Acceptability and preferences regarding long-acting injectable antiretroviral therapy among people with HIV in Pakistan

BACKGROUND: Long-acting injectable antiretroviral therapy (LAI-ART) is an emerging alternative to daily oral ART, offering the potential to improve adherence, reduce dosing frequency, and alleviate treatment fatigue among people with HIV. There is limited evidence on its real-world acceptability, feasibility, and implementation challenges in low- and middle-income countries, such as Pakistan, where structural barriers and health system limitations may influence uptake. OBJECTIVE: This study explores the perspectives on the feasibility and acceptability of LAI-ART among people currently receiving oral ART in Pakistan. METHODS: A qualitative study was conducted from November 2024 to January 2025, involving in-depth interviews from people in the ART center in Islamabad and community-based organizations, and one focus group discussion (FGD) with participants who are actively engaged in community-based peer advocacy across Pakistan. The data were analyzed using conventional thematic analysis with inductive coding. RESULTS: We conducted interviews with 37 participants, with one-to-one discussions with 31 people with HIV and 6 participants in FGD. Participants perceived LAI-ART as beneficial due to the elimination of pill burden, improved adherence, fewer side effects, lesser logistical demands, and greater privacy. However, injection-related adverse events, longer clinic waiting times, and limited availability were key barriers to its implementation. Those unwilling to adopt LAI-ART cited trust in oral ART, the convenience of multi-month refills, concerns of reduced adherence, work-related constraints. CONCLUSION: LAI-ART is acceptable to people with HIV in Pakistan, offering adherence and privacy benefits. However, successful implementation depends on addressing concerns around safety, supply, and access through responsive, stigma-free, and people-centered care models.