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Promoting U ndetectable Equals U ntransmittable in Sub-Saharan Africa: Implication for Clinical Practice and ART Adherence

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  • Nicholas Ekow Thomford

    (Division of Human Genetics, Department of Pathology & Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
    School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana)

  • Doreen Mhandire

    (Division of Human Genetics, Department of Pathology & Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa)

  • Collet Dandara

    (Division of Human Genetics, Department of Pathology & Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa)

  • George B. Kyei

    (Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
    Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA)

Abstract

In the last decade, reliable scientific evidence has emerged to support the concept that undetectable viral loads prevent human immunodeficiency virus (HIV). Undetectable equals untransmissible (U = U) is a simple message that everyone can understand. The success of this concept depends on strict adherence to antiretroviral therapy (ART) and the attainment of suppressed viral loads (VLs). To achieve U = U in sub-Saharan Africa (SSA), poor adherence to ART, persistent low-level viremia, and the emergence of drug-resistant mutants are challenges that cannot be overlooked. Short of a cure for HIV, U = U can substantially reduce the burden and change the landscape of HIV epidemiology on the continent. From a public health perspective, the U = U concept will reduce stigmatization in persons living with HIV (PLWHIV) in SSA and strengthen public opinion to accept that HIV infection is not a death sentence. This will also promote ART adherence because PLWHIV will aim to achieve U = U within the shortest possible time. This article highlights challenges and barriers to achieving U = U and suggests how to promote the concept to make it beneficial and applicable in SSA. This concept, if expertly packaged by policy-makers, clinicians, health service providers, and HIV control programs, will help to stem the tide of the epidemic in SSA.

Suggested Citation

  • Nicholas Ekow Thomford & Doreen Mhandire & Collet Dandara & George B. Kyei, 2020. "Promoting U ndetectable Equals U ntransmittable in Sub-Saharan Africa: Implication for Clinical Practice and ART Adherence," IJERPH, MDPI, vol. 17(17), pages 1-11, August.
    • Handle: RePEc:gam:jijerp:v:17:y:2020:i:17:p:6163-:d:403680
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    References listed on IDEAS

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    1. Victoria Johnston & Katherine Fielding & Salome Charalambous & Mildred Mampho & Gavin Churchyard & Andrew Phillips & Alison D Grant, 2012. "Second-Line Antiretroviral Therapy in a Workplace and Community-Based Treatment Programme in South Africa: Determinants of Virological Outcome," PLOS ONE, Public Library of Science, vol. 7(5), pages 1-11, May.
    2. Peter D Ehrenkranz & Solange L Baptiste & Helen Bygrave & Tom Ellman & Naoko Doi & Anna Grimsrud & Andreas Jahn & Thokozani Kalua & Rose Kolola Nyirenda & Michael O Odo & Pascale Ondoa & Lara Vojnov &, 2019. "The missed potential of CD4 and viral load testing to improve clinical outcomes for people living with HIV in lower-resource settings," PLOS Medicine, Public Library of Science, vol. 16(5), pages 1-8, May.
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