Journal Article

Bridging the gap: identifying barriers and strategies for widespread implementation of long-acting injectable antiretroviral therapy in Sub-Saharan Africa: a scoping review

Iradukunda, Patrick Gad, Moyo, Enos, Saramba, Eric, Ingabire, Angelique, Mwikarago, Ivan Emil, Dzinamarira, Tafadzwa, Nyirimigabo, Eric, Mutagoma, Gerard, Muvunyi, Claude Mambo, Harelimana, Jean de Dieu, Ribakare, Muhayimpundu, Gashema, Pierre, Musafiri, Tumusime, Ndahimana, Felix, Ndoli, Moise Mukire, Umuhoza, Thérèse

2025

Overview

Background Long-acting injectable antiretroviral therapy (LAI ART) is a new, and innovative approach to HIV treatment, designed to address several challenges, including the adherence issues associated with daily oral ART. This review synthesizes existing literature on the barriers and strategies for implementing LAI ART in the sub-Saharan Africa region, while identifying key knowledge gaps and research priorities. Methods We performed a comprehensive literature search, encompassing electronic databases and grey literature sources. Our review included 18 studies published between 2014 and 2023, focusing on the acceptability, feasibility, effectiveness, and cost-effectiveness of LAI ART in SSA. A narrative synthesis approach was employed for reporting review findings. Results Our review revealed a high demand and acceptability of LAI ART among people living with HIV in SSA, particularly those facing stigma and discrimination. LAI ART can improve adherence, retention, and viral suppression while reducing pill burden and frequent clinic visits. Implementation challenges include lack of regulatory approval, high cost, limited supply chain, health system capacity, trained staff, and cold storage facilities. Further research on safety and efficacy, as well as efforts in advocacy, policy, and community engagement, are needed to ensure accessibility and equity. Conclusion This review highlights key knowledge gaps and research priorities essential for the successful implementation of LAI ART in sub-Saharan Africa. Addressing these gaps such as evaluating long-term outcomes, understanding drug resistance, and exploring the impact on sexual and reproductive health will be critical to ensuring the broader accessibility, effectiveness, and sustainability of LAI ART in the region. Further research on the experiences and preferences of different subgroups, as well as the interaction with other medications and co-infections, is also needed to inform tailored implementation strategies. Clinical trials number Not applicable.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Acceptability / Accessibility / Acquired immune deficiency syndrome / Africa South of the Sahara / AIDS / Analysis / Anti-HIV Agents - administration & dosage / Anti-HIV Agents - economics / Anti-HIV Agents - therapeutic use / Antiretroviral agents / Antiretroviral drugs / Antiretroviral therapy / Antiviral agents / Care and treatment / Challenges / Clinical trials / Cold storage / Community involvement / Cost analysis / Cost effectiveness / Delayed-Action Preparations / Discrimination in medical care / Dosage and administration / Drug dosages / Drug interactions / Drug resistance / Drug therapy / Heterosexuality / HIV / HIV Infections - drug therapy / HIV long-acting treatments: profilactic and therapeutic / HIV patients / Human immunodeficiency virus / Humans / Inclusion / Infectious Diseases / Injections / Internal Medicine / Knowledge gaps / Literature reviews / Long-acting injectable antiretroviral therapy (LAI ART) / Medical Microbiology / Medication Adherence / Medicine / Medicine & Public Health / Parasitology / Patient compliance / People living with HIV (PLWH) / Prevention / Priorities / Reproductive health / Research priorities / Safety research / Sexual health / Sexually transmitted diseases / STD / Stigma / Storage facilities / sub-Saharan Africa (SSA) / Subgroups / Supply chains / Systematic Review / Teenagers / Tropical Medicine