"I just believe there is a risk" understanding of undetectable equals untransmissible (U = U) among health providers and HIV-negative partners in serodiscordant relationships in Kenya
"I just believe there is a risk" understanding of undetectable equals untransmissible (U = U) among health providers and HIV-negative partners in serodiscordant relationships in Kenya
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DOI：
10.1002/jia2.25466
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发表时间：
2020-03-01
影响因子：
6
通讯作者：
Baeten, Jared M.
中科院分区：
文献类型：
--
作者：
Ngure, Kenneth;Ongolly, Fernandos;Baeten, Jared M.
抗逆转录病毒治疗（ART）产生的持续HIV病毒抑制消除了HIV传播的风险，这一概念通常被定义为不可检测=不可传播（U = U）。我们探讨了知识和接受的信息消除艾滋病毒传播风险与ART（U = U）在Keny.Methods我们的定性研究进行了一个项目内评估使用暴露前预防（PrEP）纳入ART护理艾滋病毒血清不一致的夫妇在肯尼亚的公共诊所（合作伙伴规模扩大项目）。从2017年2月到2019年4月，我们对83名卫生服务提供者进行了半结构化的关键知情人访谈，并对61名接受PrEP服务的血清不一致关系中的艾滋病毒阴性者进行了深入访谈。成绩单进行编码使用专题analysis.Results卫生提供者报告说，意识到艾滋病毒传播的风险降低，作为一个结果，一致的抗逆转录病毒治疗的使用，并使用的话，如“非常低”，”最小”和“像零”来描述病毒抑制后的艾滋病毒传播风险。提供者报告说，发现病毒载量结果有助于咨询客户有关艾滋病毒传播的风险。许多人对U = U缺乏信心，并建议即使在病毒抑制后也要坚持使用避孕套，而一些人则表示担心，将这一信息传达给艾滋病毒感染者（PLHIV）会导致他们参与多重性关系。其他提供者报告说，他们没有就病毒抑制后艾滋病毒传播风险降低的问题提供咨询，因为担心如果发生艾滋病毒传播，他们会受到指责。艾滋病毒阴性的伙伴报告说，他们被告知U = U的供应商，但他们不相信或信任的消息。即使在他们的伴侣实现病毒抑制后，一些HIV阴性的伴侣也不愿意停止PrEP，而另一些人表示，如果他们停止PrEP，他们会使用避孕套，以确保他们免受HIV感染。在血清不一致的关系中，保健提供者和艾滋病毒阴性伙伴对该战略既缺乏深入的了解，也缺乏信念。超越U = U科学传播的新策略，考虑当地的社会和临床环境，可以最大限度地提高U = U的有效性。
Introduction Sustained HIV viral suppression resulting from antiretroviral therapy (ART) eliminates the risk of HIV transmission, a concept popularly framed as Undetectable = Untransmittable (U = U). We explored knowledge and acceptance of information around the elimination of HIV transmission risk with ART (U = U) in Kenya.Methods Our qualitative study was conducted within a project evaluating the use of pre-exposure prophylaxis (PrEP) integrated into ART care for HIV serodiscordant couples in public clinics in Kenya (the Partners Scale Up Project). From February 2017 to April 2019, we conducted semi-structured key informant interviews with 83 health providers and in-depth interviews with 61 HIV-negative people in serodiscordant relationships receiving PrEP services. Transcripts were coded using thematic analysis.Results Health providers reported being aware of reduced risk of HIV transmission as a result of consistent ART use and used words such as "very low," "minimal" and "like zero" to describe HIV transmission risk after viral suppression. Providers reported finding viral load results helpful when counselling clients about the risk of HIV transmission. Many lacked confidence in U = U and counselled on consistent condom use even after viral suppression while some expressed concerns that communicating this message to people living with HIV (PLHIV) would lead them to engage in multiple sexual relationships. Other providers reported that they did not counsel about the reduced risk of HIV transmission after viral suppression for fear of being blamed if HIV transmission occurred. HIV-negative partners reported being informed about U = U by providers but they did not believe nor trust the message. Even after their partners achieved viral suppression, some HIV-negative partners were unwilling to stop PrEP, while others indicated that they would use condoms if they stopped PrEP to be sure that they were protected from HIV.Conclusions Despite awareness that effective ART use eliminates HIV transmission risk, there is both a lack of in-depth knowledge and conviction about the strategy among health providers and HIV-negative partners in serodiscordant relationships. New strategies that go beyond communicating the science of U = U to consider the local social and clinical environments could maximize the effectiveness of U = U.