Willingness to use long-acting injectable pre-exposure prophylaxis among key populations at a large HIV prevention clinic in Kampala, Uganda: a cross-sectional study.

Background: Long-acting injectable (LAI)-PrEP provides better protection against HIV compared to oral PrEP, which requires taking a daily pill. Our study aimed to assess knowledge about oral and LAI-PrEP and identify factors associated with willingness to use LAI-PrEP among key populations (KPs) in Uganda.

Methods: We conducted a cross-sectional study at the Most at Risk Populations Initiative (MARPI) clinic between November and December 2021. Participants were recruited through convenience sampling and interviewed using a structured questionnaire by trained interviewers. Participants were categorised into three groups based on their oral PrEP use: those who had not yet initiated PrEP, those who had discontinued oral PrEP, and those currently on oral PrEP. Modified Poisson regression analysis was performed to determine factors associated with the participants' willingness to use LAI-PrEP. Data was analysed using STATA 14 software.

Results: Of the 234 participants, 135 (57.7%) were female, 82.5% knew about LAI-PrEP, and 65.8% were willing to use it. The mean age was 28.7 years (standard deviation [SD] 5.8). Willingness to use LAI-PrEP was less likely among divorced, widowed, or separated individuals than singles (i.e., people with no prior marital experience and neither in a romantic relationship) (adjusted prevalence ratio [aPR] 0.65, 95% CI: 0.43-0.98). Relative to current oral PrEP users, willingness to use LAI-PrEP was similar among those who discontinued oral PrEP (aPR 1.39, 95% CI: 0.92-2.11) and those who had not yet initiated PrEP but were at risk for HIV (aPR 1.26, 95% CI: 0.83-1.89).

Conclusions: This cross-sectional analysis of diverse members of KPs in Uganda revealed that the willingness to use LAI-PrEP was lower among individuals who were divorced, separated, or widowed compared to those who were single. Future studies should investigate effective methods for promoting the uptake of long-acting PrEP formulations among populations at high risk of HIV acquisition.