Long-Acting Antiretroviral Therapy: A Beacon of Hope for People Living with HIV Who Use Drugs?

The Promise of LA-ART: Addressing Adherence Barriers

For people living with HIV (PLHIV), antiretroviral therapy (ART) has revolutionized treatment, offering longer, healthier lives. However, daily adherence remains a significant hurdle, especially for PLHIV who use drugs and face overlapping social and structural inequities. Long-acting ART (LA-ART), administered less frequently, emerges as a potential game-changer, offering a reprieve from the daily pill burden and mitigating some of these barriers.

Exploring Acceptability: Voices from Vancouver's Downtown Eastside

A qualitative study in Vancouver, Canada, explored the perspectives of PLHIV who use drugs on LA-ART. This unique setting, with its no-cost universal access to oral ART, allowed researchers to delve into acceptability factors independent of cost concerns. In-depth interviews revealed a groundswell of enthusiasm for LA-ART, particularly among those grappling with the challenges of daily oral ART.

Pill Burden and Side Effects: The Need for Relief

Many participants expressed frustration with the burden of multiple pills for HIV and other health conditions. LA-ART’s less frequent dosing schedule resonated powerfully with them. Furthermore, participants experiencing adverse side effects from oral ART saw LA-ART as a potential path to improved well-being.

"It would be nice to get that all at one time per month. That would be really helpful," shared a 56-year-old Metis man, highlighting the appeal of reduced pill burden.

Navigating Structural Vulnerabilities: The Impact of Housing and Incarceration

The study illuminated how structural vulnerabilities, such as homelessness and incarceration, further complicate adherence to daily oral ART. Participants shared poignant stories of how these challenges disrupted their ability to maintain consistent treatment, underscoring the need for solutions tailored to their lived experiences.

Shared Decision-Making: A Critical Component of Care

The desire for shared decision-making emerged as a strong theme. Participants emphasized the importance of open communication with their physicians, access to evidence-based information about LA-ART, and the need to be active partners in their treatment journey.

"Just having…more individual time with your patient to hear their issues," a 53-year-old white woman suggested, emphasizing the value of patient-centered communication.

Universal Access: Ensuring Equity in Treatment Options

While enthusiasm for LA-ART was high, participants stressed the importance of equitable access. Concerns about cost were prominent, with many emphasizing the necessity of public funding to ensure affordability for all who could benefit.

Looking Forward: Maximizing the Benefits of LA-ART

This study provides valuable insights into the potential of LA-ART to improve the lives of PLHIV who use drugs. By addressing adherence barriers, reducing pill burden, and acknowledging individual needs, LA-ART offers a new pathway to better health outcomes. However, universal and equitable access, alongside patient-centered care, are crucial to fully realizing the transformative potential of this innovative treatment.

Study Limitations and Future Directions

While the study offers valuable insights, its limitations, including the focus on English-speaking participants connected to health services and a setting with universal healthcare coverage, should be acknowledged. Further research, encompassing diverse populations and settings, is needed to broaden our understanding of LA-ART acceptability and implementation.