1
|
Sineke T, Bor J, King R, Mokhele I, Dukashe M, Bokaba D, Inglis R, Kgowedi S, Richman B, Kinker C, Blandford J, Ruiter RAC, Onoya D. Integrating 'undetectable equals untransmittable' into HIV counselling in South Africa: the development of locally acceptable communication tools using intervention mapping. BMC Public Health 2024; 24:1052. [PMID: 38622528 PMCID: PMC11020191 DOI: 10.1186/s12889-024-18471-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/28/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND The global campaign for "Undetectable equals Untransmittable" (U = U) seeks to spread awareness of HIV treatment as prevention, aiming to enhance psychological well-being and diminish stigma. Despite its potential benefits, U = U faces challenges in Sub-Saharan Africa, with low awareness and hesitancy to endorse it. We sought to develop a U = U communications intervention to support HIV counselling in primary healthcare settings in South Africa. METHODS We used Intervention Mapping (IM), a theory-based framework to develop the "Undetectable and You" intervention for the South African context. The six steps of the IM protocol were systematically applied to develop the intervention including a needs assessment consisting of a systematic review and qualitative research including focus group discussions (FGD) and key informant (KI) interviews. Program objectives and target population were determined before designing the intervention components and implementation plan. RESULTS The needs assessment indicated low global U = U awareness, especially in Africa, and scepticism about its effectiveness. Lay counsellors and clinic managers stressed the need for a simple and standardized presentation of U = U addressing both patients' needs for encouragement and modelling of U = U success but also clear guidance toward ART adherence behaviour. Findings from each step of the process informed successive steps. Our final intervention consisted of personal testimonials of PLHIV role models and their partners, organized as an App to deliver U = U information to patients in primary healthcare settings. CONCLUSIONS We outline an intervention development strategy, currently in evaluation stage, utilizing IM with formative research and input from key U = U stakeholders and people living with HIV (PLHIV).
Collapse
Affiliation(s)
- Tembeka Sineke
- Health Economics and Epidemiology Research Office, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Jacob Bor
- Health Economics and Epidemiology Research Office, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Rachel King
- Institute for Global Health Sciences, University of California, San Francisco, USA
| | - Idah Mokhele
- Health Economics and Epidemiology Research Office, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mandisa Dukashe
- South African National AIDS Council (SANAC), Johannesburg, South Africa
| | - Dorah Bokaba
- Tshwane Department of Health, City of Tshwane, South Africa, City of Tshwane, South Africa
| | | | - Sharon Kgowedi
- Health Economics and Epidemiology Research Office, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Bruce Richman
- Prevention Access Campaign, United States of America, New York City, USA
| | - Cameron Kinker
- Prevention Access Campaign, United States of America, New York City, USA
| | - John Blandford
- Centers for Disease Control and Prevention, Johannesburg, South Africa
| | - Robert A C Ruiter
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Dorina Onoya
- Health Economics and Epidemiology Research Office, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| |
Collapse
|
2
|
Martinez EZ, Zucoloto ML. U=U should also include information on blood transfusion transmission. Int J STD AIDS 2024; 35:158-159. [PMID: 37830365 DOI: 10.1177/09564624231206847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
|
3
|
Lai A, Giacomet V, Bergna A, Zuccotti GV, Zehender G, Clerici M, Trabattoni D, Fenizia C. Early-Transmitted Variants and Their Evolution in a HIV-1 Positive Couple: NGS and Phylogenetic Analyses. Viruses 2021; 13:v13030513. [PMID: 33808903 PMCID: PMC8003824 DOI: 10.3390/v13030513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/12/2021] [Accepted: 03/17/2021] [Indexed: 12/05/2022] Open
Abstract
We had access to both components of a couple who became infected with human immunodeficiency virus (HIV)-1 through sexual behavior during the early initial phase of infection and before initiation of therapy. We analyzed blood samples obtained at the time of diagnosis and after six months of combined antiretroviral therapy. Next-generation sequencing (NGS) and phylogenetic analyses were used to investigate the transmission and evolution of HIV-1 quasispecies. Phylogenetic analyses were conducted using Bayesian inference methods. Both partners were infected with an HIV-1 B subtype. No evidence of viral recombination was observed. The lowest intrapersonal genetic distances were observed at baseline, before initiation of therapy, and in particular in the V1V2 fragment (distances ranging from 0.102 to 0.148). One HIV-1 single variant was concluded to be dominant in all of the HIV-1 regions analyzed, although some minor variants could be observed. The same tree structure was observed both at baseline and after six months of therapy. These are the first extended phylogenetic analyses performed on both members of a therapy-naïve couple within a few weeks of infection, and in which the effect of antiretroviral therapy on viral evolution was analyzed. Understanding which HIV-1 variants are most likely to be transmitted would allow a better understanding of viral evolution, possibly playing a role in vaccine design and prevention strategies.
Collapse
Affiliation(s)
- Alessia Lai
- Department of Biomedical and Clinical Sciences, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy; (A.L.); (A.B.); (G.Z.); (D.T.)
| | - Vania Giacomet
- Clinic of Pediatrics, ASST Fatebenefratelli-Sacco, Sacco Clinical Sciences Institute, Via G.B. Grassi 74, 20157 Milan, Italy; (V.G.); (G.V.Z.)
| | - Annalisa Bergna
- Department of Biomedical and Clinical Sciences, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy; (A.L.); (A.B.); (G.Z.); (D.T.)
| | - Gian Vincenzo Zuccotti
- Clinic of Pediatrics, ASST Fatebenefratelli-Sacco, Sacco Clinical Sciences Institute, Via G.B. Grassi 74, 20157 Milan, Italy; (V.G.); (G.V.Z.)
| | - Gianguglielmo Zehender
- Department of Biomedical and Clinical Sciences, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy; (A.L.); (A.B.); (G.Z.); (D.T.)
| | - Mario Clerici
- Department of Pathophysiology and Transplantation, University of Milan, Via F. Sforza 35, 20122 Milan, Italy;
- IRCCS Fondazione Don Carlo Gnocchi, Via Capecelatro 66, 20148 Milan, Italy
| | - Daria Trabattoni
- Department of Biomedical and Clinical Sciences, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy; (A.L.); (A.B.); (G.Z.); (D.T.)
| | - Claudio Fenizia
- Department of Biomedical and Clinical Sciences, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy; (A.L.); (A.B.); (G.Z.); (D.T.)
- Department of Pathophysiology and Transplantation, University of Milan, Via F. Sforza 35, 20122 Milan, Italy;
- Correspondence: ; Tel.: +39-02-5031-9679; Fax: +39-02-5031-9677
| |
Collapse
|
4
|
Card KG, St Denis F, Higgins R, Klassen B, Ablona A, Rutherford L, Jollimore J, Ibáñez-Carrasco F, Lachowsky NJ. Who knows about U = U? Social positionality and knowledge about the (un)transmissibility of HIV from people with undetectable viral loads. AIDS Care 2021; 34:753-761. [PMID: 33739198 DOI: 10.1080/09540121.2021.1902928] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
"U = U" is the principle that HIV is untransmittable from people living with an undetectable HIV viral-load. Wide-spread knowledge about U = U is believed to produce public health benefit by reducing HIV-related stigma - promoting wellbeing for people living with HIV. Therefore, we examined the diffusion of U = U with respect to the social position of sexual and gender minority men (SGMM). Participants were SGMM recruited from 16 LGBTQ2S+ pride festivals across Canada. Social position was measured using an index assessing whether participants were (a) trans, (b) a person of colour, (c) Indigenous, (d) born abroad, (e) bisexual or straight, (f) not out, (g) struggling with money, (h) not college educated, (i) and not participating in LGBTQ2S+ Organizations, Queer Pop-ups, or HIV advocacy organizations. Multivariable logistic regression tested whether Index Scores were associated with knowledge about U = U. Among 2681 participants, 72.6% knew about U = U. For HIV-negative/unknown status SGMM, each 1-point increase in Social Positionality Index Scores was associated with a 21% reduction in the odds that they knew about U = U (aOR: 0.79 [0.73, 0.85], per 1-point increase). Results indicate that social marginalization harms the diffusion of HIV-related biomedical knowledge, independent of risk-taking behaviour and other factors.
Collapse
Affiliation(s)
- Kiffer G Card
- Community-based Research Centre, Vancouver, BC, Canada.,Faculty of Human and Social Development, School of Public Health and Social Policy, Victoria, BC, Canada
| | - Finn St Denis
- Community-based Research Centre, Vancouver, BC, Canada
| | - Rob Higgins
- Faculty of Human and Social Development, Social Dimensions of Health, Victoria, BC, Canada
| | | | - Aidan Ablona
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Leo Rutherford
- Faculty of Human and Social Development, Social Dimensions of Health, Victoria, BC, Canada
| | | | | | - Nathan J Lachowsky
- Community-based Research Centre, Vancouver, BC, Canada.,Faculty of Human and Social Development, School of Public Health and Social Policy, Victoria, BC, Canada
| |
Collapse
|