Factors Associated with Preferences for Long-Acting Injectable Antiretroviral Therapy Among Adolescents and Young People Living with HIV in South Africa

• Type of Material: Article
• Authors: Elona Toska, University of Cape Town; Siyanai Zhou, University of Cape Town; Jenny Chen-Charles, University of Oxford; Lesley Gittings, University of Cape Town; Don Operario, Emory University; Lucie Cluver, University of Oxford
• Language: English
• Date: 2023-01-09
• Publisher: SPRINGER/PLENUM PUBLISHERS
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2023
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1007/s10461-022-03949-2
• Title of Journal or Parent Work: AIDS AND BEHAVIOR
• Start Page: 1
• End Page: 13
• Grant/Funding Information: This study has received funding from The International AIDS Society through the CIPHER grant [155-Hod] and [2018/625-TOS] (the views expressed in written materials or publications do not necessarily reflect the official policies of the International AIDS society); Evidence for HIV Prevention in Southern Africa (EHPSA), a UK aid programme managed by Mott MacDonald; Janssen Pharmaceutica N.V., part of the Janssen Pharmaceutical Companies of Johnson & Johnson; the Nuffield Foundation, but the views expressed are those of the authors and not necessarily the Foundation; the John Fell Fund [161/033] and [103/757]; the Leverhulme Trust; University of Oxford’s ESRC Impact Acceleration Account (IAA) [K1311-KEA-004]; UNICEF Eastern and Southern Africa Office (UNICEF-ESARO); Oak Foundation/GCRF "Accelerating Violence Prevention in Africa" [OFIL-20-057]; UKRI GCRF Accelerating Achievement for Africa's Adolescents (Accelerate) Hub (Grant Ref: ES/S008101/1); the Regional Inter-Agency Task Team for Children Affected by AIDS—Eastern and Southern Africa (RIATT-ESA); and the Fogarty International Center, National Institute on Mental Health, National Institutes of Health under Award Number K43TW011434 (the content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health).
• Keywords: Antiretroviral; South Africa; SCALE; Social Sciences; ADHERENCE; Life Sciences & Biomedicine; PREVENTION; AGENTS; YOUTH; OUTCOMES; CABOTEGRAVIR; ADULTS; Adolescents; Social Sciences, Biomedical; Injectables; Science & Technology; Long-acting; Public, Environmental & Occupational Health; Biomedical Social Sciences; RETENTION; RILPIVIRINE
• Research Categories: Health Sciences, Public Health; Sociology, General

Abstract

Long-acting injectable anti-retroviral therapy (LAART) may overcome barriers to long-term adherence and improve the survival of adolescents and young people living with HIV (AYLHIV). Research on the acceptability of LAART for this age-group is limited. We asked 953 AYLHIV about their preferred (theoretical) ART mode of delivery (pill, injectable, or other) in 2017–2018, before LAART was available or known to AYLHIV in South Africa. One in eight (12%) AYLHIV preferred LAART over single or multiple pill regimens. In multivariate analyses, six factors were associated with LAART preference: medication stock-outs (aOR = 2.56, 95% CI 1.40–4.68, p = 0.002), experiencing side-effects (aOR = 1.84, 95% CI 1.15–2.97, p = 0.012), pill-burden (aOR = 1.88, 95% CI 1.20–2.94, p = 0.006), past-year treatment changes (aOR = 1.63, 95% CI 1.06–2.51, p = 0.025), any HIV stigma (aOR = 2.22, 95% CI 1.39–3.53, p ≤ 0.001) and recent ART initiation (aOR = 2.02, 95% CI 1.09–3.74, p = 0.025). In marginal effects modelling, 66% of adolescents who experienced all factors were likely to prefer LAART, highlighting the potential high acceptability of LAART among adolescents and young people living with HIV struggling to adhere and have good HIV treatment outcomes. Adolescent boys who reported high ART pill burden were more likely to prefer LAART than their female peers in moderation analyses, suggesting that LAART may be particularly important to improve treatment outcomes among male AYLHIV as they become older. Adding LAART to existing treatment options for AYLHIV, particularly higher risk groups, would support AYLHIV to attain and sustain viral suppression—the third 95, and reduce their risk of AIDS-related mortality.