Anticipated facilitators and barriers for long-acting injectable antiretrovirals as HIV treatment and prevention in Vietnam: a qualitative study among healthcare workers

• Published in: BMC infectious diseases 2024-12, Vol.24 (1), p.1462-11
• Main Authors: Dang, My T, Le, Yen N, Naz-McLean, Sarah, Vo, Nhung T T, Do, Phuong T, Doan, Linh T T, Do, Nhan T, Nguyen, Mai T, Phan, An H, Dziuban, Eric J, Bhatia, Ramona, Cosimi, Lisa, Phan, Huong T T, Pollack, Todd M
• Format: Article
• Language: English
• Subjects: Adult; AIDS treatment; Anti-HIV Agents - administration & dosage; Anti-HIV Agents - therapeutic use; Antiviral agents; Delayed-Action Preparations; Dosage and administration; Drug therapy; Female; Health Personnel; Healthcare worker; HIV; HIV infection; HIV Infections - drug therapy; HIV Infections - prevention & control; Humans; Implementation; Injections; Long-acting injectable antiretrovirals; Male; Medication Adherence - statistics & numerical data; Methods; Middle Aged; Patient outcomes; Prevention; Qualitative Research; Sexually transmitted diseases; Treatment; Vietnam
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-024-10352-w

Long-acting injectable antiretrovirals (LAI-ARVs) for HIV prevention and treatment have been demonstrated in clinical trials to be non-inferior to daily oral medications, providing an additional option to help users overcome the challenges of daily adherence. Approval and implementation of these regimens in low- and middle-income settings have been limited. This study describes the anticipated barriers and facilitators to implementing LAI-ARVs in Vietnam to inform future roll-out. From July to August 2022, we conducted 27 in-depth interviews with healthcare workers and public health stakeholders involved in HIV programs at national, provincial, and clinic levels across four provinces in Vietnam. The interviews followed a semi-structured questionnaire and were audio recorded. Data were analyzed using a rapid thematic analysis approach to identify facilitators and barriers to the adoption of LAI-ARVs. In total, 27 participants from 4 provinces were interviewed including 14 (52%) men and 13 (48%) women. Participants median age was 48 years and they had 11.5 years of experience with HIV services and programs. Perceived user-level facilitators included the greater convenience of injectables in comparison to oral regimens, while barriers included the increased frequency of visits, fear of pain and side effects, and cost. Clinic-level facilitators included existing technical capacity to administer injections and physical storage availability in district health centers, while barriers included lack of space and equipment for administering injections for HIV-related services, concerns about cold chain maintenance for LAI-ART, and workload for healthcare workers. Health system-level facilitators included existing mechanisms for medication distribution, while barriers included regulatory approval processes and concerns about supply chain continuity. Overall, participants were optimistic about the potential impact of LAI-ARVs but highlighted important considerations at multiple levels needed to ensure successful implementation in Vietnam. Not applicable.