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. 2023 Jul;27(7):2163-2175.
doi: 10.1007/s10461-022-03949-2. Epub 2023 Jan 9.

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

Elona Toska  1   2   3   4 , Siyanai Zhou  5   6 , Jenny Chen-Charles  7 , Lesley Gittings  5   8 , Don Operario  9 , Lucie Cluver  7   10
Affiliations

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

Elona Toska et al. AIDS Behav. 2023 Jul.

Abstract
in English, Spanish

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.

La terapia antirretroviral inyectable de acción prolongada (TAR LA) puede superar las barreras a la adherencia y mejorar la supervivencia de los adolescentes y jóvenes que viven con el VIH (AJVVIH). La investigación sobre la aceptabilidad del TAR LA para este grupo de edad es limitada. Preguntamos a 953 AJVVIH sobre su modo preferido (teórico) de administración de ART (píldora, inyectable u otro) en 2017–2018, antes de que TAR LA estuviera disponible o fuera conocido por los AJVVIH en Sudáfrica. Uno de cada ocho (12%) AJVVIH prefirió TAR LA sobre los regímenes de píldoras simples o múltiples. En los análisis multivariantes, seis factores se asociaron con la preferencia de TAR LA: agotamiento de la medicación (odd ratio ajustada [ORa] = 2,56, IC95% 1,40–4,68 p = 0,002), experimentar efectos secundarios (ORa = 1,84, IC95% 1,15–2,97 p = 0,012), carga de píldoras (ORa = 1. 88, IC95% 1,20–2,94 p = 0,006), cambios de tratamiento en el último año (ORa = 1,63, IC95% 1,06–2,51 p = 0,025), cualquier estigma del VIH (ORa = 2,22, IC95% 1,39–3,53 p ≤ 0,001) y el inicio reciente del TAR (ORa = 2,02, IC95% 1,09–3,74 p = 0,025). En la modelización de efectos marginales, el 66% de los adolescentes que experimentaron todos los factores eran propensos a preferir la TAR LA, lo que pone de relieve la alta aceptabilidad potencial de la TAR LA entre los adolescentes y los jóvenes que viven con el VIH que luchan por adherirse y tener buenos resultados en el tratamiento del VIH. Los adolescentes varones que informaron de una alta carga de píldoras para el tratamiento antirretroviral eran más propensos a preferir la TAR LA que sus pares mujeres en los análisis de moderación, lo que sugiere que la TAR LA puede ser particularmente importante para mejorar los resultados del tratamiento entre los hombres que viven con el VIH a medida que crecen. La adición de la TAR LA a las opciones de tratamiento existentes para las personas que viven con el VIH, en particular los grupos de mayor riesgo, ayudaría a las personas que viven con el VIH a alcanzar y mantener la supresión vírica -el tercer 95- y a reducir el riesgo de mortalidad relacionada con el sida.

Keywords: Adolescents; Antiretroviral; Injectables; Long-acting; South Africa.

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Conflict of interest statement

Study sponsors were not involved in study design, data collection, analyses nor interpretation, the writing of this manuscript, nor the decision to submission of this manuscript.

Figures

Fig. 1
Fig. 1
Study sample flowchart. *933 participants were interviewed across all the data collection waves and 20 participants included here were those interviewed at baseline and at Wave 3 but not Wave 2
Fig. 2
Fig. 2
A moderator analysis between pill burden and LAART preference
See this image and copyright information in PMC

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