Is U=U consistently known and implemented? A survey among different medical specialists in Brazil

Abstract

Despite solid scientific evidence, the concepts of treatment as prevention (TASP) and Undetectable = Untransmittable (U = U) remain unfamiliar and underutilized for some healthcare providers. We conducted a self-completion survey to evaluate the knowledge of TASP/U = U in different medical specialties. Wilcoxon Rank-Sum, Chi-square and Fisher’s exact tests were used for group comparisons and a logistic regression model was used to assess factors independently associated with U = U-non-supportive attitudes. 197 physicians were included; 74% agreed/strongly agreed that people living with HIV (PLHIV) under regular treatment with undetectable viral do not transmit HIV sexually. However, only 66% agree/strongly agree that PLHIV should be informed about that. The knowledge about these concepts was poorer among gynecologists, urologists and internal medicine specialists when compared to infectious diseases specialists after adjustment for age, race/skin color, gender, and sexual orientation. Our study found that knowledge of crucial concepts of HIV prevention may be lacking for some medical specialties. This highlights the need of improvement in medical education.

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

“…Our study identified 26% of GPs were neutral towards or disagreed with U=U. Nunes et al 6 reported a similar result of 26% of health professionals in Brazil being neutral or disagreeing with U=U. The messages from doctors regarding HIV have been about using condoms since the 1980s, and this is entrenched, so it is difficult for GPs, especially with no training on the most updated science of HIV transmission, to believe in the accuracy of U=U.…”

“…A study from Brazil identified that 74% of healthcare providers agreed with U=U; however, only 66% strongly agreed or agreed that PLHIV should be informed about U=U. 6 Studies have reported barriers to communicating U=U from the healthcare providers' perspective. A UK study 7 identified the following barriers: hesitation with communicating zero transmission risk of HIV; and perceptions that clients may not want to hear this message.…”

Messaging about HIV Transmission Risk When Viral Load Is Undetectable: Reactions and Perceived Accuracy among US Sexual Minority Men

“…Even recognized health authorities continue to contribute to uncertainty and misunderstanding. For example, health care providers throughout the world refrain from or convolute delivery of the U=U message to patients, 16,19,20,33,34 and US health department websites communicate about U=U inconsistently, if at all. 21 Health authorities have sometimes used the terms "undetectable" and "virally suppressed" interchangeably 32,35 and have defined the terms according to variable numerical thresholds (eg, ,20, ,50, or ,200 copies/mL).…”

U=U should also include information on blood transfusion transmission

“…We believe that the article by Nunes and colleagues 1 addresses a very important issue that should not be underestimated. Their findings highlight the urgent need for improvement in medical education, where knowledge of the U=U concept should be disseminated and expanded.…”

“…We read with great interest the recent article by Nunes and colleagues describing that the concepts of treatment as prevention and “Undetectable equals Untransmittable” (U=U) remain unfamiliar and underutilized by some Brazilian healthcare providers. 1 U=U is a prevention access campaign launched in 2016 by a group of HIV activists, aiming to “end the dual epidemics of HIV and HIV related stigma by empowering people with accurate and meaningful information”. 2 An undetectable viral load is generally defined as less than 200 copies/ml, and several studies have shown that the likelihood of transmitting the virus through sexual intercourse is negligible at this level.…”