Abstract:
Introduction: Adolescents and young people living with HIV (AYPLHIV) face
significant hurdles in adhering to daily oral antiretroviral therapy (ART). Long-
acting (LA) ART, such as injectable cabotegravir and rilpivirine, may help
overcome these hurdles. However, little is known about the perceived benefits
and barriers to LA ART usage by AYPLHIV in resource-limited settings.
Methods: We conducted focus group discussions (FGDs) with four target
groups of adolescents/youth, providers, policymakers, and other advocates in
western Kenya from November 2021 to April 2022. The FGDs elicited participants’
thoughts on LA ART implementation in Kenya, particularly the benefits and
barriers of LA ART use amongst AYPLHIV. Our analysis combined both inductive
and deductive approaches, beginning with open coding of the data, then
organizing them in predetermined socio-ecological model (SEM) domains.
Results and discussion: We conducted a total of seven FGDs with 58 participants
across four stakeholder groups: AYPLHIV (2 FGDs, n = 14), healthcare providers (2
FGDs, n = 19), health/youth advocates (2 FGDs, n = 16), and policymakers (1 FGD,
n = 9). We identified several benefits, largely centered around the individual and
interpersonal level, as well as barriers, largely centered around the health systems
levels. Participants viewed LA ART as a welcome alternative to oral ART due to
benefits like improved adherence, reduced pill burden, increased convenience,
enhanced privacy, decreased stigma, lower risk of accidental disclosure, and
convergence in using LA contraception. At the interpersonal level, LA ART was
valued for furthering relationships, especially for AYPLHIV (e.g., dating). At the
health systems level, LA ART expanded first-line treatment options. Conversely,
barriers to health systems integration included conflicts with service models,
increased clinic burden, supply chain issues, and waste disposal. Individual-level
barriers included fears of injections, side effects, concerns about a new drug, and
reduced effectiveness if mixing LA ART with oral ART.Conclusions: The perceived benefits of LA ART for AYPLHIV, centering on
individual and interpersonal levels of positive impacts, appear in tension with the
anticipated barriers for health systems readiness in Kenya. While the prospect of
offering LA ART is overwhelming positive, country programs will have to invest
in health systems readiness before rolling out LA ART.
