Acceptance of long-acting injectable HIV treatment and prevention options among people living with HIV and PrEP-service participants in Uganda
A cross-sectional study in Uganda found that while acceptance of long-acting injectable HIV treatment and prevention is substantial overall, it is significantly higher among people living with HIV than among PrEP-service participants, with perceived benefits being the strongest independent predictor of willingness to adopt these options.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
For decades, the standard way to manage HIV has been a daily routine of swallowing pills. For those living with the virus, these medications keep the infection in check, allowing them to live long, healthy lives. For those at risk of catching it, a similar daily pill can act as a shield, preventing infection before it starts. While these daily treatments work well when taken exactly as prescribed, the rhythm of life often gets in the way. Travel, busy schedules, or the fear of being seen taking medication can make remembering a daily tablet difficult. In recent years, scientists have developed a new kind of medicine: long-acting injections. Instead of a daily pill, these shots are given by a healthcare worker every few months, offering a way to stay protected or stay healthy without the daily burden of a pillbox. But before these shots can become a standard part of care, doctors need to know if the people who would use them actually want them.
In Uganda, a team of researchers set out to understand this question by asking two distinct groups of people about their willingness to switch from daily pills to these new injections. They focused on people living with HIV who are already on treatment, and on HIV-negative people who are using services designed to help them stay negative. The researchers wanted to see if the desire for a long-acting shot was the same for someone managing a lifelong condition as it was for someone trying to prevent a new infection. They gathered 232 participants from two medical facilities in central Uganda, interviewing them in private to learn what they thought about the benefits and the worries associated with these injections.
The study found that while a large majority of people were open to the idea, the desire to switch was not equal across the two groups. Nearly nine out of ten people living with HIV said they would be willing to try a long-acting injection for their treatment. In contrast, only about two out of three people in the prevention group said they would be willing to use a long-acting injection to prevent HIV. The researchers discovered that this difference was not simply because one group was older or younger, or because one group knew more about the shots than the other. Instead, the strongest factor was how much benefit the person felt they would get from the change. Those who saw the most value in the idea of not taking daily pills were the most likely to say yes to the injection.
When the researchers looked closer at what people were thinking, they saw that both groups appreciated the practical advantages. Many participants liked the idea of reduced pill-taking, better privacy, and the freedom to travel without worrying about carrying medication. However, the people in the prevention group expressed more hesitation about the practicalities of the shot itself. They were more concerned about the need to return to the clinic on a strict schedule, the possibility of pain at the injection site, and the worry that the medicine might not always be available. The people living with HIV, who are already committed to lifelong treatment, seemed more ready to trade their daily routine for the convenience of a few visits a year.
The study suggests that introducing these new shots will require different conversations for different people. For those living with HIV, the message might focus on how the injection simplifies their daily life and protects their privacy. For those seeking prevention, the conversation needs to address their specific concerns about safety, the commitment to clinic visits, and the reliability of the supply. The researchers noted that while the shots offer a promising alternative, they are not a one-size-fits-all solution. The willingness to use them depends heavily on how much a person values the freedom from daily pills compared to the potential downsides of a scheduled injection.
This research highlights that the success of new medical tools depends not just on how well they work in a lab, but on how well they fit into the lives of the people who will use them. The findings show that while the technology is ready, the path to widespread use requires understanding the unique needs and fears of each group. By listening to what people say about the benefits and the risks, health workers can better prepare to offer these injections in a way that people will actually accept and stick with. The study does not prove that everyone will switch, but it provides a clear map of who is ready and what they need to hear to make that choice.
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