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. 2025 Apr 8;25(1):476.
doi: 10.1186/s12879-025-10871-0.

Bridging the gap: identifying barriers and strategies for widespread implementation of long-acting injectable antiretroviral therapy in Sub-Saharan Africa: a scoping review

Pierre Gashema  1   2 , Patrick Gad Iradukunda  3   4   5 , Eric Saramba  6 , Tumusime Musafiri  7 , Thérèse Umuhoza  5 , Felix Ndahimana  6 , Angelique Ingabire  8 , Moise Mukire Ndoli  8 , Gerard Mutagoma  8 , Ivan Emil Mwikarago  5 , Eric Nyirimigabo  4 , Muhayimpundu Ribakare  9 , Jean de Dieu Harelimana  6 , Enos Moyo  10 , Tafadzwa Dzinamarira  11 , Claude Mambo Muvunyi  12
Affiliations

Bridging the gap: identifying barriers and strategies for widespread implementation of long-acting injectable antiretroviral therapy in Sub-Saharan Africa: a scoping review

Pierre Gashema et al. BMC Infect Dis. .

Abstract

Background: Long-acting injectable antiretroviral therapy (LAI ART) is a new, and innovative approach to HIV treatment, designed to address several challenges, including the adherence issues associated with daily oral ART. This review synthesizes existing literature on the barriers and strategies for implementing LAI ART in the sub-Saharan Africa region, while identifying key knowledge gaps and research priorities.

Methods: We performed a comprehensive literature search, encompassing electronic databases and grey literature sources. Our review included 18 studies published between 2014 and 2023, focusing on the acceptability, feasibility, effectiveness, and cost-effectiveness of LAI ART in SSA. A narrative synthesis approach was employed for reporting review findings.

Results: Our review revealed a high demand and acceptability of LAI ART among people living with HIV in SSA, particularly those facing stigma and discrimination. LAI ART can improve adherence, retention, and viral suppression while reducing pill burden and frequent clinic visits. Implementation challenges include lack of regulatory approval, high cost, limited supply chain, health system capacity, trained staff, and cold storage facilities. Further research on safety and efficacy, as well as efforts in advocacy, policy, and community engagement, are needed to ensure accessibility and equity.

Conclusion: This review highlights key knowledge gaps and research priorities essential for the successful implementation of LAI ART in sub-Saharan Africa. Addressing these gaps such as evaluating long-term outcomes, understanding drug resistance, and exploring the impact on sexual and reproductive health will be critical to ensuring the broader accessibility, effectiveness, and sustainability of LAI ART in the region. Further research on the experiences and preferences of different subgroups, as well as the interaction with other medications and co-infections, is also needed to inform tailored implementation strategies.

Clinical trials number: Not applicable.

Keywords: Challenges; Knowledge gaps; Long-acting injectable antiretroviral therapy (LAI ART); People living with HIV (PLWH); Research priorities; sub-Saharan Africa (SSA).

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Details of screening procedure
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References

    1. Berruti M, Riccardi N, Canetti D, Lo Caputo S, Taramasso L, Di Biagio A. Injectable Antiretroviral Drugs: Back to the Future, Viruses, 2021;13(2):228, 10.3390/v13020228 - PMC - PubMed
    1. Global HIV. & AIDS statistics — Fact sheet. Accessed: Jan. 20, 2025. Available: https://www.unaids.org/en/resources/fact-sheet
    1. Cooper SE, Rosenblatt J, Gulick RM. Barriers to Uptake of Long-Acting Antiretroviral Products for Treatment and Prevention of Human Immunodeficiency Virus (HIV) in High-Income Countries, Clin. Infect. Dis. Off. Publ. Infect. Dis. Soc. Am., 2022;75(Suppl 4):S541–S548, 10.1093/cid/ciac716 - PMC - PubMed
    1. Murray M, et al. Patient-reported tolerability and acceptability of cabotegravir + rilpivirine long-acting injections for the treatment of HIV-1 infection: 96-week results from the randomized LATTE-2 study. HIV Res Clin Pract. 2019;20:4–5. 10.1080/25787489.2019.1661696 - PubMed
    1. Scarsi KK, Swindells S. The promise of improved adherence with Long-Acting antiretroviral therapy: what are the data?? J Int Assoc Provid AIDS Care. 2021;20:23259582211009011. 10.1177/23259582211009011 - PMC - PubMed

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