Tadese Bekana K, Cambron-Mellott M Janelle, Arduino Jean Marie, Balkaran Bridget L, Eslamimehr Shakiba, Zuniga José M
Outcome Research, Merck & Co., Inc., Rahway, NJ, USA.
Real-World Evidence, Oracle Life Sciences, Austin, TX, USA.
J Int Assoc Provid AIDS Care. 2025 Jan-Dec;24:23259582251370236. doi: 10.1177/23259582251370236. Epub 2025 Aug 19.
BackgroundLaunched in the United States (US) in 2016, the 'undetectable equals untransmittable' (U = U) message has revolutionized human immunodeficiency virus (HIV) management by affirming that individuals on antiretroviral therapy (ART) with undetectable viral loads (VL) cannot sexually transmit the virus. This study aimed to assess the knowledge and understanding of U = U and factors associated with the lack of understanding among people living with HIV (PLHIV) in the US.MethodsA cross-sectional, online survey was fielded from February to June 2022 in the US to PLHIV aged ≥18 years who were currently taking ART. Data on sociodemographic variables, HIV-related and general health characteristics were collected. The study assessed the knowledge and understanding of U = U and sources of U = U information. Multivariable analyses were used to identify the factors associated with the lack of U = U understanding among PLHIV.ResultsA total of 781 PLHIV completed the study and were included in the analysis. Most participants were <50 years old (67.0%), cisgender males (56.2%), and majority having at least some college education (80.5%). More than half (54.5%) of the participants did not know the meaning of the U = U. Sources of learning about the meaning of 'undetectable' included a healthcare provider (HCP) alone (50.4%), the U = U campaign alone (7.6%), both an HCP and the U = U campaign (14.7%), and sources other than HCPs or the U = U campaign (32.2%); 3.1% of participants reported having never heard the term before. About 12.0% of the participants were unaware of their VL status. After adjusting for covariates, PLHIV who lacked an understanding of U = U were more likely to have a college degree or higher education (OR: 0.6, 95% CI: 0.41-0.86, 0.006), recent HIV diagnosis (6 months to <12 months) (OR: 2.06, 95% CI: 1.14-3.77, 0.018), suboptimal ART adherence (OR: 2.74, 95% CI: 1.88-4.01, 0.001), and lack HCP communication about the importance of an undetectable VL compared to those who understood U = U.ConclusionThe study highlights substantial gaps in understanding U = U among PLHIV and in HCP-patient communication. These findings underscore the need for targeted education for both PLHIV and HCPs, emphasizing the clinical implications and benefits of U = U in relation to HIV prevention.
背景
“检测不到即不具传染性”（U=U）信息于2016年在美国发布，它通过确认接受抗逆转录病毒疗法（ART）且病毒载量（VL）检测不到的个体不会通过性行为传播病毒，彻底改变了人类免疫缺陷病毒（HIV）的管理方式。本研究旨在评估美国HIV感染者（PLHIV）对U=U的知晓和理解情况，以及与理解不足相关的因素。
方法
2022年2月至6月在美国对年龄≥18岁且正在接受ART的PLHIV进行了一项横断面在线调查。收集了社会人口统计学变量、HIV相关和一般健康特征的数据。该研究评估了对U=U的知晓和理解情况以及U=U信息的来源。采用多变量分析来确定PLHIV中对U=U理解不足的相关因素。
结果
共有781名PLHIV完成了研究并纳入分析。大多数参与者年龄<50岁（67.0%），为顺性别男性（56.2%），且大多数至少接受过一些大学教育（80.5%）。超过一半（54.5%）的参与者不知道U=U的含义。了解“检测不到”含义的来源包括仅医疗保健提供者（HCP）（50.4%）、仅U=U宣传活动（7.6%）、HCP和U=U宣传活动两者（14.7%）以及HCP或U=U宣传活动以外的来源（32.2%）；3.1%的参与者报告从未听说过这个术语。约12.0%的参与者不知道自己的VL状态。在调整协变量后，对U=U缺乏理解的PLHIV更有可能拥有大学学位或更高学历（比值比：0.6，95%置信区间：0.41-0.86，P=0.006）、近期HIV诊断（6个月至<12个月）（比值比：2.06，95%置信区间：1.14-3.77，P=0.018）、抗逆转录病毒治疗依从性欠佳（比值比：2.74，95%置信区间：1.88-4.01，P=0.001），并且与理解U=U的人相比，缺乏HCP关于检测不到的VL的重要性的沟通。
结论
该研究凸显了PLHIV在理解U=U以及HCP与患者沟通方面存在的重大差距。这些发现强调了对PLHIV和HCP进行针对性教育的必要性，强调U=U在HIV预防方面的临床意义和益处。
