Long-Acting HIV Shots Appeal to Many but Uptake Remains Low

When it comes to HIV medication, many patients think they'd prefer an occasional injection over a daily pill, but uptake remains an issue, according to a Rutgers Health-led survey.

When researchers surveyed 801 people living with HIV in Boston, Chapel Hill, N.C., and San Diego, 68% of respondents said they would prefer an antiretroviral shot every two months to a daily pill. Yet according to a study in the Journal of Acquired Immune Deficiency Syndromes, only 2.8% of the patients actually received such shots, even though they've been available for four years.

"There's clearly something that is limiting the ability of patients to translate their preferences into actually being on the medicine," said Deanna Kerrigan, a professor and vice dean at the Rutgers School of Public Health and the study's lead author.

The gap matters because HIV outcomes in the United States remain uneven. As of 2022, 65% of the 1.2 million people living with HIV nationwide consistently kept virus levels low enough to prevent disease symptoms and transmission.

The Food and Drug Administration approved the long-acting regimen - a combination of two drugs given at a medical office - in 2021 for monthly use and in 2022 for every two months dosing in hopes of improving viral suppression with an easier treatment option. For some patients, injections mean less to remember, fewer missed doses, less pill fatigue and less worry that pill bottles at home will reveal their HIV diagnosis.

Researchers set out to identify which patients are most interested in the injectable option and why. The team drew participants from a National Institutes of Health -supported clinical cohort and used statistical models to examine factors tied to preferences.

In adjusted analyses, greater perceived "pill burden" predicted a preference for injections, whether given monthly or every two months.

Participants with a detectable viral load also had higher odds of strongly preferring monthly injections, but providers may be least inclined to offer them a treatment regimen that depends on reliable clinical attendance.

"If you have a detectable viral load, it may mean that you're either not taking medicine at all, or you're not adhering," Kerrigan said. "They might think, 'Oh, they can't adhere to the medicine, so I'm not going to offer them injectable treatment because maybe they won't come for their appointment.'"

Black participants were nearly twice as likely as white participants to prefer long-acting therapy. Previous qualitative research by the team suggests privacy may be part of the appeal: Not keeping pills at home can reduce worries about stigma and unwanted disclosure.

Other factors pushed preferences toward daily oral medication. Older participants were less likely to prefer injections, possibly because they were already taking other daily medications. People who reported a strong fear of needles were less likely to want shots, as were those who lived more than an hour from their clinic.

Based on these findings and earlier interviews, the research team has developed a tool to help caregivers discuss options with patients, explaining how daily pills and long-acting injections work and outlining the pros and cons of each. The team has piloted the tool and plans a larger trial to test whether structured conversations can increase uptake and improve equity in who gets access.

Newer long-acting options, including a twice-yearly shot, are under study. That makes it even more important, Kerrigan said, for clinics to routinely ask patients what fits their lives rather than assuming the answer.

David Wohl and Clare Barrington, both from the University of North Carolina at Chapel Hill, were co-principal investigators on the study, which was funded by the National Institute of Mental Health.