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Original research
Undetectable equals untransmittable (U = U): awareness and associations with health outcomes among people living with HIV in 25 countries
  1. Chinyere Okoli1,
  2. Nicolas Van de Velde1,
  3. Bruce Richman2,
  4. Brent Allan3,
  5. Erika Castellanos4,
  6. Benjamin Young5,
  7. Garry Brough6,
  8. Anton Eremin7,
  9. Giulio Maria Corbelli8,
  10. Marta Mc Britton9,
  11. W. David Hardy10,
  12. Patricia de los Rios5
  1. 1ViiV Healthcare, Brentford, UK
  2. 2Prevention Access Campaign, New York City, New York, USA
  3. 3International Council of AIDS Service Organizations (ICASO), Toronto, Ontario, Canada
  4. 4Global Action for Trans* Equality (GATE), Belize City, Belize
  5. 5ViiV Healthcare, Research Triangle Park, North Carolina, USA
  6. 6Positively UK, London, UK
  7. 7AIDS Center Foundation, Moscow, Russia, Moscow, Russian Federation
  8. 8European AIDS Treatment Group, Rome, Lazio, Italy, Rome, Italy
  9. 9Instituto Cultural Barong, São Paulo, Brazil, São Paulo, Brazil
  10. 10Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr Chinyere Okoli, ViiV Healthcare, Brentford TW8 9GS, UK; Chinyere.x.okoli{at}


Objectives ‘Undetectable equals Untransmittable’ (U=U) is an empowering message that may enable people living with HIV (PLHIV) to reach and maintain undetectability. We estimated the percentage of PLHIV who ever discussed U=U with their main HIV care provider, and measured associations with health-related outcomes. Secondarily, we evaluated whether the impact of the U=U message varied between those who heard it from their healthcare provider (HCP) vs from elsewhere.

Methods Data were from the 25-country 2019 Positive Perspectives Survey of PLHIV on treatment (n=2389). PLHIV were classified as having discussed U=U with their HCP if they indicated that their HCP had ever told them about U=U. Those who had not discussed U=U with their HCP but were nonetheless aware that ‘My HIV medication prevents me from passing on HIV to others’ were classified as being made aware of U=U from non-HCP sources. Multivariable logistic regression was used to measure associations between exposure to U=U messages and health outcomes.

Results Overall, 66.5% reported ever discussing U=U with their HCP, from 38.0% (South Korea) to 87.3% (Switzerland). Prevalence was lowest among heterosexual men (57.6%) and PLHIV in Asia (51.3%). Compared with those unaware of U=U, those reporting U=U discussions with their HCP had lower odds of suboptimal adherence (AOR=0.59, 95% CI 0.44 to 0.78) and higher odds of self-reported viral suppression (AOR=2.34, 95% CI 1.72 to 3.20), optimal sexual health (AOR=1.48, 95% CI 1.14 to 1.92) and reporting they ‘always shared’ their HIV status (AOR=2.99, 95% CI 1.42 to 6.28). While exposure to U=U information from non-HCP sources was beneficial too, the observed associations were attenuated relative to those seen with reported discussions with HCPs.

Conclusion HCP discussion of U=U with PLHIV was associated with favourable health outcomes. However, missed opportunities exist since a third of PLHIV reported not having any U=U discussion with their HCP. U=U discussions with PLHIV should be considered as a standard of care in clinical guidelines.

  • attitudes
  • behavioural interventions
  • education
  • HIV clinical care
  • communication skills

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  • Handling editor Anna Maria Geretti

  • Twitter @DrAntonEremin, @giuliomcorbelli

  • Special Acknowledgement Data analyses and medical writing services were provided by Zatum LLC.

  • Contributors CO, PdlR, BY and NVdV conceptualised the study. All authors contributed to study design, analyses, drafting of the manuscript and substantial revisions. All authors gave final approval for the manuscript to be submitted.

  • Funding This work was supported by ViiV Healthcare.

  • Competing interests The following authors are employees of ViiV Healthcare: CO, PdlR, BY and NVdV.

  • Patient consent for publication Not required.

  • Ethics approval Ethical review was provided by the Pearl Institutional Review Board (no. 18–0 80 622). In addition, specific approval for South Africa was obtained from the Sefako Makgatho Research Ethics Committee (no. SMUREC/M/223/2019).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Requests to access the primary data analysed should be directed to the corresponding author.