Interest in long-acting injectable ART among adolescents with perinatally acquired HIV in Cameroon: Implications for implementation in developing countries

Abstract

Long-acting injectable antiretroviral therapy (LAI-ART) has the potential to transform HIV treatment for adolescents with perinatal HIV infection (APHI). Given the existing knowledge gaps surrounding this recent strategy, we aimed to assess interest in LAI-ART among ART-experienced APHI in Cameroon. We conducted a cross-sectional study among ART-experienced APHI aged 10-19 years, across four paediatric HIV clinics in the Centre region of Cameroon. Data were collected from 4 to 30 November 2024 using structured questionnaires to assess sociodemographic characteristics, awareness of, and interest in LAI-ART. HIV-1 viral load (VL) and CD4 cell counts were measured during the same period. Logistic regression analysis was used to identify factors associated with interest in switching to LAI-ART. Of 248 participants (48.8% female; median [IQR] age 15 [13-17]), 40.0% lived with a guardian and 75.8% had partial/full HIV-disclosure; 3.2% reported stigma. Clinically, 77.5% were in multi-month ARV-dispensation (MDSD) and 28.2% had poor ART-adherence; fear of injection was none/moderate/high in 73.4%, 15.7% and 10.9%, respectively. Viral undetectability (VL < 50 copies/mL) and CD4 ≥ 500 cells/mm³ were 71.6% and 72.5%, respectively. Overall, 92.3% expressed interest in LAI-ART, motivated by reduced pill burden/fatigue (63.7%) and expected better adherence (74.2%); 30.2% reported prior LAI-ART awareness. In multivariable analysis, no prior awareness had 81% lower odds of interest (p = 0.036). Compared with no-fear, moderate-fear was associated with 46% lower odds (p = 0.393), while high-fear was associated with 78% lower odds (p = 0.017). Disparities in sex, education, residence, adherence, virological response, or treatment history did not influence interest in LAI-ART. Among all respondents, 77.1% said they would choose LAI-ART if available, whereas 20.2% preferred MDSD. In this Cameroonian APHI cohort, awareness of LAI-ART was low despite high-interest once adolescents were informed. Rollout in low/middle-income countries should prioritise targeted education, youth-friendly counselling to close knowledge gaps, reduce fear and ensure equitable uptake.