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Background: Adherence to antiretroviral therapy (ART) among people living with HIV (PLHIV) is essential to improve individual outcomes and curb ongoing transmission. Challenges with daily oral medication have stimulated the development of long-acting injectable (LAI) ART as a means to address barriers.
Methods: We conducted 39 in-depth interviews including with 27 PLHIV (25 men, 2 women) and 12 clinical providers participating in a Phase IIb study (LATTE-2) evaluating a long-acting intramuscular ART regimen in the United States and Spain. Participants were treatment-naïve upon study entry and randomized to daily oral ART or LAI ART every 4 or 8 weeks. Interviews explored participant and provider attitudes and experiences with daily oral and LAI ART. Interviews were audiotaped, transcribed, coded and analyzed using thematic content analysis. All trial participants had completed a minimum of 32 weeks of LAI ART following 20 weeks of oral ART.
Results: Almost all participants experienced some level of side effects associated with LAI ART, mostly temporary soreness at the injection site. Yet, all reported being satisfied and interested in continuing LAI ART. Participants relayed practical and emotional benefits of LAI ART compared to oral ART. Practical benefits included convenience and logistical ease of receiving an injection every 4 or 8 weeks versus a daily pill. In many cases, participants reported LAI ART helped them manage stigma. LAI ART was seen as more discreet with less possibility of others discovering one''s HIV status and it did not involve the “daily reminder of living with HIV”. Most participants felt LAI ART could be beneficial to all PLHIV but particularly those with oral ART adherence challenges. While providers recognized the benefits of LAI ART, they expressed concerns LAI ART candidates would still need to be able to adhere to clinic visits for injections and concerns regarding the clinical management of LAI ART if it were necessary to stop the regimen given its long-acting nature.
Conclusions: LAI ART was preferable to a daily oral regimen among PLHIV participating in a Phase IIb trial given its practical and emotional benefits. Further research is needed regarding appropriate candidates for LAI ART including among women and “non-adherent” populations.