School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
Joint Clinical Research Centre, Fort Portal Regional Centre of Excellence, Fort Portal, Uganda.
BMC Infect Dis. 2024 Aug 28;24(1):876. doi: 10.1186/s12879-024-09748-5.
Long-acting injectable antiretroviral treatment (LAI-ART) has emerged as a novel alternative to the burden of daily oral pills. The bi-monthly intramuscular injectable containing cabotegravir and rilpivirine holds the promise of improving adherence to ART. The perspectives of potential users of LAI-ART, the majority of whom reside in Eastern and Southern Africa, are still largely unexplored. We set out to understand the experiences of people with HIV (PWH) who received LAI-ART at Fort Portal Regional Referral Hospital in mid-Western Uganda for at least 12 months.
This qualitative study, conducted between July and August 2023, was nested within a larger study. We conducted four focus groups with 32 (out of 69) PWH who received intramuscular injections of cabotegravir and rilpivirine. In-depth interviews were held with six health workers who delivered LAI-ART to PWH. Data were analyzed by thematic approach broadly modeled on the five domains of the Consolidated Framework for Implementation Research (CFIR).
There was high acceptability of LAI-ART (30 /32 or 94%) participants requested to remain on LAI-ART even after the end of the 12-month trial. Adherence to ART was reportedly improved when compared to daily oral treatment. Participants credited LAI-ART with; superior viral load suppression, redemption from the daily psychological reminder of living with HIV, enhanced privacy in HIV care and treatment, reduced HIV-related stigma associated with taking oral pills and that it absolved them from carrying bulky medication packages. Conversely, nine participants reported pain around the injection site and a transient fever soon after administering the injection as side effects of LAI-ART. Missed appointments for receiving the bi-monthly injection were common. Providers identified health system barriers to the prospective scale-up of LAI-ART which include the perceived high cost of LAI-ART, stringent cold chain requirements, physical space limitations, and workforce skills gaps in LAI-ART delivery as potential drawbacks.
Overall, PWH strongly preferred LAI-ART and expressed a comparatively higher satisfaction with this treatment alternative. Health system barriers to potential scale-up are essential to consider if a broader population of PWH will benefit from this novel HIV treatment option in Uganda and other resource-limited settings.
Trial Registry Number PACTR ID PACTR202104874490818 (registered on 16/04/2021).
长效注射型抗逆转录病毒治疗（LAI-ART）已成为一种替代每日口服药物的新型治疗方法。每两个月进行一次的肌肉注射制剂，包含卡替拉韦和利匹韦林，有望提高抗逆转录病毒治疗（ART）的依从性。然而，这种新型治疗方法的潜在使用者，即大多数居住在东非和南非的艾滋病病毒感染者（PWH）的观点，在很大程度上仍未得到探索。我们旨在了解在乌干达中西部福图尔地区转诊医院接受至少 12 个月 LAI-ART 治疗的 PWH 的体验。
这项定性研究于 2023 年 7 月至 8 月期间进行，是一项更大研究的嵌套研究。我们与 32 名（69 名中的 32 名）接受肌肉注射卡替拉韦和利匹韦林的 PWH 进行了 4 次焦点小组讨论，并对 6 名为 PWH 提供 LAI-ART 的卫生工作者进行了深入访谈。数据采用主题分析方法进行分析，广泛借鉴了实施研究综合框架（CFIR）的五个领域。
接受调查的参与者（30/32 或 94%）对 LAI-ART 高度接受，即使在 12 个月试验结束后，他们仍要求继续使用 LAI-ART。与每日口服治疗相比，ART 的依从性据报道有所提高。参与者认为 LAI-ART 具有以下优点：更好的病毒载量抑制效果、摆脱因 HIV 而产生的每日心理提醒、在 HIV 护理和治疗方面增强隐私、减少与服用口服药物相关的 HIV 相关耻辱感，并免除携带大量药物的负担。然而，也有 9 名参与者报告了注射部位疼痛和注射后短暂发热等 LAI-ART 的副作用。错过每两个月接受注射的预约很常见。提供者确定了 LAI-ART 潜在扩大规模的卫生系统障碍，包括 LAI-ART 的高成本、严格的冷链要求、物理空间限制以及 LAI-ART 提供方面的劳动力技能差距，这些都是潜在的缺点。
总体而言，PWH 非常喜欢 LAI-ART，并对这种治疗替代方案表示出相对较高的满意度。如果乌干达和其他资源有限的环境中更广泛的 PWH 受益于这种新型 HIV 治疗选择，那么潜在扩大规模的卫生系统障碍是需要考虑的重要因素。
试验注册号 PACTR ID PACTR202104874490818（注册于 2021 年 4 月 16 日）。
