Changing Knowledge and Attitudes Towards HIV Treatment-as-Prevention and “Undetectable = Untransmittable”: A Systematic Review

Abstract

People on HIV treatment with undetectable virus cannot transmit HIV sexually (Undetectable = Untransmittable, U = U). However, the science of treatment-as-prevention (TasP) may not be widely understood by people with and without HIV who could benefit from this information. We systematically reviewed the global literature on knowledge and attitudes related to TasP and interventions providing TasP or U = U information. We included studies of providers, patients, and communities from all regions of the world, published 2008–2020. We screened 885 papers and abstracts and identified 72 for inclusion. Studies in high-income settings reported high awareness of TasP but gaps in knowledge about the likelihood of transmission with undetectable HIV. Greater knowledge was associated with more positive attitudes towards TasP. Extant literature shows low awareness of TasP in Africa where 2 in 3 people with HIV live. The emerging evidence on interventions delivering information on TasP suggests beneficial impacts on knowledge, stigma, HIV testing, and viral suppression.Review was pre-registered at PROSPERO: CRD42020153725

Perceived efficacy of HIV treatment-as-prevention among university students in Johannesburg, South Africa

“…A recent systematic review found that 31 studies measured TasP knowledge globally, from 2008 to 2020. 13 However, just two were quantitative studies of community-based samples in sub-Saharan Africa. In 2013, 65% of survey participants in rural Malawi perceived that ART had no impact on transmission risk.…”

“…[9][10][11][12] However, data from sub-Saharan Africa are scarce. 13 Evidence from South Africa, Zambia and Uganda suggest low familiarity with TasP in rural areas. [14][15][16] However, information may have diffused faster in urban areas, among young adults, and among those with access to secondaryschool HIV education and university health services.…”

A comprehensive analysis of excess depressive disorder in women and men living with HIV in France compared to the general population

“…The HIV prevention, treatment and care landscape has nevertheless evolved, e.g. immediate ART initiation (fewer HIV-related complications), new more well-tolerated classes of ART, and campaigns targeting HIV-stigma 15 , 16 , potentially easing the burden of depressive disorder in PLWH. Thus, we aimed to (1) estimate the prevalence of depressive disorder in PLWH, (2) identify factors associated with depressive disorder in PLWH, and (3) understand which factors are associated with an excess of depressive disorder in PLWH compared to the GP.…”

Adopting U = U to end stigma and discrimination

“…Yet, considerable work remains to use this message widely towards ending stigma and thus advancing health equity for PLHIV. In sub-Saharan Africa, for instance U = U awareness remains very low and varies by HIV status [3]. Even in areas with higher levels of U = U awareness in some communities (such as in Europe, Asia, the Americas and Oceania), misinformation abounds regarding its effectiveness [3], limiting full realization of this powerful health strategy [4].…”