Acceptability of Hypothetical HIV Cure-Related Research Modalities: A Cross-Sectional Study of People Living with HIV in Soweto, South Africa

Various modalities are being explored in HIV cure-related research, but little is documented on their acceptability in Africa, where HIV is most prevalent. To address this, we conducted a cross-sectional study in Soweto, South Africa, assessing stated acceptability of five potential HIV cure-related research modalities and identifying associated factors. Between May and August 2024, we sampled 100 adults living with HIV who provided informed consent. Participants completed questionnaires of socio-demographics and the Theoretical Framework of Acceptability scale measuring general acceptability and seven constructs (affective attitude, burden, ethicality, perceived effectiveness, intervention coherence, self-efficacy, opportunity costs). We summarized data using descriptive statistics. We assessed factors associated with acceptability using univariate and multivariate logistic regression. We found that of 100 participants (44% female, median age 39 years), 66% were willing to accept an intervention that would allow lifelong remission (antiretroviral treatment-free control), 88% were willing if the intervention guaranteed remission for everyone treated, and 87% were willing if the intervention had minimal side effects. Total mean acceptability scores of hypothetical HIV cure-related research modalities were oral or injectable chemotherapeutics (3.8/5), intravenous or injectable antibodies (3.7/5), radiotherapy (3.3/5), transplantation (3.1/5), gene therapy (2.9/5), and across all modalities (3.4/5). Participants rated antibodies and chemotherapeutics with tied top scores for affective attitude (3.8/5) and self-efficacy (4.0/5); chemotherapeutics with top scores for perceived effectiveness (4.0/5), intervention coherence (4.1/5) and having least burden (3.2/5) and opportunity costs (3.3/5); and antibodies with the top score for ethicality (4.2/5). Acceptability was associated with non-binary gender and willingness to take an intervention achieving 2 years remission. In conclusion, people living with HIV have moderately high acceptability for oral or injectable chemotherapeutics and intravenous or injectable antibodies but would need more information about gene therapy, transplantation, and radiotherapy. Antibodies aligned highest with personal values, suggesting support for antibody research and applications.