Agreement of and discussion with clients about Undetectable equals Untransmissible among general practitioners in Australia: a cross-sectional survey
Jason Wu
A B * , Christopher K. Fairley B C , Daniel Grace D , Eric P. F. Chow B C E § and Jason J. Ong B C F §
A Kings Park Medical Centre, General Practice, 40 Gourlay Road, Hillside, Melbourne, Vic., Australia.
B Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia.
C Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia.
D University of Toronto, Dalla Lana School of Public Health, Toronto, ON, Canada.
E Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, Vic., Australia.
F Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
Sexual Health - https://doi.org/10.1071/SH23051
Submitted: 12 March 2023 Accepted: 4 May 2023 Published online: 29 May 2023
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Background: The message of undetectable HIV viral load equals untransmissible (U=U) is important to reduce HIV stigma. We examined Australian general practitioner (GP)s’ agreement of and discussion with clients about U=U.
Methods: We conducted an online survey through GP networks from April to October 2022. All GPs working within Australia were eligible. Univariable and multivariable logistic regression analyses were performed to identify factors associated with: (1) agreement of U=U; and (2) discussing U=U with clients.
Results: Of 703 surveys, 407 were included in the final analysis. Mean age was 39.7 years (s.d.: 8.4). Most GPs (74.2%, n = 302) agreed with U=U, but only 33.9% (n = 138) had ever discussed U=U with clients. Key barriers to discussing U=U were lack of relevant client presentations (48.7%), lack of understanding about U=U (39.9%), and difficulty identifying those who would benefit from U=U (6.6%). Agreement with U=U was associated with greater odds of discussing U=U (adjusted odds ratio (AOR) 4.75, 95% confidence interval (CI): 2.33–9.68), younger age (AOR 0.96 per additional year of age, 95%CI: 0.94–0.99), and extra training in sexual health (AOR 1.96, 95%CI: 1.11–3.45). Discussing U=U was associated with younger age (AOR 0.97, 95%CI: 0.94–1.00), extra training with sexual health (AOR 1.93, 95%CI: 1.17–3.17), and negatively associated with working in a metropolitan or suburban area (AOR 0.45, 95%CI: 0.24–0.86).
Conclusion: Most GPs agreed with U=U, but most had not discussed U=U with their clients. Concerningly, one in four GPs were neutral or disagreed with U=U, suggesting that further qualitative research to understand this finding, and implementation research to promote U=U among Australian GPs, is urgently needed.
Keywords: barriers, general practitioners, GP, HIV, primary care, U=U, undetectable, untransmissible.
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