with younger age (AOR 0.97, 95%CI: 0.94–1.00), extra training with sexual health (AOR 1.93, 95%CI: 1.17–3.17), and negatively associated with working in a metropolitan or suburban area (AOR 0.45, 95%CI: 0.24–0.86). Conclusion Most GPs agreed with U=U, but most had not discussed U=U with their clients. Concerningly, one in four GPs were neutral or disagreed with U=U, suggesting that further qualitative research to understand this finding, and implementation research to promote U=U among Australian GPs, is urgently needed.

Prescribing pre-exposure prophylaxis (PrEP) for HIV prevention: A cross-sectional survey of General Practitioners in Australia

“…A further 171 were excluded as they were completed in countries outside Australia, and 35 were excluded because the number of questions answered was <90%. The sociodemographic characteristics of the 407 participants are detailed in our other study (16). Briefly, the median age of the participants was 38, with an interquartile range (IQR) of 33-44.…”

2023 Undetectable = Untransmittable global policy roundtable report: a multistakeholder perspective on Undetectable = Untransmittable research and policy priorities

“…23 While knowledge of the preventive benefits of antiretroviral therapies is not necessarily new, official endorsement of both pre-exposure prophylaxis and treatment as prevention as 'legitimate' HIV prevention strategies has challenged traditional ways of thinking about HIV prevention centred on condom use. It was argued that consequently, some clinicians may be hesitant to communicate UVL as an effective HIV prevention strategy, 12,18,[23][24][25] and that there is a need to increase trust and awareness of U=U among healthcare professionals. At the same time, it was said that healthcare workers must be encouraged to proactively inform their clients about the health and protective benefits of U=U.…”