LONG-ACTING injectable antiretroviral therapy (ART) may ease pill burden, improve adherence, and privacy in Pakistan, interviews suggest.
Why Long-Acting Injectable Antiretroviral Therapy Appeals
Long-acting injectable ART is being explored as an alternative to daily oral antiretroviral therapy (ART), with potential to reduce dosing frequency and treatment fatigue for people with HIV. In a qualitative study conducted from November 2024 to January 2025, researchers examined acceptability and feasibility by interviewing people receiving oral ART through an ART center in Islamabad and community-based organizations, alongside a focus group discussion with peer advocates across Pakistan.
Across interviews and the focus group, participants described long-acting injectable ART as attractive for eliminating pill burden and supporting adherence. Participants also associated long-acting injectable ART with fewer logistical demands and greater privacy, suggesting that injection-based dosing could help some individuals feel less exposed in their daily lives.
Barriers That Could Limit Implementation
Despite perceived advantages, participants identified multiple concerns that could limit real-world uptake of long-acting injectable ART. Injection-related adverse events were a prominent worry. Practical system factors also surfaced, including longer clinic waiting times and limited availability, both of which were viewed as potential friction points for ongoing dosing.
Among those unwilling to adopt long-acting injectable ART, reasons included established trust in oral ART and the convenience of multi-month refills. Some also expressed concern that switching away from daily routines could reduce adherence, while others cited work-related constraints that could make clinic-based injections harder to manage.
What People-Centered Delivery Might Require
Overall, long-acting injectable ART was considered acceptable by many participants, particularly for adherence and privacy-related benefits. The authors conclude that successful implementation in Pakistan will likely depend on addressing safety concerns and strengthening reliable supply and access, supported by responsive, stigma-free, and people-centered care models.
Reference: Shahid MW et al. Acceptability and preferences regarding long-acting injectable antiretroviral therapy among people with HIV in Pakistan. HIV Res Clin Pract. 2026;27(1):2635223.
