Exploring Preferences, Concerns, and Implementation of Different Long-Acting Antiretroviral Strategies for Youth with HIV Facing Adherence Challenges.

Abstract

Youth living with human immunodeficiency virus (YHIV) aged 13-25 often struggle with adherence to daily oral antiretroviral treatment (ART) regimens. Recently approved intramuscular injectable long-acting ART (LA-ART) may promote adherence and improve longitudinal health outcomes. The study explores the willingness to use LA-ART strategies among YHIV. This cross-sectional pilot study included a telephone-based survey embedded into a randomized controlled trial of an intervention (NCT03600103) designed to enhance viral suppression among YHIV with baseline adherence challenges and detectable viremia. Participants completed 34-item telephone surveys between October 2021 and February 2022 to evaluate preferences and willingness to use four LA-ART delivery alternatives [intramuscular injection (IM), subcutaneous injection (SC), subdermal implant (SDI), and LA-ART pills] compared with daily oral ART. Long-acting pills were most preferred (84%, 16/19), while 79% of participants (15/19) expressed willingness to try IM, 79% (15/19) SC, and 74% (14/19) SDI. However, when asked to choose only one method, most (58%, 11/19) selected IM as the method that would work best. The arm was the preferred injection site (73% [8/11]) compared with the thigh (18% [2/11]). Willingness to use LA-ART was higher with less frequent injections, e.g., for IM LA-ART, 47% (9/19) were willing to try weekly vs. 79% (15/19) were willing to try every three-month injections. YHIV experiencing adherence challenges are willing to use novel LA-ART delivery methods. Addressing concerns around LA-ART methods and educating YHIV on their efficacy could help increase uptake, which could reduce rates of non-adherence in YHIV.