Readiness for long-acting injectable HIV care splits along age, information, and cost lines in Uganda
Long-acting injectable HIV treatment and prevention may simplify care, but willingness to try these options does not mean a person is ready to start them today. In a cross-sectional study from central Uganda, readiness was defined in a practical way: participants had to prefer initiation immediately or within three months. Using that threshold, just under half of the 225 clinic clients were ready to begin injectable HIV medicines, while nearly as many wanted more information before deciding.
The finding is clinically important because uptake decisions for long-acting products are not driven by interest alone. Injectables shift the burden of adherence from daily pill-taking to scheduled clinic visits, which can help some patients and create new barriers for others. In settings where clinic access, privacy, and out-of-pocket expense remain daily realities, the question is not simply whether people like the idea. It is whether the service model fits the life they are already living.
Nearly half were ready, but many were still deciding
Among the 225 participants at Mildmay Hospital and Kajjansi Health Centre IV, 108 people, or 48.0%, were ready to start injectable HIV treatment or prevention. A nearly identical share, 111 participants or 49.3%, wanted more information about the options. Only six participants, 2.7%, preferred to wait six to twelve months before starting.
Those proportions point to a population that is not resistant so much as undecided. In practice, that is an opening for counseling, not a dead end. If a patient remains on the fence, the barrier may be uncertainty about side effects, doubts about whether injections work better than oral therapy, or concern about how often appointments will have to be kept.
Younger people living with HIV were far more ready than older adults
The strongest age pattern appeared among people living with HIV. Readiness reached 80.8% in those aged 15 to 24 years, compared with 34.4% in those aged 25 years or older, yielding an adjusted prevalence ratio of 2.35 (95% CI 1.63–3.38). The pattern did not look the same among PrEP-service clients, where readiness was 39.2% in those aged 15 to 24 years and 41.4% in those aged 25 years or older, with an adjusted prevalence ratio of 0.95 (95% CI 0.60–1.50). The interaction was statistically significant (p=0.002).
That age-by-service-group split suggests that readiness is not one uniform behavior across HIV care settings. For younger people living with HIV, long-acting injections may represent convenience, discretion, or relief from daily pill routines. For older adults, the calculus may be different: established pill habits, greater caution about new medicines, or concern about repeated visits could slow adoption. Among PrEP clients, readiness appeared flatter by age, suggesting that prevention users may approach the decision through a separate set of expectations and tradeoffs.
A regimen that removes daily dosing can still fail if the service schedule feels burdensome.
Information from clinic staff carried real weight
Several modifiable factors were tied to readiness. Receiving information from clinic staff was associated with greater readiness, with an adjusted prevalence ratio of 1.94 (95% CI 1.42–2.66). Belief that injectable options would be more effective was also linked to readiness, with an adjusted prevalence ratio of 2.00 (95% CI 1.43–2.80). A one-point increase in the benefit score corresponded to a much higher likelihood of readiness, with an adjusted prevalence ratio of 3.27 (95% CI 2.36–4.55).
These associations fit with a straightforward behavioral model. Long-acting products are novel enough that patients may not infer their value from pill-based treatment experience alone. If clinic staff can explain how injectable antiretroviral therapy or prevention works, why it is used, and what advantages it may offer, they are not merely sharing information. They are shaping how the patient weighs the burden of adherence against the promise of convenience and sustained drug exposure.
Safety concerns and money remained powerful obstacles
Concerns pulled in the opposite direction. A one-point increase in concern score was associated with lower readiness, with an adjusted prevalence ratio of 0.70 (95% CI 0.60–0.80). Financial difficulty, reported sometimes or more often, was also associated with reduced readiness, with an adjusted prevalence ratio of 0.68 (95% CI 0.48–0.96).
Those effects are unsurprising and yet highly relevant. Long-acting injectables introduce a different type of adherence burden: the patient may no longer remember daily pills, but must still find time, transport, and money for repeated visits. If appointments are missed, the drug’s long pharmacologic tail can become a liability rather than an advantage. Concerns about side effects may be just as important, especially when people are being asked to accept a new route of administration for prevention or treatment that may feel less familiar than tablets.
Fewer side effects was the condition people wanted most
When participants were asked what would make them accept injectable HIV treatment or prevention, fewer side effects came first across service groups and readiness categories. That response is telling. It suggests that tolerability is not a secondary issue buried behind convenience; it is part of the core decision to start.
For clinicians and programme planners, the implication is direct. Readiness assessments should ask not only whether a person is willing, but when they would want to start and what would have to change first. Counseling can then address the specific worries that slow uptake: safety, flexible appointment scheduling, privacy, and affordability. The delivery system around a long-acting medicine may matter almost as much as the medicine itself.
The study was conducted as a cross-sectional analysis, so it captured readiness at one point in time rather than actual initiation behavior over months of follow-up. Still, it offers a useful snapshot of the decision environment facing HIV services in Uganda: a large group that is open, a large group that still wants information, and a smaller group held back by cost and concern. For long-acting injectable HIV treatment and prevention to move beyond novelty, clinics will need to treat readiness as a process, not a yes-or-no answer.