Interest in long-acting injectable ART amongadolescents with perinatally acquired HIVin Cameroon: Implications for implementationin developing countries

Par Yagai Bouba et al.

Abstract

Long-acting injectable antiretroviral therapy (LAI-ART) has the potential to transform HIV treatment for adolescents with perinatal HIV infection (APHI). Given the existing knowledge gaps surrounding this recent strategy, we aimed to assess interest in LAIART among ART-experienced APHI in Cameroon. We conducted a cross-sectional study among ART-experienced APHI aged 10–19 years, across four paediatric HIV clinics in the Centre region of Cameroon. Data were collected from 4 to 30 November 2024 using structured questionnaires to assess sociodemographic characteristics, awareness of, and interest in LAI-ART. HIV-1 viral load (VL) and CD4 cell counts were measured during the same period. Logistic regression analysis was used to identify factors associated with interest in switching to LAI-ART. Of 248 participants (48.8% female; median [IQR] age 15 [13–17]), 40.0% lived with a guardian and 75.8% had partial/full HIV-disclosure; 3.2% reported stigma. Clinically, 77.5% were in multi-month ARV-dispensation (MDSD) and 28.2% had poor ART-adherence; fear of injection was none/moderate/high in 73.4%, 15.7% and 10.9%, respectively. Viral undetectability (VL < 50 copies/mL) and CD4 ≥ 500 cells/mm³ were 71.6% and 72.5%, respectively. Overall, 92.3% expressed interest in LAI-ART, motivated by reduced pill burden/fatigue (63.7%) and expected better adherence (74.2%); 30.2% reported prior LAI-ART awareness. In multivariable analysis, no prior awareness had 81% lower odds of interest (p = 0.036). Compared with no-fear, moderate-fear was associated with 46% lower odds (p = 0.393), while high-fear was associated with 78% lower odds (p = 0.017). Disparities in sex, education, residence, adherence, virological response, or treatment history did not influence interest in LAI-ART. Among all respondents, 77.1% said they would choose LAI-ART if available, whereas 20.2% preferred MDSD. In this Cameroonian APHI cohort, awareness of LAI-ART was low despite high-interest once adolescents were informed. Rollout in low/middle-income countries should prioritise targeted education, youth-friendly counselling to close knowledge gaps, reduce fear and ensure equitable uptake.