{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:58:14Z","timestamp":1790791094599,"version":"4.1.0"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Long-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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a mixed-methods study among people living with HIV (PLHIV) in two tertiary hospitals in Nairobi, Kenya\u2014a 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 72.2% of survey participants indicated a willingness to switch to LAI-ART. In the final adjusted multivariable models, prior awareness of LAI-ART was a powerful independent predictor, nearly tripling a patient\u2019s willingness to switch (aOR = 2.851; 95% CI: 1.742\u20134.666; p\u2009&lt;\u20090.001). Finding information through online resources (aOR = 2.246; 95% CI: 1.303\u20133.873; p\u2009=\u20090.004) and missing oral pill doses (aOR = 2.154; 95% CI: 1.266\u20133.664; p\u2009=\u20090.005) both independently more than doubled a participant\u2019s odds of finding LAI-ART acceptable. Conversely, the enrollment hospital site had no independent statistical effect on acceptability once the analysis controlled for baseline demographics and how often individuals must visit the hospital for care (aOR = 1.188; 95% CI: 0.659\u20132.141; p\u2009=\u20090.567). Drivers of interest among those willing to switch included reducing pill burden (77.8%), avoiding forgetting doses (55.6%), and improving privacy (45.5%). Despite high baseline acceptability, focus group discussions revealed a state of cautious optimism, driven by significant fears of potential side effects (68.1%), treatment rigidity, and logistical challenges such as travel and clinic access.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These findings suggest that although LAI-ART is widely viewed as a promising treatment option, its uptake will depend on effective patient-centered communication, increased awareness, trust in the intervention, and reliable service delivery. However, successful implementation in Kenya will require more than patient willingness alone. Health system readiness must be a central consideration, with implementation strategies focused on securing dependable drug supply chains, decentralizing access through county-level clinics, and strengthening digital systems to support patient monitoring, retention, and continuity of care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0320713","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:28:57Z","timestamp":1790789337000},"page":"e0320713","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cThe injection gives freedom\u201d - An exploration of long-acting injectable HIV treatment acceptance among patients seeking care in two Nairobi tertiary hospitals"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4739-2000","authenticated-orcid":true,"given":"Duncan","family":"Nyukuri","sequence":"first","affiliation":[{"name":"Kenyatta National Hospital","place":["Nairobi, Kenya"],"department":["Department of Medicine"]},{"name":"Aga Khan University Hospital","place":["Nairobi, Kenya"],"department":["Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Abongo","sequence":"additional","affiliation":[{"name":"Kenyatta National Hospital","place":["Nairobi, Kenya"],"department":["Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastacia","family":"Mbithi","sequence":"additional","affiliation":[{"name":"Aga Khan University Hospital","place":["Nairobi, Kenya"],"department":["Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Kundu","sequence":"additional","affiliation":[{"name":"Kenyatta National Hospital","place":["Nairobi, Kenya"],"department":["Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Mutai","sequence":"additional","affiliation":[{"name":"Kenyatta National Hospital","place":["Nairobi, Kenya"],"department":["Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1729-5012","authenticated-orcid":true,"given":"Reena Chhotala","family":"Shah","sequence":"additional","affiliation":[{"name":"Aga Khan University Hospital","place":["Nairobi, Kenya"],"department":["Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"pone.0320713.ref001","unstructured":"FDA Approves Cabenuva and Vocabria for the Treatment of HIV-1 Infection | FDA. [cited 2023 Jan 30]. Available from: https:\/\/www.fda.gov\/drugs\/human-immunodeficiency-virus-hiv\/fda-approves-cabenuva-and-vocabria-treatment-hiv-1-infection"},{"key":"pone.0320713.ref002","first-page":"179","article-title":"Evaluating cabotegravir\/rilpivirine long-acting, injectable in the treatment of HIV infection: emerging data and therapeutic potential","volume":"11","author":"C Fernandez","year":"2019","journal-title":"HIV AIDS (Auckl)"},{"key":"pone.0320713.ref003","author":"UNAIDS\/WHO. Global HIV Programme","year":"2023"},{"key":"pone.0320713.ref004","unstructured":"UNAIDS. Kenya | UNAIDS. Country factsheets. 2023 [cited 2025 Jan 6]. Available from: https:\/\/www.unaids.org\/en\/regionscountries\/countries\/kenya"},{"issue":"4","key":"pone.0320713.ref005","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2016-000125","article-title":"Determinants of adherence to antiretroviral therapy among HIV-positive adults in sub-Saharan Africa: A systematic review","volume":"1","author":"T Heestermans","year":"2016","journal-title":"BMJ Glob Health"},{"issue":"4","key":"pone.0320713.ref006","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1080\/15381501.2012.754392","article-title":"A qualitative assessment of barriers to antiretroviral therapy adherence among adolescents in western Kenya","volume":"13","author":"CJ Kunapareddy","year":"2014","journal-title":"J HIV AIDS Soc Serv"},{"issue":"12","key":"pone.0320713.ref007","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1056\/NEJMoa1904398","article-title":"Long-Acting Cabotegravir and Rilpivirine for Maintenance of HIV-1 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of youth living with HIV","volume":"33","author":"JM Simoni","year":"2019","journal-title":"AIDS Patient Care STDS"},{"issue":"10101","key":"pone.0320713.ref013","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1016\/S0140-6736(17)31917-7","article-title":"Long-acting intramuscular cabotegravir and rilpivirine in adults with HIV-1 infection (LATTE-2): 96-week results of a randomised, open-label, phase 2b, non-inferiority trial","volume":"390","author":"DA Margolis","year":"2017","journal-title":"Lancet"},{"issue":"9","key":"pone.0320713.ref014","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.26006","article-title":"Perspectives of people living with HIV\u20101 on implementation of long\u2010acting cabotegravir plus rilpivirine in US healthcare settings: Results from the CUSTOMIZE hybrid III implementation\u2010effectiveness study","volume":"25","author":"CP Garris","year":"2022","journal-title":"J Int AIDS 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a large clinic cohort","volume":"12","author":"KA Christopoulos","year":"2025","journal-title":"Open Forum Infect Dis"},{"issue":"8","key":"pone.0320713.ref018","doi-asserted-by":"crossref","DOI":"10.1016\/S2352-3018(17)30068-1","article-title":"Safety and tolerability of long-acting cabotegravir injections in HIV-uninfected men (ECLAIR): A multicentre, double-blind, randomised, placebo-controlled, phase 2a trial","volume":"4","author":"M Markowitz","year":"2017","journal-title":"Lancet HIV"},{"issue":"1","key":"pone.0320713.ref019","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12879-024-09748-5","article-title":"Long-acting injectable antiretroviral treatment: Experiences of people with HIV and their healthcare providers in Uganda","volume":"24","author":"H Zakumumpa","year":"2024","journal-title":"BMC Infect Dis"},{"issue":"7","key":"pone.0320713.ref020","doi-asserted-by":"crossref","first-page":"2163","DOI":"10.1007\/s10461-022-03949-2","article-title":"Factors 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