Suboptimal Patient-Provider Communication About Undetectable = Untransmittable and HIV Transmission Risk in Australia and the US.

Abstract

The Undetectable = Untransmittable (U = U) campaign aims to raise global awareness that people living with HIV whose viral load is undetectable cannot sexually transmit HIV. Healthcare providers are uniquely positioned to disseminate the U = U message. Our study explored patient-provider communication about U = U and HIV risk from the perspectives of gay, bisexual, and other men living with HIV (MLHIV) and healthcare providers engaged in HIV treatment and prevention service delivery. We conducted 40 semi-structured interviews with key informants recruited through HIV community-based and professional organizations in Australia (n = 20) and the US (n = 20). Key informants included 20 MLHIV and 20 providers. Data were analyzed thematically. MLHIV were cisgender men aged 29-67 years (M[SD] = 52[13.1]). Providers were cisgender adults aged 30-65 years (M[SD] = 38[9.0]). MLHIV preferred that providers use clear and direct language to explain U = U. When prompted to explain U = U as they would to patients, 8 of 10 Australian and 4 of 10 US providers used language consistent with those preferences. MLHIV, especially US MLHIV, reported that their providers' explanation of the U = U message was often absent, ambiguous, or inaccurate in practice. Such suboptimal communication aligned with the skepticism about U = U and concerns about patient behavior (e.g., adherence) expressed by several providers in the study. Providers relayed multiple reservations regarding new World Health Organization recommendations about informing patients that low-level viremia (detectable viral load ≥ copies/mL) conferred "almost zero" risk. Many Australian and US providers would benefit from training developed in collaboration with people living with HIV to improve patient-provider communication about U = U and HIV transmission risk.