Preferred characteristics of long-acting injectable antiretroviral treatment for adolescents with HIV in KwaZulu-Natal, South Africa: a qualitative study of key stakeholders

Adolescents with HIV (AHIV) in South Africa experience poor outcomes across the HIV care continuum. Long-acting injectable antiretroviral therapy (LAI-ART) may address key adherence barriers, but its acceptability and feasibility among AHIV remain understudied. As formative qualitative work for a cluster-randomized stepped-wedge trial (ATTUNE), we explored perceptions of LAI-ART using the technology acceptance model (TAM). Four facilitators conducted 23 focus group discussions (FGDs) across four clinics with purposively sampled stakeholders: AHIV aged 12–19 years, their caregivers, and healthcare workers. FGDs were transcribed, double-coded, and thematically analyzed using Braun and Clarke’s framework. Participants included caregivers (7 FGDs; n = 69), adolescents (8 FGDs; n = 64), and healthcare workers (8 FGDs; n = 80). Across groups, barriers to oral ART adherence included poor taste, stigma, and inconsistent social support. LAI-ART was widely perceived as useful, with anticipated benefits including reduced pill burden, increased privacy, and improved adherence. Concerns centered on injection pain, side effects, and administration, affecting perceived ease of use. Overall, LAI-ART is a highly acceptable alternative to oral ART for adolescents with HIV in South Africa, with potential to reduce stigma and treatment burden. Implementation should consider concerns about injection safety, delivery methods, and the need for community education.