Acceptance of long-acting injectable HIV treatment and prevention options among people living with HIV and PrEP-service participants in Uganda

Background Long-acting injectable antiretroviral products provide alternatives to daily oral medication for both HIV treatment and prevention. Their successful introduction will depend not only on clinical efficacy but also on whether potential users consider the products acceptable and feasible within routine care. We compared hypothetical acceptance of long-acting injectable HIV treatment and prevention options among people living with HIV (PLHIV) and HIV-negative participants recruited through PrEP services in Uganda, and examined associations with perceived benefits and risks. Methods We conducted a cross-sectional survey among 232 participants at Mildmay Hospital Uganda and Kajjansi Health Centre IV. The analysis included 116 PLHIV and 116 PrEP-service participants. Willingness was recorded on a five-point scale from 1 (very unwilling) to 5 (very willing); scores of 4 or 5 were classified as acceptance. Six perceived-benefit items were scored from 1 (strongly disagree) to 5 (strongly agree) and averaged, while eight perceived-risk items were scored from 1 (not concerned) to 4 (highly concerned) and averaged. Modified Poisson regression with robust standard errors was used to estimate crude and adjusted prevalence ratios. Results Overall, 178/232 participants (76.7%) accepted a long-acting injectable option. Acceptance was higher among PLHIV than among PrEP-service participants (104/116 [89.7%] vs 74/116 [63.8%], P < 0.001). Mean perceived-benefit scores were higher among PLHIV than PrEP-service participants (4.44 [SD 0.43] vs 4.19 [SD 0.57], P < 0.001), whereas mean perceived-risk scores were similar (2.63 [SD 0.85] vs 2.60 [SD 0.77], P = 0.640). In adjusted analysis, PrEP-service participants had a lower prevalence of acceptance than PLHIV (aPR 0.78, 95% CI 0.68–0.90), while each one-unit increase in the perceived-benefit score was associated with higher acceptance (aPR 1.48, 95% CI 1.26–1.73). Age, sex, prior awareness and perceived-risk score were not independently associated with acceptance. Conclusions Acceptance of long-acting injectable HIV treatment and prevention options was substantial but differed by service population. Perceived benefit was the strongest independent correlate of acceptance. Introduction strategies in Uganda should distinguish injectable HIV treatment from injectable PrEP, communicate product-specific benefits and requirements, and address concerns about safety, continuity of supply and scheduled clinic attendance.