Interest in long-acting injectable antiretroviral therapy (ART) among adults living with HIV newly starting or restarting ART in Cape Town, South Africa

Abstract

Long-acting injectable antiretroviral therapy (LAI ART) has proven effective in maintaining viral suppression among people living with HIV but recommendations to switch to LAI ART are limited to individuals stable and virologically suppressed on oral ART. Understanding LAI perceptions among diverse populations living with HIV is essential. In a cross-sectional survey at two peri-urban clinics in Cape Town, adults starting or restarting treatment rated their hypothetical interest in LAI ART on a quantitative Likert-scale (1= not at all interested to 5 = very interested) and provided open-ended explanations. Among 329 participants (61% women; median age 39 years), 74% were very interested, 15% were unsure or somewhat interested (response 3 or 4) and 11% were not very or not at all interested (response 1 or 2). In thematic analysis of open-ended responses, participants commonly viewed LAI ART as a way to avoid daily pills, reduce adherence-related stress, and maintain privacy, noting that injections offered convenience and discretion. Concerns centred on fear of injections, potential side effects, and desire to hear others' experiences before deciding. The substantial interest observed suggests, once accessible, LAI ART as a treatment option in this population could move us closer to individual- and population-level HIV treatment goals.