BACKGROUND: Initiation of and adherence to daily oral HIV pre-exposure prophylaxis (PrEP) has been low among African adolescent girls and young women (AGYW). Along with other sociocultural factors, PrEP uptake and adherence are a function of product acceptability. Understanding the acceptability barriers and facilitators faced by AGYW in regard to long-acting HIV prevention products is critical for successful implementation. This qualitative analysis explored acceptability of long-acting injectable cabotegravir (CAB-LA) among cisgender adolescent females in South Africa, Uganda, and Zimbabwe.
METHODS: The HPTN 084-01 study, which examined safety, tolerability and acceptability of CAB-LA among 55 adolescent cisgender females, included a qualitative component to better understand the participants’ experiences with CAB-LA (2021-2022). In-depth qualitative interviews were conducted near the end of the product exposure period (Week 34 – after 5 injections) with 15 participants (5 per site) to explore issues of acceptability of CAB-LA injections, including negatives and positives associated with CAB-LA, as well as qualities of the injection itself. Participant interviews were deductively coded by five team members using NVivo 12 and representative memos were created via thematic analysis.
RESULTS: Several major themes emerged regarding acceptability of CAB-LA injections. The needle size (1½ inch) and site of administration (gluteal muscle) were generally deemed acceptable by participants. Injection pain was the most reported barrier to acceptability, followed by injection site reactions and fear of the injection. Despite this, positive overall experiences with injections were reported because of the lack of adherence challenges with bi-monthly injections as well as the discretion offered by CAB-LA in comparison to daily oral tablets. In addition, familiarity with the mode of administration of CAB-LA emerged as a theme around CAB-LA and injectable contraceptives.
CONCLUSIONS: In regard to HIV prevention products, the importance of choices is evident in the HPTN 084-01 data. While many participants reported a preference for CAB LA, and most (92%) chose to stay on CAB-LA during the open label extension (HPTN 084), some participants still preferred oral tablets for various reasons, including pain and fear of the injection. These barriers and facilitators should be discussed with future clients as part of the decision-making process around HIV prevention product choice.