Acceptability and feasibility of long-acting injectable antiretroviral therapy for HIV-infected persons who inject drugs in Vietnam: A qualitative study

Sarah E Rutstein; Adams L Sibley; Hanna E Huffstetler; Trang Thu Do Nguyen; Ha Viet Tran; Giang Le Minh; Teerada Sripaipan; Minh Nguyen; William C Miller; Joseph J Eron; Cynthia L Gay; Vivian F Go

doi:10.1016/j.lanwpc.2022.100603

Acceptability and feasibility of long-acting injectable antiretroviral therapy for HIV-infected persons who inject drugs in Vietnam: A qualitative study

Lancet Reg Health West Pac. 2022 Sep 23:31:100603. doi: 10.1016/j.lanwpc.2022.100603. eCollection 2023 Feb.

Affiliations

¹ Division of Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Rd, Chapel Hill, North Carolina 27599, USA.
² Department of Health Behavior, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, North Carolina 27599, USA.
³ UNC Project-Vietnam, Hanoi, Vietnam.
⁴ Hanoi Medical University, Hanoi, Vietnam.
⁵ Department of Epidemiology, The Ohio State University, 1841 Neil Ave, Columbus, Ohio 43210, USA.

Abstract

Background: In Vietnam, HIV prevalence among people who inject drugs (PWID) is several times higher than in the general population (15% versus 0.3%). PWID also experience higher rates of HIV-related mortality, driven by poor antiretroviral therapy (ART) adherence. Long-acting injectable ART (LAI) is a compelling opportunity to improve treatment outcomes, but acceptability and feasibility among HIV-infected PWID remains unexplored.

Methods: We conducted key informant in-depth interviews in Hanoi, Vietnam (February-November 2021). Participants were purposively sampled and included policymakers, ART clinic staff, and HIV-infected PWID. We applied the Consolidated Framework for Implementation Research to guide study design and analysis, using thematic coding to develop and iteratively refine a codebook and characterize barriers and facilitators to LAI implementation.

Findings: We interviewed 38 key stakeholders: 19 PWID, 14 ART clinic staff, and five policymakers. Participants were enthusiastic about LAI convenience, highlighting less frequent and more discreet dosing. However, contrasting providers, several policymakers suggested LAI was not needed given perceived exceptional oral ART outcomes and rare viral failure among PWID. Policymakers also criticized strategies prioritizing PWID for LAI, emphasizing equity, whereas providers identified PWID as an ideal population for LAI given adherence challenges. LAI complexity, including storage and administration logistics, were deemed surmountable with training and resources. Finally, providers and policymakers acknowledged that adding LAI to drug formularies was key, but an onerous process.

Interpretation: Although anticipated to be resource-intensive, LAI was a welcome addition for interviewed stakeholders and likely an acceptable alternative to oral ART among PWID living with HIV in Vietnam. Despite enthusiasm among PWID and providers that LAI could improve viral outcomes, some policymakers-whose buy-in is critical to LAI implementation-opposed strategies that preferentially distributed LAI to PWID, highlighting values of equity and revealing differences in perceived HIV outcomes among PWID. Results provide a vital foundation for developing LAI implementation strategies.

Funding: Supported by National Institutes of Health.

Keywords: Consolidated framework for implementation research; HIV; Implementation science; Long-acting injectable; Substance use disorder.