Designing effective U = U communication strategies considering the needs of PLHIV, their partners, and healthcare worker constraints in South African clinics

• Published in: PloS one Vol. 18; no. 12; p. e0295920
• Main Authors: Onoya, Dorina, Sineke, Tembeka, King, Rachel, Mokhele, Idah, Sharma, Shubhi, Dukashe, Mandisa, Cele, Refiloe, Bokaba, Dorah, Inglis, Robert, Sigasa, Simangele, Bor, Jacob
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 20.12.2023; Public Library of Science (PLoS)
• Subjects: Antiretroviral drugs; Antiretroviral therapy; Biology and Life Sciences; Care and treatment; Clinics; Communication; Complications and side effects; Counseling; Disease transmission; Females; Focus Groups; Health aspects; Health care; Health Personnel - psychology; Highly active antiretroviral therapy; HIV; HIV (Viruses); HIV Infections - drug therapy; Human immunodeficiency virus; Humans; Interviews; Medical personnel; Medicine and Health Sciences; Messages; Nurses; Patient compliance; Patient outcomes; Patients; People and Places; Prevention; Primary health care; Risk communication; Sexually transmitted diseases; Social aspects; South Africa - epidemiology; STD; Stigma; South Africa
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0295920

We sought to understand the Undetectable = Untransmittable (U = U) communication needs of persons living with HIV (PLHIV) and barriers to U = U communication among healthcare providers (HCPs) in South Africa. We conducted five focus group discussions (FGDs) with HCPs (N = 42) including nurses and counsellors from primary healthcare clinics (PHCs) in the Gauteng and Free State Provinces of South Africa, three FGDs (N = 27) with PLHIV recruited by snowball sampling from civil society organizations, and 27 in-depth interviews (IDIs) with recently diagnosed PLHIV in Johannesburg. IDIs and FGDs were audio recorded, transcribed, translated to English, and analysed thematically. PLHIV were largely unaware and sceptical of U = U as the message appeared to contradict the mainstream HIV prevention clinical guidance. The low viral load (VL) knowledge further reduced confidence in U = U. PLHIV need support and guidance on the best approaches for sharing U = U information and disclosing their VL status to their partners, highlighting the central role of community understanding of U = U and VL to mediate the desired stigma reduction, social acceptance and emotional benefits of U = U for PLHIV. HCPs were uneasy about sharing U = U due to concerns about risk compensation and ART non-adherence and worried about enabling any ensuing HIV transmission. HCPs also need a simple, unambiguous, and consistent narrative for U = U, integrated with other HIV prevention messages. PLHIV and HCPs alike recommended a patient-centred approach to communicating U = U, focusing primarily on attaining viral suppression and emphasizing that condomless sex is only safe during periods of ART adherence. These data highlight the need for simple U = U communication support targeting both HCP and PLHIV. Culturally appropriate communication materials, with training and ongoing mentorship of the clinic staff, are essential to improve patient-centred U = U communication in clinics.