"The injection gives freedom" - An exploration of long-acting injectable HIV treatment acceptance among patients seeking care in two Nairobi tertiary hospitals

BackgroundLong-acting injectable antiretroviral therapy offers an alternative to daily oral HIV treatment, potentially improving adherence and reducing stigma. While its adoption has been successful in some settings, evidence on its acceptability in sub-Saharan Africa, outside clinical trials, remains limited. MethodsWe conducted a mixed-methods study among people living with HIV (PLHIV) in two tertiary hospitals in Nairobi, Kenya--a public facility (Kenyatta National Hospital) and a private facility (Aga Khan University Hospital). A cross-sectional survey of 356 participants assessed awareness, willingness to switch, and predictors of acceptability. In addition, 30 participants took part in three focus group discussions (FGDs) exploring perceptions, concerns, and system-level considerations. Quantitative data were analyzed using descriptive and inferential statistics, while qualitative data were analyzed thematically. ResultsOverall, 72.2% of survey participants indicated willingness to switch to LAI-ART. Prior awareness of LAI-ART was the strongest independent predictor of acceptability (aOR 4.03, 95% CI: (1.45-11.18). Drivers of interest included reducing pill burden (77.8%), improving adherence (55.6%), and maintaining privacy (45.5%). Despite high acceptability, FGDs revealed cautious optimism, with concerns about side effects, treatment rigidity, and logistical challenges such as travel and clinic access. ConclusionThese findings suggest that while LAI-ART is seen as promising, its uptake will depend on education, trust-building, and reliable delivery systems. Successful introduction in Kenya will require patient-centered communication, system readiness, and equitable access strategies.