Thorp Marguerite, Phiri Sam, Phiri Khumbo, Robson Isabella, Mphande Misheck, Dovel Kathryn, Hoffman Risa
Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; and.
Partners in Hope, Lilongwe, Malawi .
J Acquir Immune Defic Syndr. 2024 Dec 15;97(5):e25-e29. doi: 10.1097/QAI.0000000000003525.
BACKGROUND: Long-acting injectable (LAI) antiretroviral medications are as effective as daily oral antiretroviral therapy (ART) and offer discreet, less frequent dosing. LAIs may be ideal treatment options for people who experience challenges with adherence to daily oral ART, including mobile men living with HIV (MLHIV). METHODS: We conducted a qualitative substudy within two parent trials in 24 health facilities in Malawi that enrolled MLHIV ≥15 years not on ART. We conducted in-depth interviews with a stratified random sample of participants who had taken oral ART and self-reported mobility (travel) during the 6-month study (≥1 trip of ≥3 nights). Interviews described cabotegravir/rilpivirine and asked about clients' stated preferences for LAI vs. oral ART and their reasoning. Interviews were translated, transcribed, coded in Atlas.ti, and analyzed using framework analysis. RESULTS: We interviewed 29 mobile MLHIV from July 1, 2022, to August 30, 2022, median age 36 years (interquartile range: 31-41), mean 28 nights away in the past 6 months (SD: 40). Nearly all participants (26/29) expressed a preference for LAI over daily oral ART because LAI would reduce the risks of forgetting to take pills and unwanted disclosure. Three men preferred oral ART primarily because of fear of side effects from a new medication. A few men reported they would change their preference if injection site reactions prevented them from working. CONCLUSIONS: Mobile MLHIV in Malawi with previous ART adherence challenges expressed strong stated preferences for LAI over daily oral ART. Further research is needed to understand implementation challenges and potential effectiveness of LAI among harder-to-reach populations.
背景：长效注射用抗逆转录病毒药物与每日口服抗逆转录病毒疗法（ART）效果相当，且给药方式更隐秘、频率更低。对于在坚持每日口服ART方面存在困难的人群，包括感染艾滋病毒的流动男性（MLHIV），长效注射用药物可能是理想的治疗选择。 方法：我们在马拉维24个医疗机构的两项主要试验中开展了一项定性子研究，纳入了年龄≥15岁且未接受ART的MLHIV。我们对在6个月研究期间服用过口服ART并自我报告有流动（出行）情况（≥1次行程≥3晚）的参与者进行分层随机抽样，进行深入访谈。访谈中介绍了卡博特韦/利匹韦林，并询问了参与者对长效注射用药物与口服ART的既定偏好及其理由。访谈内容被翻译、转录，在Atlas.ti中编码，并采用框架分析法进行分析。 结果：2022年7月1日至2022年8月30日，我们访谈了29名流动MLHIV，中位年龄36岁（四分位间距：31 - 41岁），过去6个月平均外出28晚（标准差：40）。几乎所有参与者（26/29）都表示相较于每日口服ART，更喜欢长效注射用药物，因为长效注射用药物会降低忘记服药和意外暴露的风险。三名男性主要因为担心新药的副作用而更喜欢口服ART。少数男性报告称，如果注射部位反应导致他们无法工作，他们会改变偏好。 结论：马拉维曾在ART依从性方面存在困难的流动MLHIV表示，相较于每日口服ART，他们明显更喜欢长效注射用药物。需要进一步研究以了解在更难接触到的人群中长效注射用药物的实施挑战和潜在效果。
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