Long-acting injectable drugs are reshaping the way HIV is treated and prevented, offering an alternative to pills that must be taken every day. A new qualitative study from MetroHealth Medical Center in Cleveland, Ohio, examines how people living with HIV and people who are HIV-negative experience these injections in routine care. The research, published in BMC Infectious Diseases, focuses on patients receiving either long-acting injectable antiretroviral therapy, known as LAI-ART, or long-acting injectable pre-exposure prophylaxis, known as LAI-PrEP. The findings suggest that injectable treatment can reduce the daily psychological burden of HIV medication, but its success depends heavily on flexible services, clear communication and trust between patients and healthcare professionals.
Long-acting injectable HIV medicines are designed to maintain effective concentrations of antiretroviral drugs in the body for weeks or months after administration. Unlike oral regimens, which require consistent daily dosing, injectable therapies create a sustained pharmacological “depot” that releases medication gradually. For people living with HIV, this can suppress viral replication and protect immune function without requiring a tablet every day. For people without HIV, injectable prevention can reduce the risk of acquiring the virus by maintaining drug levels capable of interfering with HIV replication soon after exposure. These approaches are particularly important because missed oral doses can reduce protection and, in some circumstances, contribute to the development of drug resistance.
The Cleveland study involved 30 patients between 25 and 66 years old who had been using a long-acting injectable medication for more than two months. Participants were recruited through a safety-net hospital clinic, a setting that provides care regardless of insurance status or ability to pay. Twenty-two participants were receiving LAI-ART, while the remaining participants were using LAI-PrEP. Most participants identified as Black or African American, and the median age was 42. The researchers conducted in-depth, one-on-one interviews between May and November 2024, asking patients to describe their experiences, expectations, concerns and interactions with the healthcare system.
Rather than measuring outcomes only through viral-load tests or medication records, the investigators used thematic analysis to identify recurring ideas in the interviews. This method, developed systematically through the six-step framework associated with researchers Virginia Braun and Victoria Clarke, involves familiarizing investigators with interview material, generating codes, organizing themes, reviewing patterns and interpreting their significance. The approach is useful for understanding dimensions of treatment that conventional clinical measurements may overlook, including stigma, emotional responses, perceived autonomy and the practical demands of attending appointments.
Convenience emerged as one of the strongest advantages of injectable medication. Participants described relief at no longer having to remember an HIV pill each day, arrange doses around work or travel, or worry that medication bottles could reveal their HIV status to other people. For people living with HIV, the absence of a daily reminder was especially meaningful. Oral treatment can be medically effective while still serving as a recurring psychological signal of diagnosis, and some interviewees reported that injections helped lessen this emotional burden. Patients also linked injectable therapy with improved peace of mind and a greater sense of stability in their lives.
The reduction in daily medication routines may also have implications for privacy and stigma. HIV-related stigma remains a barrier to treatment and prevention in many communities, influencing whether people disclose their status, collect prescriptions or take medicine around family members and partners. An injection administered at a clinic can be less visible than tablets stored or taken at home. For patients who fear judgment or unwanted disclosure, this difference can make treatment feel more manageable. However, injectable care does not eliminate stigma; it shifts the point of visibility from daily pill-taking to scheduled healthcare visits, where privacy, respectful communication and discreet clinic procedures remain essential.
Participants also reported important disadvantages. Injection-site pain was a common concern, and some patients experienced soreness or discomfort after administration. Although these reactions are generally localized, they can affect willingness to continue treatment, particularly when injections are repeated over time. Others described side effects or uncertainty about how long symptoms might last. With a daily oral medication, discontinuation can usually be followed by a relatively rapid decline in drug exposure. Long-acting formulations behave differently: once administered, the drug cannot simply be removed, and low concentrations may persist for an extended period. This pharmacokinetic “tail” makes counseling and follow-up important if a patient stops receiving injections.
Appointment scheduling was another major challenge. Long-acting therapy reduces the number of medication-taking events but increases reliance on a healthcare system capable of delivering injections on time. Participants described inflexible appointment schedules, transportation difficulties and conflicts with work or other responsibilities. This creates a paradox at the center of injectable treatment: the regimen may be simpler pharmacologically, yet more demanding logistically. Maintaining protection or viral suppression requires reliable attendance, timely reminders, access to rescheduling and rapid support when a patient misses an appointment. In a safety-net setting, these needs may be intensified by unstable housing, limited transportation, irregular employment and gaps in insurance coverage.
Some patients also felt that injectable care reduced their autonomy over treatment decisions. The need to return to a clinic for administration can make patients feel dependent on providers, especially when choices about timing, side effects or switching therapies are not fully discussed. The study found that trust and communication were decisive in both starting and continuing LAI-ART or LAI-PrEP. Patients were more receptive when clinicians explained how the medications worked, what adverse effects to expect, how missed injections would be managed and what alternatives were available. Shared decision-making may be particularly important for HIV prevention, where people without HIV must weigh perceived risk, sexual health priorities and the practical realities of recurring clinic visits.
The researchers conclude that long-acting injectable HIV medications have significant potential, especially for vulnerable populations who struggle with daily pills, medication stigma or adherence barriers. But the technology alone cannot guarantee success. Programs must pair injectable drugs with patient-centered services, including flexible scheduling, accessible follow-up, careful management of injection-site reactions and communication that respects individual preferences. The study is limited by its small, convenience-based sample from a single Cleveland hospital, so the experiences may not represent all people receiving HIV treatment or prevention. Even so, the findings highlight a central lesson for the future of HIV care: innovation is not only a matter of extending drug release in the body. It also requires designing healthcare systems that fit the lives, concerns and choices of the people who depend on them.
Subject of Research: Experiences of people living with and without HIV using long-acting injectable HIV treatment and prevention in a safety-net hospital.
Article Title: Experiences of people living with and without HIV with long-acting injectable HIV treatment and prevention in a safety-net hospital in Cleveland – a cross-sectional thematic analysis
Article References: Heath M, Sudovec-Somogyi JV, Avery A. BMC Infectious Diseases. 2026.
Image Credits: AI Generated
DOI: 10.1186/s12879-026-14151-3
Keywords: HIV; long-acting injectable medication; LAI-ART; LAI-PrEP; antiretroviral therapy; pre-exposure prophylaxis; safety-net hospital; adherence; HIV prevention.
Tags: flexible healthcare services for HIV patientsHIV long-acting injectable treatmentsHIV prevention strategiesHIV treatment adherence and medication burdenHIV viral suppression through injectable therapyimpact of injectable HIV medicationsLAI-ART and LAI-PrEPpatient experiences with injectable HIV therapypre-exposure prophylaxis for HIVpsychological benefits of long-acting HIV treatmentsqualitative study on HIV treatment experiencesrole of healthcare provider communication in HIV caretrust between patients and healthcare providers
