Skip to main content


Log in

Efficacy and Freedom: Patient Experiences with the Transition from Daily Oral to Long-Acting Injectable Antiretroviral Therapy to Treat HIV in the Context of Phase 3 Trials

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript


Long-acting injectable antiretroviral therapy (LA ART) may be an alternative for people living with HIV (PLHIV) with adherence challenges or who prefer not to take pills. Using in-depth interviews, this study sought to understand the experiences of PLHIV (n = 53) participating in Phase 3 LA ART trials in the United States and Spain. The most salient consideration when contemplating LA ART was its clinical efficacy; many participants reported wanting to ensure that it worked as well as daily oral ART, including with less frequent dosing (every 8 versus 4 weeks). While injection side effects were often reported, most participants felt that regimen benefits outweighed such drawbacks. Participants described the main benefit of LA ART as the “freedom” it afforded both logistically and psychosocially, including through reduced HIV stigma. Findings highlight the importance of patient-provider communication related to weighing potential benefits and side effects and the continued need to address HIV stigma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. Palella FJ Jr, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. N Engl J Med. 1998;338(13):853–60.

    Article  Google Scholar 

  2. Cohen MS, McCauley M, Gamble TR. HIV treatment as prevention and HPTN 052. Curr Opinion HIV AIDS. 2012;7(2):99.

    Article  CAS  Google Scholar 

  3. Grinsztejn B, Hosseinipour MC, Ribaudo HJ, Swindells S, Eron J, Chen YQ, et al. Effects of early versus delayed initiation of antiretroviral treatment on clinical outcomes of HIV-1 infection: results from the phase 3 HPTN 052 randomised controlled trial. Lancet Infect Dis. 2014;14(4):281–90.

    Article  CAS  Google Scholar 

  4. Tanser F, Barnighausen T, Grapsa E, Zaidi J, Newell ML. High coverage of ART associated with decline in risk of HIV acquisition in rural KwaZulu-Natal, South Africa. Science (New York, NY). 2013;339(6122):966–71.

    Article  CAS  Google Scholar 

  5. Das M, Chu PL, Santos GM, Scheer S, Vittinghoff E, McFarland W, et al. Decreases in community viral load are accompanied by reductions in new HIV infections in San Francisco. PLoS ONE. 2010;5(6):e11068.

    Article  Google Scholar 

  6. Montaner JS, Lima VD, Barrios R, Yip B, Wood E, Kerr T, et al. Association of highly active antiretroviral therapy coverage, population viral load, and yearly new HIV diagnoses in British Columbia, Canada: a population-based study. Lancet (London, England). 2010;376(9740):532–9.

    Article  Google Scholar 

  7. Beer L, Heffelfinger J, Frazier E, Mattson C, Roter B, Barash E, et al. Use of and adherence to antiretroviral therapy in a large US sample of HIV-infected adults in care. 2007–2008. The open AIDS Journal. 2012, 6(1).

  8. Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis: An off Publ Infect Dis Soc Am. 2011;52(6):793–800.

    Article  Google Scholar 

  9. Chesney MA. Factors affecting adherence to antiretroviral therapy. Clin Infect Dis. 2000;30(Supplement 2):S171–S176176.

    Article  Google Scholar 

  10. Kagee A, Remien RH, Berkman A, Hoffman S, Campos L, Swartz L. Structural barriers to ART adherence in Southern Africa: challenges and potential ways forward. Global public health. 2011;6(1):83–97.

    Article  CAS  Google Scholar 

  11. Reda AA, Biadgilign S. Determinants of adherence to antiretroviral therapy among HIV-infected patients in Africa. AIDS Res Treat. 2012;2012:574656.

    PubMed  PubMed Central  Google Scholar 

  12. Gross IM, Hosek S, Richards MH, Fernandez MI. Predictors and Profiles of Antiretroviral Therapy Adherence Among African American Adolescents and Young Adult Males Living with HIV. AIDS patient care and STDs. 2016;30(7):324–38.

    Article  Google Scholar 

  13. Mellins CA, Kang E, Leu CS, Havens JF, Chesney MA. Longitudinal study of mental health and psychosocial predictors of medical treatment adherence in mothers living with HIV disease. AIDS Patient Care STDs. 2003;17(8):407–16.

    Article  Google Scholar 

  14. Golin CE, Liu H, Hays RD, Miller LG, Beck CK, Ickovics J, et al. A prospective study of predictors of adherence to combination antiretroviral medication. J Gen Intern Med. 2002;17(10):756–65.

    Article  Google Scholar 

  15. Kacanek D, Angelidou K, Williams PL, Chernoff M, Gadow KD, Nachman S. Psychiatric symptoms and antiretroviral nonadherence in US youth with perinatal HIV: a longitudinal study. AIDS (London, England). 2015;29(10):1227–37.

    Article  CAS  Google Scholar 

  16. Katz IT, Ryu AE, Onuegbu AG, Psaros C, Weiser SD, Bangsberg DR, et al. Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis. Journal of the International AIDS Soc. 2013,16(3).

  17. Rintamaki LS, Davis TC, Skripkauskas S, Bennett CL, Wolf MS. Social stigma concerns and HIV medication adherence. AIDS Patient Care STDs. 2006;20(5):359–68.

    Article  Google Scholar 

  18. Murray LK, Semrau K, McCurley E, Thea DM, Scott N, Mwiya M, et al. Barriers to acceptance and adherence of antiretroviral therapy in urban Zambian women: a qualitative study. AIDS care. 2009;21(1):78–86.

    Article  Google Scholar 

  19. Margolis DA, Gonzalez-Garcia J, Stellbrink HJ, Eron JJ, Yazdanpanah Y, Podzamczer D, et al. 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. Lancet (London, England). 2017;390(10101):1499–510.

    Article  CAS  Google Scholar 

  20. Swindells S, Andrade-Villanueva JF, Richmond GJ, Rizzardini G, Baumgarten A, Masia M, et al. Long-Acting cabotegravir and rilpivirine for maintenance of HIV-1 suppression. N Engl J Med. 2020;382(12):1112–23.

    Article  CAS  Google Scholar 

  21. Orkin C, Arasteh K, Gorgolas Hernandez-Mora M, Pokrovsky V, Overton ET, Girard PM, et al. Long-acting cabotegravir and rilpivirine after oral induction for HIV-1 infection. N Engl J Med. 2020;382(12):1124–35.

    Article  CAS  Google Scholar 

  22. Kerrigan D, Mantsios A, Gorgolas M, Montes ML, Pulido F, Brinson C, et al. Experiences with long acting injectable ART: A qualitative study among PLHIV participating in a Phase II study of cabotegravir + rilpivirine (LATTE-2) in the United States and Spain. PloS One. 2018;13(1):e0190487.

    Article  Google Scholar 

  23. amfAR. Long-Acting HIV Treatment and Prevention Are Coming: Preparing for Potential Game Changers 2019 [Available from: Accessed 30 May 2019.

  24. Study Evaluating the Efficacy, Safety, and Tolerability of Switching to Long-acting Cabotegravir Plus Long-acting Rilpivirine From Current Antiretroviral Regimen in Virologically Suppressed HIV-1-infected Adults Bethesda, MD: National Library of Medicine (US); 2016 [May 30 2019].

  25. Study to evaluate the efficacy, safety, and tolerability of long-acting intramuscular cabotegravir and rilpivirine for maintenance of virologic suppression following switch from an integrase inhibitor in HIV-1 infected therapy naive participants bethesda, MD: National Library of Medicine (US). 2016. 30 May 2019

  26. Efficacy, safety and tolerability study of long-acting cabotegravir plus long-acting rilpivirine (cab la + rpv la) in human-immunodeficiency virus-1 (HIV-1) infected adults bethesda, MD: National Library of Medicine (US). 2017. 30 May 2019

  27. Patton MQ. Qualitative Research and Evaluation Methods (3rd Edition). United States: Sage Publications; 2002.

    Google Scholar 

  28. Scientific Software Development GmbH. ATLAS.ti 1.0.50 ed. Eden Prairie, MN,2013.

  29. Pope C, Ziebland S, Mays N. 2000. Analysing qualitative data. BMJ: British Medical Journal. 320(7227): 114–116.

  30. Murray M, et al. editor Patient-reported outcomes on long-acting cabotegravir + rilpivirine as maintenance therapy: FLAIR 48-Week Results. 10th IAS Conference. 2019 July 21–24. Mexico City, Mexico.

  31. Murray M, et al., editor Patient views on long-acting HIV treatment: cabotegravir + rilpivirine as maintenance therapy (ATLAS 48-Week Results). 10th IAS Conference. 2019 July 21–24. Mexico City, Mexico.

  32. Simoni JM, Beima-Sofie K, Mohamed ZH, Christodoulou J, Tapia K, Graham SG, et al. Long-acting injectable antiretroviral treatment acceptability and preferences: a qualitative study among US providers, adults living with HIV, and parents of youth living with HIV. AIDS Patient Care STDs. 2019;33(3):104–11.

    Article  Google Scholar 

  33. Parker R, Aggleton P. HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action. Soc Sci Med. 2003;57(1):13–24.

    Article  Google Scholar 

  34. Land H, Linsk N. HIV stigma and discrimination: enduring issues. J HIV/AIDS Soc Serv. 2013;12(1):3–8.

    Article  Google Scholar 

  35. Pantelic M, Sprague L, Stangl AL. It’s not “all in your head”: critical knowledge gaps on internalized HIV stigma and a call for integrating social and structural conceptualizations. BMC Infect Dis. 2019;19(1):210.

    Article  Google Scholar 

  36. Hatzenbuehler ML. Structural stigma: research evidence and implications for psychological science. Am Psychol. 2016;71(8):742–51.

    Article  Google Scholar 

  37. Mantsios A, Murray M, Karver T, Davis W, Margolis D, Kumar P, et al. “I feel empowered”: Women’s perspectives on and experiences with long-acting injectable anti-retroviral therapy in the USA and Spain. Culture, Health, and Sexuality (forthcoming).

  38. Harris RA, Xue X, Selwyn PA. Housing stability and medication adherence among HIV-positive individuals in antiretroviral therapy: a meta-analysis of observational studies in the United States. J Acquir Immune Defic Syndr. 2017;74(3):309–17.

    Article  Google Scholar 

  39. Leaver CA, Bargh G, Dunn JR, Hwang SW. The effects of housing status on health-related outcomes in people living with HIV: a systematic review of the literature. AIDS Behav. 2007;11(6 Suppl):85–100.

    Article  Google Scholar 

  40. Milloy MJ, Marshall BD, Montaner J, Wood E. Housing status and the health of people living with HIV/AIDS. Curr HIV/AIDS Rep. 2012;9(4):364–74.

    Article  Google Scholar 

  41. Palepu A, Milloy MJ, Kerr T, Zhang R, Wood E. Homelessness and adherence to antiretroviral therapy among a cohort of HIV-infected injection drug users. J Urban Health. 2011;88(3):545–55.

    Article  Google Scholar 

  42. Nachega JB, Uthman OA, Peltzer K, Richardson LA, Mills EJ, Amekudzi K, et al. Association between antiretroviral therapy adherence and employment status: systematic review and meta-analysis. Bull World Health Organ. 2015;93(1):29–41.

    Article  Google Scholar 

  43. Chen NE, Meyer JP, Avery AK, Draine J, Flanigan TP, Lincoln T, et al. Adherence to HIV treatment and care among previously homeless jail detainees. AIDS Behav. 2013;17(8):2654–66.

    Article  Google Scholar 

  44. Cohn SE, Jiang H, McCutchan JA, Koletar SL, Murphy RL, Robertson KR, et al. Association of ongoing drug and alcohol use with non-adherence to antiretroviral therapy and higher risk of AIDS and death: results from ACTG 362. AIDS care. 2011;23(6):775–85.

    Article  Google Scholar 

  45. Milloy MJ, Kerr T, Buxton J, Rhodes T, Guillemi S, Hogg R, et al. Dose-response effect of incarceration events on nonadherence to HIV antiretroviral therapy among injection drug users. J Infect Dis. 2011;203(9):1215–21.

    Article  CAS  Google Scholar 

  46. Uthman OA, Oladimeji O, Nduka C. Adherence to antiretroviral therapy among HIV-infected prisoners: a systematic review and meta-analysis. AIDS care. 2017;29(4):489–97.

    Article  Google Scholar 

  47. Mantsios A, Karver T, Davis W, Kerrigan D. Patient and provider perspectives on and experiences with the transition from daily oral to long-acting injectable anti-retroviral therapy in the United States and Spain. Final Report: Prepared for ViiV Healthcare; 2019 June 10.

Download references


This study was funded by ViiV Healthcare. We thank everyone who has contributed to the success of this study including all study participants and their families, clinical investigators and their staff in Spain, and the USA; and ViiV Spain Medical Scientific Liaisons (Beatriz Pereira, Ramón Almansa-Fernández, David Suarez Fábregas, Marta Rosell-Fontanet and Silvia Esteban Sánchez), Pilar Moliner Domenech (GSK local Study Manager) and Carlos Martin Español (GSK Clinical Study Manager), and from PPD, Blanca Galobart de los Reyes, Inmaculada Escudero Pablos, Itziar Yagüe Muñoz, Rocío Molina Fernández-Bravo, Evangelina Alonso Alzaga, Ricardo Plaza Cacho and Patricia López Belmonte and JHD staff.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Andrea Mantsios.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mantsios, A., Murray, M., Karver, T.S. et al. Efficacy and Freedom: Patient Experiences with the Transition from Daily Oral to Long-Acting Injectable Antiretroviral Therapy to Treat HIV in the Context of Phase 3 Trials. AIDS Behav 24, 3473–3481 (2020).

Download citation

  • Published:

  • Issue Date:

  • DOI: