Journal of the International AIDS Society · 2025
Early experiences with usage of long-acting injectable cabotegravir among adults in rural Ugandan and Kenyan communities: qualitative research from the SEARCH "Dynamic Choice HIV Prevention" intervention trials.
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Camlin Carol S, Onyango Anjeline, Johnson-Peretz Jason, Akatukwasa Cecilia, Arunga Titus O, Owino Lawrence, Atwine Frederick, Byamukama Ambrose, Mutabazi Andrew, Balzer Laura B, Czarnogorski Maggie, Kakande Elijah, Sunday Helen, Chamie Gabriel, Ayieko James, Petersen Maya, Sutter Nicole, Kamya Moses R, Havlir Diane V, Kabami Jane
Аннотация
INTRODUCTION: Despite oral HIV pre-exposure prophylaxis (PrEP) effectiveness, uptake and adherence remains a challenge. Newer HIV prevention technologies, including long-acting injectable cabotegravir (CAB-LA), are promising for addressing known barriers to oral PrEP uptake and adherence, yet research remains limited on experiences with CAB-LA among at-risk adults in community settings. This descriptive qualitative study explored experiences with CAB-LA among adults participating in the SEARCH Dynamic Choice HIV Prevention (DCP) trial in rural Kenya and Uganda, which evaluated HIV prevention uptake through a structured, person-centred DCP model.
METHODS: We conducted in-depth semi-structured interviews in July-October 2023 with a purposively selected sample of 47 DCP trial participants who initiated CAB-LA and had at least two injections. Interviews explored participants' reasons for choosing CAB-LA and their experiences with the method. We also included 10 participants who subsequently discontinued CAB-LA or switched to another method. Data were analysed using inductive coding, memoing and framework analysis.
RESULTS: The 47 participants ranged from 20 to 59 years of age; 13 were men and 34 were women. Participants were enthusiastic about CAB-LA. They perceived it as novel, efficacious and advantageous relative to oral daily PrEP, which had been hindered by stigma, interruptions due to work, family visits and travel, side effects, and pill attributes (size and smell). Two major advantages of CAB-LA over PrEP were improved protection from HIV stigma and from HIV acquisition due to easier adherence. Participants felt CAB-LA was clearly distinguishable from antiretroviral therapy and would not mark them (mistakenly) as living with HIV; among women, clandestine use to guard against stigma from family members was more achievable compared to oral PrEP. Appointments for injections were rare enough (monthly, then bimonthly) that they could be kept, especially with reminders from providers, although for some, unpredictable work and travel schedules hindered their uptake of CAB-LA. Participants cited injection-site pain as the main drawback.
CONCLUSIONS: CAB-LA overcame several known barriers to HIV prevention uptake and adherence for women and men. In contexts of continued HIV-related stigma, CAB-LA met some participants' preferences for a product that permitted prevention to be visibly distinguishable from treatment, enabling HIV prevention uptake to feel safer. Moreover, adherence was more easily achieved with CAB-LA compared to PrEP, boosting confidence in prevention efficacy.
METHODS: We conducted in-depth semi-structured interviews in July-October 2023 with a purposively selected sample of 47 DCP trial participants who initiated CAB-LA and had at least two injections. Interviews explored participants' reasons for choosing CAB-LA and their experiences with the method. We also included 10 participants who subsequently discontinued CAB-LA or switched to another method. Data were analysed using inductive coding, memoing and framework analysis.
RESULTS: The 47 participants ranged from 20 to 59 years of age; 13 were men and 34 were women. Participants were enthusiastic about CAB-LA. They perceived it as novel, efficacious and advantageous relative to oral daily PrEP, which had been hindered by stigma, interruptions due to work, family visits and travel, side effects, and pill attributes (size and smell). Two major advantages of CAB-LA over PrEP were improved protection from HIV stigma and from HIV acquisition due to easier adherence. Participants felt CAB-LA was clearly distinguishable from antiretroviral therapy and would not mark them (mistakenly) as living with HIV; among women, clandestine use to guard against stigma from family members was more achievable compared to oral PrEP. Appointments for injections were rare enough (monthly, then bimonthly) that they could be kept, especially with reminders from providers, although for some, unpredictable work and travel schedules hindered their uptake of CAB-LA. Participants cited injection-site pain as the main drawback.
CONCLUSIONS: CAB-LA overcame several known barriers to HIV prevention uptake and adherence for women and men. In contexts of continued HIV-related stigma, CAB-LA met some participants' preferences for a product that permitted prevention to be visibly distinguishable from treatment, enabling HIV prevention uptake to feel safer. Moreover, adherence was more easily achieved with CAB-LA compared to PrEP, boosting confidence in prevention efficacy.