“It is a better option, but we need to see it work”: Perceived benefits, concerns and implementation requirements for long-acting injectable HIV treatment and prevention in Uganda

Abstract Background: Long-acting injectable antiretroviral products are moving from efficacy trials into policy and service-delivery discussions. Their population impact will depend on whether prospective users consider them acceptable and whether health systems can deliver time-sensitive doses reliably. Objective: To explore how people living with HIV, PrEP users and healthcare providers in Uganda understood the perceived benefits, concerns and implementation requirements of long-acting injectable HIV treatment and prevention products. Methods: We conducted a qualitative study at Kajjansi Health Centre IV and Mildmay Hospital in Uganda. Through purposive maximum-variation sampling, we recruited three participant categories: people living with HIV receiving ART, current or previous PrEP users, and healthcare providers. The sample comprised 46 participants: 36 clients in six focus group discussions and 10 healthcare providers in key informant interviews. Data were audio-recorded, transcribed verbatim and analysed using hybrid deductive-inductive thematic analysis. Results: Four themes emerged: (1) reported challenges with daily oral regimens; (2) concerns that could hinder injectable acceptance; (3) differences in preferences by social and treatment context; and (4) service requirements for injectable delivery. Participants expected injections to reduce pill burden, medication visibility, unintended disclosure and disruption during travel or work. Interest depended on confidence in effectiveness, manageable injection pain, information about prolonged adverse effects, provider competence, reliable supply, appointment reminders, missed-dose plans, privacy and accessible delivery. Conclusions: Long-acting injectable HIV products were perceived as offering personal and programmatic advantages, but interest and anticipated acceptability were conditional and varied with product attributes, lived circumstances and expected service reliability. Roll-out in Uganda should pair product-specific counselling with evidence on safety and effectiveness, provider preparation, dependable supply and flexible delivery models.