Brief Communication: Oral pre-exposure prophylaxis history and willingness to use injectable HIV prevention among clients at two Ugandan clinics
This study of 116 clients at two Ugandan clinics found that willingness to use injectable HIV pre-exposure prophylaxis was highest among current oral users (81.8%) compared to former (42.4%) and never users (50.0%), highlighting the need to assess information needs across different oral-use histories and verify if stated willingness translates to actual initiation.
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
HIV prevention has long relied on daily pills that people take before potential exposure to the virus, a strategy known as oral pre-exposure prophylaxis. While effective, sticking to a daily routine can be difficult for many, leading some to stop taking the medication or never start at all. To address this, scientists are developing long-acting injectable versions of these preventive drugs, which would require visits to a clinic only every few months instead of daily attention. The central question for public health officials is not just whether these new shots work, but whether people who have tried the daily pills, those who have stopped, and those who have never tried them at all are actually willing to switch to or try this new method. Understanding these differences is crucial because a one-size-fits-all approach to prevention often fails to reach the people who need it most.
In a recent study conducted at two clinics in central Uganda, researchers set out to explore exactly this question among 116 people who were already using HIV prevention services. The team visited Mildmay Hospital and Kajjansi Health Centre IV, interviewing clients who were HIV-negative and asking them about their history with oral pills and their feelings toward a hypothetical injectable option. The researchers did not offer the shots or assess medical eligibility; instead, they simply asked participants to imagine the new product and rate how willing they would be to use it on a scale from very unwilling to very willing. The group included people who were currently taking daily pills, those who had stopped in the past, and those who had never tried oral prevention at all.
The results revealed a clear divide in willingness based on past experience. Among the people who were currently taking oral pills, a strong majority of 81.8 percent said they would be willing to try the injectable version. In contrast, willingness dropped significantly among those who had stopped taking the pills in the past, with only 42.4 percent expressing interest. Similarly, those who had never used oral prevention before showed a willingness rate of 50.0 percent. When the researchers adjusted their analysis to account for age and sex, the gap remained significant: former users were about half as likely to say yes compared to current users, and never-users were also significantly less likely to agree. This suggests that having a positive, ongoing experience with daily prevention might make a person more open to trying a new form of it, while a history of stopping or never starting creates more hesitation.
Perhaps the most telling finding was not just the "yes" or "no" answers, but the large number of people who sat on the fence. Among those who had stopped taking oral pills, more than half gave a neutral response, neither agreeing nor disagreeing with the idea of the injection. A similar pattern appeared among those who had never tried oral prevention, where nearly half remained undecided. This neutrality indicates that many people are not firmly against the idea but are unsure, likely needing more information about how the shots work, what the side effects might be, or how often they would need to visit the clinic. The study suggests that for these groups, the decision is not yet made, and simply offering the product without addressing their specific uncertainties may not be enough to get them to start.
The researchers also looked at other factors like income, education, and where people lived, finding that those who were willing to try the injection tended to have slightly higher household incomes and lived in urban areas compared to those who were not willing. However, the study did not find strong evidence that age, gender, or marital status drove these differences. The authors caution that because this was a snapshot in time based on what people said they might do, rather than what they actually did, the results show stated interest rather than guaranteed future action. People might feel differently once they are offered the real product and face the actual logistics of clinic visits.
Ultimately, the study highlights that the path to successful HIV prevention is not uniform. Current users of oral pills are the most eager to explore injectable options, but a large portion of former and never-users remain uncertain rather than outright refusing. This suggests that health services need to tailor their approach, recognizing that people who have stopped taking pills or never started have different concerns and information needs than those currently on treatment. To turn this stated willingness into actual use, clinics will need to provide clear counseling that addresses the specific doubts of these hesitant groups, ensuring that the promise of long-acting prevention reaches everyone who could benefit from it.
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