Long-acting antiretroviral injections: perspectives of people living with HIV in three Middle East countries

Abstract

BACKGROUND: Although daily oral antiretroviral therapy (ART) is effective, pill burden, adherence challenges, stigma, and confidentiality concerns remain problematic for people living with HIV (PLHIV). Long-acting injectable ART (LAI-ART) is a promising alternative; however, data from the Middle East and North Africa (MENA) are limited. This study assessed PLHIV interest in LAI-ART and explored perceived benefits and barriers to implementation. METHODS: A multicenter cross-sectional survey was conducted from October 2023 to December 2024 among PLHIV in Egypt, the Kingdom of Saudi Arabia, and Oman who were receiving or had previously received ART. RESULTS: Among 1010 respondents, 88.7% expressed an interest in LAI-ART. Reported benefits included avoiding daily pills (91.1%), improved adherence (87.8%), enhanced confidentiality (86.7%), support for treatment adherence with comorbidities (88.3%), and reduced missed doses (74.5%). Reported barriers included injection pain (31.9%), difficulty scheduling travel within injection windows (30.6%), and frequent clinic visits (23.3%) to receive the injection. CONCLUSION: High interest in LAI-ART suggests readiness for adoption in the MENA region. Successful implementation requires addressing injection-related concerns through patient education, ensuring trained healthcare personnel, and adopting flexible scheduling to accommodate travel and lifestyle needs, while leveraging confidentiality benefits to mitigate HIV-related stigma and support adherence.