{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T15:43:12Z","timestamp":1792597392148,"version":"4.5.0"},"reference-count":27,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2023,12,20]],"date-time":"2023-12-20T00:00:00Z","timestamp":1703030400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R34MH122323"],"award-info":[{"award-number":["R34MH122323"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>We sought to understand the Undetectable = Untransmittable (U = U) communication needs of persons living with HIV (PLHIV) and barriers to U = U communication among healthcare providers (HCPs) in South Africa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted five focus group discussions (FGDs) with HCPs (N = 42) including nurses and counsellors from primary healthcare clinics (PHCs) in the Gauteng and Free State Provinces of South Africa, three FGDs (N = 27) with PLHIV recruited by snowball sampling from civil society organizations, and 27 in-depth interviews (IDIs) with recently diagnosed PLHIV in Johannesburg. IDIs and FGDs were audio recorded, transcribed, translated to English, and analysed thematically.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>PLHIV were largely unaware and sceptical of U = U as the message appeared to contradict the mainstream HIV prevention clinical guidance. The low viral load (VL) knowledge further reduced confidence in U = U. PLHIV need support and guidance on the best approaches for sharing U = U information and disclosing their VL status to their partners, highlighting the central role of community understanding of U = U and VL to mediate the desired stigma reduction, social acceptance and emotional benefits of U = U for PLHIV. HCPs were uneasy about sharing U = U due to concerns about risk compensation and ART non-adherence and worried about enabling any ensuing HIV transmission. HCPs also need a simple, unambiguous, and consistent narrative for U = U, integrated with other HIV prevention messages. PLHIV and HCPs alike recommended a patient-centred approach to communicating U = U, focusing primarily on attaining viral suppression and emphasizing that condomless sex is only safe during periods of ART adherence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These data highlight the need for simple U = U communication support targeting both HCP and PLHIV. Culturally appropriate communication materials, with training and ongoing mentorship of the clinic staff, are essential to improve patient-centred U = U communication in clinics.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0295920","type":"journal-article","created":{"date-parts":[[2023,12,20]],"date-time":"2023-12-20T13:37:33Z","timestamp":1703079453000},"page":"e0295920","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":12,"title":["Designing effective U = U communication strategies considering the needs of PLHIV, their partners, and healthcare worker constraints in South African clinics"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2664-7342","authenticated-orcid":true,"given":"Dorina","family":"Onoya","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tembeka","family":"Sineke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"King","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8054-0116","authenticated-orcid":true,"given":"Idah","family":"Mokhele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7842-6955","authenticated-orcid":true,"given":"Shubhi","family":"Sharma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandisa","family":"Dukashe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Refiloe","family":"Cele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorah","family":"Bokaba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Inglis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simangele","family":"Sigasa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Bor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,12,20]]},"reference":[{"issue":"9","key":"pone.0295920.ref001","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1056\/NEJMoa1600693","article-title":"Antiretroviral Therapy for the Prevention of HIV-1 Transmission.","volume":"375","author":"MS Cohen","year":"2016","journal-title":"New England Journal of Medicine"},{"issue":"13","key":"pone.0295920.ref002","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1056\/NEJM200003303421303","article-title":"Viral load and heterosexual transmission of human immunodeficiency virus type 1","volume":"342","author":"TC Quinn","year":"2000","journal-title":"New England Journal of Medicine"},{"issue":"11","key":"pone.0295920.ref003","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.1097\/QAD.0b013e32832b7dca","article-title":"Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis","volume":"23","author":"S Attia","year":"2009","journal-title":"AIDS"},{"issue":"9731","key":"pone.0295920.ref004","doi-asserted-by":"crossref","first-page":"2092","DOI":"10.1016\/S0140-6736(10)60705-2","article-title":"Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis","volume":"375","author":"D Donnell","year":"2010","journal-title":"Lancet (London, England)."},{"key":"pone.0295920.ref005","volume-title":"Progress report 2016: prevent HIV, test and treat all: WHO support for country impact.","author":"World Health Organization (WHO).","year":"2016"},{"key":"pone.0295920.ref006","volume-title":"Fast-tracking implementation of the 90-90-90 strategy for HIVthrough the implementation of the test and treat (TT) policy and same-day anti-retroviral therapy (ART) initiation for positive patients.","author":"South African National Department of Health (SA-NDoH).","year":"2017"},{"key":"pone.0295920.ref007","volume-title":"National Department of Health annual report 2017\/2018.","author":"SA-NDoH.","year":"2018"},{"key":"pone.0295920.ref008","volume-title":"National Department of Health Annual Report 2020 \/ 2021.","author":"SA-NDoH.","year":"2021"},{"key":"pone.0295920.ref009","volume-title":"The Fifth South African National HIV Prevalence, Incidence, Behaviour and Communication Survey2017: HIV Impact Assessment Summary Report.","author":"Human Sciences Research Council (HSRC).","year":"2018"},{"issue":"12","key":"pone.0295920.ref010","doi-asserted-by":"crossref","first-page":"4209","DOI":"10.1007\/s10461-021-03296-8","article-title":"Changing Knowledge and Attitudes Towards HIV Treatment-as-Prevention and \u201cUndetectable\u2009 = \u2009Untransmittable\u201d: A Systematic Review.","volume":"25","author":"J Bor","year":"2021","journal-title":"AIDS and Behavior"},{"issue":"25","key":"pone.0295920.ref011","doi-asserted-by":"crossref","first-page":"2305","DOI":"10.1056\/NEJMp2113118","article-title":"A Failure to Disseminate Transformative Science\u2014HIV Treatment as Prevention, 10 Years On","volume":"385","author":"J Bor","year":"2021","journal-title":"New England Journal of Medicine"},{"issue":"1","key":"pone.0295920.ref012","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1097\/QCO.0000000000000613","article-title":"Undetectable viral load and HIV transmission dynamics on an individual and population level: where next in the global HIV response?","volume":"33","author":"BR Bavinton","year":"2020","journal-title":"Current Opinion in Infectious Diseases"},{"issue":"6","key":"pone.0295920.ref013","doi-asserted-by":"crossref","first-page":"e25955","DOI":"10.1002\/jia2.25955","article-title":"Turning the tide in HIV through health communication research","volume":"25","author":"C Lawhorn","year":"2022","journal-title":"J Int AIDS Soc"},{"issue":"10","key":"pone.0295920.ref014","doi-asserted-by":"crossref","first-page":"3128","DOI":"10.1007\/s10461-021-03284-y","article-title":"Undetectable\u2009 = \u2009Untransmittable (U\u2009 = \u2009U) Messaging Increases Uptake of HIV Testing Among Men: Results from a Pilot Cluster Randomized Trial.","volume":"25","author":"P Smith","year":"2021","journal-title":"AIDS and Behavior"},{"issue":"10","key":"pone.0295920.ref015","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1089\/apc.2020.0137","article-title":"Treatment is more than prevention: perceived personal and social benefits of undetectable = untransmittable messaging among sexual minority men living with HIV","volume":"34","author":"HJ Rendina","year":"2020","journal-title":"AIDS Patient Care and STDs"},{"issue":"9","key":"pone.0295920.ref016","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1089\/apc.2021.0070","article-title":"Prevalence of U = U awareness and its association with anticipated HIV stigma among low-income heterosexually active Black and Latino adults in New York City, 2019","volume":"35","author":"AV Rivera","year":"2021","journal-title":"AIDS patient care and STDs"},{"issue":"1","key":"pone.0295920.ref017","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1136\/sextrans-2020-054551","article-title":"Undetectable equals untransmittable (U = U): awareness and associations with health outcomes among people living with HIV in 25 countries.","volume":"97","author":"C Okoli","year":"2021","journal-title":"Sexually Transmitted Infections"},{"issue":"8","key":"pone.0295920.ref018","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1136\/sextrans-2021-055031","article-title":"Perceived efficacy of HIV treatment-as-prevention among university students in Johannesburg, South Africa.","volume":"97","author":"J Bor","year":"2021","journal-title":"Sexually Transmitted Infections"},{"key":"pone.0295920.ref019","article-title":"Beliefs about the benefits of HIV treatment in the era of \u201ctreat all\u201d: evidence from rural South Africa.","author":"J Bor","year":"2018","journal-title":"Population Association of America Annual Meeting"},{"issue":"11","key":"pone.0295920.ref020","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1080\/09540121003693514","article-title":"Literacy, education and adherence to antiretroviral therapy in The Gambia.","volume":"22","author":"A Hegazi","year":"2010","journal-title":"AIDS Care"},{"key":"pone.0295920.ref021","article-title":"\u201cI was scared dating\u2026 who would take me with my status?\u201d- Living with HIV in the UTT era in Johannesburg, South Africa.","author":"T Sineke","year":"2022","journal-title":"medRxiv"},{"issue":"5","key":"pone.0295920.ref022","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1080\/09540121.2021.1902927","article-title":"HIV and ART related knowledge among newly diagnosed patients with HIV under the universal-test-and-treat (UTT) policy in Johannesburg, South Africa.","volume":"34","author":"T Sineke","year":"2022","journal-title":"AIDS Care"},{"issue":"7","key":"pone.0295920.ref023","doi-asserted-by":"crossref","first-page":"e0271607","DOI":"10.1371\/journal.pone.0271607","article-title":"Challenges to communicating the Undetectable equals Untransmittable (U = U) HIV prevention message: Healthcare provider perspectives.","volume":"17","author":"D Grace","year":"2022","journal-title":"Plos ONE."},{"issue":"7","key":"pone.0295920.ref024","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1080\/09540120500038660","article-title":"Relation between literacy and HIV treatment knowledge among patients on HAART regimens","volume":"17","author":"MS Wolf","year":"2005","journal-title":"AIDS Care"},{"issue":"3","key":"pone.0295920.ref025","doi-asserted-by":"crossref","first-page":"e25466","DOI":"10.1002\/jia2.25466","article-title":"\u201cI just believe there is a risk\u201d understanding of undetectable equals untransmissible (U = U) among health providers and HIV-negative partners in serodiscordant relationships in Kenya.","volume":"23","author":"K Ngure","year":"2020","journal-title":"Journal of the International AIDS Society"},{"key":"pone.0295920.ref026","first-page":"550","article-title":"Love in the Time of HIV: Testing as a Signal of Risk.","author":"L Derksen","year":"2016","journal-title":"Natural Field Experiments."},{"issue":"1","key":"pone.0295920.ref027","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12961-020-00673-y","article-title":"Health provider perspectives on the implementation of the same-day-ART initiation policy in the Gauteng province of South Africa.","volume":"19","author":"D Onoya","year":"2021","journal-title":"Health Research Policy and Systems"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0295920","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,20]],"date-time":"2023-12-20T13:38:13Z","timestamp":1703079493000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0295920"}},"subtitle":[],"editor":[{"given":"Allanise","family":"Cloete","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,12,20]]},"references-count":27,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,12,20]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0295920","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,20]]}}}