"The injection gives freedom" - An exploration of long-acting injectable HIV treatment acceptance among patients seeking care in two Nairobi tertiary hospitals.

BACKGROUND: Long-acting injectable antiretroviral therapy offers an alternative to daily oral HIV treatment, potentially improving adherence and reducing stigma. While its adoption has been successful in some settings, evidence on its acceptability in sub-Saharan Africa, outside clinical trials, remains limited.

METHODS: We conducted a mixed-methods study among people living with HIV (PLHIV) in two tertiary hospitals in Nairobi, Kenya-a public facility (Kenyatta National Hospital) and a private facility (Aga Khan University Hospital). A cross-sectional survey of 356 participants assessed awareness, willingness to switch, and predictors of acceptability. In addition, 30 participants took part in three focus group discussions (FGDs) exploring perceptions, concerns, and system-level considerations. Quantitative data were analyzed using descriptive and inferential statistics, while qualitative data were analyzed thematically.

RESULTS: Overall, 72.2% of survey participants indicated a willingness to switch to LAI-ART. In the final adjusted multivariable models, prior awareness of LAI-ART was a powerful independent predictor, nearly tripling a patient's willingness to switch (aOR = 2.851; 95% CI: 1.742-4.666; p < 0.001). Finding information through online resources (aOR = 2.246; 95% CI: 1.303-3.873; p = 0.004) and missing oral pill doses (aOR = 2.154; 95% CI: 1.266-3.664; p = 0.005) both independently more than doubled a participant's odds of finding LAI-ART acceptable. Conversely, the enrollment hospital site had no independent statistical effect on acceptability once the analysis controlled for baseline demographics and how often individuals must visit the hospital for care (aOR = 1.188; 95% CI: 0.659-2.141; p = 0.567). Drivers of interest among those willing to switch included reducing pill burden (77.8%), avoiding forgetting doses (55.6%), and improving privacy (45.5%). Despite high baseline acceptability, focus group discussions revealed a state of cautious optimism, driven by significant fears of potential side effects (68.1%), treatment rigidity, and logistical challenges such as travel and clinic access.

CONCLUSION: These findings suggest that although LAI-ART is widely viewed as a promising treatment option, its uptake will depend on effective patient-centered communication, increased awareness, trust in the intervention, and reliable service delivery. However, successful implementation in Kenya will require more than patient willingness alone. Health system readiness must be a central consideration, with implementation strategies focused on securing dependable drug supply chains, decentralizing access through county-level clinics, and strengthening digital systems to support patient monitoring, retention, and continuity of care.