Changing Knowledge and Attitudes Towards HIV Treatment‑as‑Prevention and “Undetectable=Untransmittable”: A Systematic Review

By  Dr. Jacob Bor  Dr Dorina Onoya  Professor Sydney Rosen  Tembeka Sineke  Charlie Fischer  Mirva Mod  Bruce Richman  Cameron Kinke  Rachel King  Dr Idah Mokhele  |  | 

People on HIV treatment with an undetectable virus cannot transmit HIV sexually (Undetectable=Untransmittable, U=U). However, the science of treatment-as-prevention (TasP) may not be widely understood by people with and without HIV who could benefit from this information. We systematically reviewed the global literature on knowledge and attitudes related to TasP and interventions providing TasP or U=U information. We included studies of providers, patients, and communities from all regions of the world, published 2008–2020. We screened 885 papers and abstracts and identified 72 for inclusion. Studies in high-income settings reported high awareness of TasP but gaps in knowledge about the likelihood of transmission with undetectable HIV. Greater knowledge was associated with more positive attitudes towards TasP. Extant literature shows low awareness of TasP in Africa where 2 in 3 people with HIV live. The emerging evidence on interventions delivering information on TasP suggests beneficial impacts on knowledge, stigma, HIV testing, and viral suppression.

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AIDS and Behavior