Anticipated Facilitators and Barriers for Long-acting Injectable Antiretrovirals As HIV Treatment and Prevention in Vietnam: a Qualitative Study Among Healthcare Workers

Overview

Journal BMC Infect Dis

Publisher Biomed Central

Specialty Infectious Diseases

Date 2024 Dec 25

PMID 39722011

Authors

My T Dang

Yen N Le

Sarah Naz-McLean

Nhung T T Vo

Phuong T Do

Linh T T Doan

Nhan T Do

Mai T Nguyen

An H Phan

Eric J Dziuban

Ramona Bhatia

Lisa Cosimi

Huong T T Phan

Todd M Pollack

Affiliations

Soon will be listed here.

Abstract

Background: 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.

Method: 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.

Results: 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.

Conclusion: 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.

Clinical Trial Number: Not applicable.

References

Carillon S, Laborde-Balen G, Diop M, Diop K, Breton G, Ndiaye B . Implementing long-acting injectable antiretroviral treatments in Senegal: issues, challenges and conditions for introducing them. Qualitative study with healthcare providers and patients. AIDS Care. 2023; 36(5):703-709. DOI: 10.1080/09540121.2023.2253506. View

Orkin C, Arasteh K, Gorgolas Hernandez-Mora M, Pokrovsky V, Overton E, Girard P . Long-Acting Cabotegravir and Rilpivirine after Oral Induction for HIV-1 Infection. N Engl J Med. 2020; 382(12):1124-1135. DOI: 10.1056/NEJMoa1909512. View

Nguyen V, Dat V, Truc H, Nguyen Anh Thu P, Linh D, Johnson C . Preference and retention of daily and event-driven pre-exposure prophylaxis for HIV prevention: a prospective cohort in Can Tho city, Viet Nam. BMJ Open. 2024; 14(2):e075976. PMC: 10910397. DOI: 10.1136/bmjopen-2023-075976. View

Orkin C, Bernal Morell E, Tan D, Katner H, Stellbrink H, Belonosova E . Initiation of long-acting cabotegravir plus rilpivirine as direct-to-injection or with an oral lead-in in adults with HIV-1 infection: week 124 results of the open-label phase 3 FLAIR study. Lancet HIV. 2021; 8(11):e668-e678. DOI: 10.1016/S2352-3018(21)00184-3. View

Scarsi K, Swindells S . The Promise of Improved Adherence With Long-Acting Antiretroviral Therapy: What Are the Data?. J Int Assoc Provid AIDS Care. 2021; 20:23259582211009011. PMC: 8082990. DOI: 10.1177/23259582211009011. View

Kandel C, Walmsley S . Dolutegravir - a review of the pharmacology, efficacy, and safety in the treatment of HIV. Drug Des Devel Ther. 2015; 9:3547-55. PMC: 4500604. DOI: 10.2147/DDDT.S84850. View

Landovitz R, Donnell D, Clement M, Hanscom B, Cottle L, Coelho L . Cabotegravir for HIV Prevention in Cisgender Men and Transgender Women. N Engl J Med. 2021; 385(7):595-608. PMC: 8448593. DOI: 10.1056/NEJMoa2101016. View

Mantsios A, Murray M, Karver T, Davis W, Galai N, Kumar P . Multi-level considerations for optimal implementation of long-acting injectable antiretroviral therapy to treat people living with HIV: perspectives of health care providers participating in phase 3 trials. BMC Health Serv Res. 2021; 21(1):255. PMC: 7980753. DOI: 10.1186/s12913-021-06214-9. View

Cresswell F, Lamorde M . Implementation of long-acting antiretroviral therapy in low-income and middle-income countries. Curr Opin HIV AIDS. 2022; 17(3):127-134. DOI: 10.1097/COH.0000000000000732. View

10.

Nevedal A, Reardon C, Widerquist M, Jackson G, Cutrona S, White B . Rapid versus traditional qualitative analysis using the Consolidated Framework for Implementation Research (CFIR). Implement Sci. 2021; 16(1):67. PMC: 8252308. DOI: 10.1186/s13012-021-01111-5. View

11.

Kennedy C, Zhao T, Vo A, Nakubulwa R, Nabakka P, Jackson J . High Acceptability and Perceived Feasibility of Long-Acting Injectable Antiretroviral Treatment Among People Living with HIV Who Are Viremic and Health Workers in Uganda. AIDS Patient Care STDS. 2023; 37(6):316-322. PMC: 10280193. DOI: 10.1089/apc.2023.0017. View

12.

Katz I, Ryu A, Onuegbu A, Psaros C, Weiser S, Bangsberg D . Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis. J Int AIDS Soc. 2013; 16(3 Suppl 2):18640. PMC: 3833107. DOI: 10.7448/IAS.16.3.18640. View

13.

Sidebottom D, Ekstrom A, Stromdahl S . A systematic review of adherence to oral pre-exposure prophylaxis for HIV - how can we improve uptake and adherence?. BMC Infect Dis. 2018; 18(1):581. PMC: 6240194. DOI: 10.1186/s12879-018-3463-4. View

14.

Mgodi N, Murewanhema G, Moyo E, Samba C, Musuka G, Dzinamarira T . Advancing the use of Long-Acting Extended Delivery formulations for HIV prevention in sub-Saharan Africa: challenges, opportunities, and recommendations. J Int AIDS Soc. 2023; 26 Suppl 2:e26115. PMC: 10338997. DOI: 10.1002/jia2.26115. View

15.

Kityo C, Cortes C, Phanuphak N, Grinsztejn B, Venter F . Barriers to Uptake of Long-Acting Antiretroviral Products for Treatment and Prevention of HIV in Low- and Middle-Income Countries (LMICs). Clin Infect Dis. 2022; 75(Suppl 4):S549-S556. DOI: 10.1093/cid/ciac752. View

16.

Swindells S, Andrade-Villanueva J, Richmond G, Rizzardini G, Baumgarten A, Masia M . Long-Acting Cabotegravir and Rilpivirine for Maintenance of HIV-1 Suppression. N Engl J Med. 2020; 382(12):1112-1123. DOI: 10.1056/NEJMoa1904398. View

17.

Slama L, Porcher R, Linard F, Chakvetadze C, Cros A, Carillon S . Injectable long acting antiretroviral for HIV treatment and prevention: perspectives of potential users. BMC Infect Dis. 2023; 23(1):98. PMC: 9936705. DOI: 10.1186/s12879-023-08071-9. View

18.

Bui H, Giang L, Chen J, Sripaipan T, Nong H, Nguyen N . A Brief Alcohol Intervention (BAI) to reduce alcohol use and improve PrEP outcomes among men who have sex with men in Vietnam: study protocol for a randomized controlled trial. Trials. 2024; 25(1):552. PMC: 11337901. DOI: 10.1186/s13063-024-08382-5. View

19.

Nguyen V, Moi F, Boonstoppel L, Duong H, Vien C, Van Hoang M . The cost of delivering COVID-19 vaccines in Vietnam. BMC Health Serv Res. 2024; 24(1):779. PMC: 11232236. DOI: 10.1186/s12913-024-11202-w. View

20.

Durham S, Chahine E . Cabotegravir-Rilpivirine: The First Complete Long-Acting Injectable Regimen for the Treatment of HIV-1 Infection. Ann Pharmacother. 2021; 55(11):1397-1409. DOI: 10.1177/1060028021995586. View