Inside the experiences as Uganda implements Long-acting injectable ART to combat HIV/AIDS

In 2024, the Uganda AIDS Commission announced the introduction of long-acting Cabotegravir (CAB-LA), an injectable PrEP option with 99% efficacy, following approval by the National Drug Authority. This marks a major milestone in Uganda’s HIV prevention efforts. 

In 2023, Uganda recorded 38,000 new HIV infections with almost half of new infections among adolescents and young people. The prevalence of new infections remains higher among females, with adolescent girls representing 80% of new infections among young people, highlighting the urgent need for targeted interventions.

Dr. Vincent Bagambe, the AIDS Commission Director of Planning and Strategic Information, emphasized that multiple initiatives are ongoing to strengthen Uganda’s HIV response. Other efforts include the introduction of the Dapivirine vaginal ring in July 2022 in high-risk districts. The Dapivirine vaginal ring offers 50% efficacy. However, Lenacapavir, a six-monthly injectable with 100% efficacy has not yet received National Drug Authority (NDA) approval, delaying its potential rollout.

Long-acting Injectable ART (LAI-ART) and Experiences 

Long-injectable antiretroviral treatment is a bi-monthly intramuscular treatment that combines       cabotegravir and rilpivirine. It offers an alternative to daily oral medication.

The first research study documenting the experiences of people living with HIV in Uganda with long-acting injectable ART (LAI-ART) indicates that it is a promising alternative to daily pills for people living with HIV.     

"People with HIV strongly prefer LAI-ART and there is comparatively higher satisfaction with this treatment," part of the report reads. This reinforces the demand for more accessible and convenient HIV treatment options.

At Fort Portal Regional Referral Hospital, one of the three sites in Uganda implementing a clinical trial of LAI-ART, people living with HIV preferred LAI-ART. Many credited its effectiveness in achieving viral load suppression, enhanced privacy in HIV care and treatment, relief from mental health challenges due to daily pill reminders and carrying bulky packages of drugs. 

Study participants experienced better satisfaction with their HIV treatment under LAI-ART compared to the daily routine of taking oral tablets. They noted that the bi-monthly injection enhanced privacy as it was administered by a healthcare worker in a private room, compared to taking daily oral treatment in the presence of family or work colleagues. Participants also felt ‘liberated from the daily psychological reminder of living with HIV’.      

Overall, the study indicated that people living with HIV strongly prefer LAI-ART and recommended tackling health-system barriers to widen access to this treatment.

Health Workers' Take

Health workers administering LAI-ART explained that most people living with HIV are between 25 to 64 years old. Most preferred to remain anonymous, citing concerns linked to the recent suspension of USAID support.      

"Most beneficiaries had been on ART for many years, but no complications due to changing to LAI-ART," one health worker shared.

Another health worker added, "LAI-ART should be supported. More sensitization and enhanced services should be ensured. You also have a role to play as journalists."      

Specific criteria had to be followed before participants were enrolled for the injectable. The first group to be considered included patients who were suppressed and stable. Patients with liver or hepatitis conditions and those using herbal medicine were excluded. Pregnant or breastfeeding mothers were also excluded.

"We did serious screening to ensure that we enroll only eligible people.  Some people were scared due to rumors from peers that LAI-ART causes complications, which is not true. We       carried out sensitisation to address these fears," explained one of the health workers.

Suspension of USAID support sparks concern

Uganda has a population of 45 million people, with approximately 1.5 million people living with HIV. Of these, 1.4 million are on ART.

Sexual and Reproductive Health and Rights (SRHR) activists in Uganda have already raised       concerns that the recent suspension of USAID - linked to policies introduced under U.S. President Donald Trump - has left people living with HIV vulnerable to health threats, with some already missing out on treatment. 

Niwamanya Aaron,an SRHR activist with Rwizi Network Organization in Western Uganda said this hinders Uganda’s ability to meet the 95-95-95 targets to help end HIV. 

"Yes, the health ministry says LAI-ART will boost the fight against HIV, but we have to understand that Uganda still lacks enough funds to sustain these efforts. " He explained.

Aminah (not her real name), a widow living with HIV, shared how the suspension of USAID support is already affecting people in remote areas. "The government should plan better. The AIDS Support Organization (TASO) and other organizations should step in to help us. We'll die," she narrated.

Sources at TASO disclosed that some key activities have already been suspended amidst growing concerns from the community.

Health experts have also called on  the government and partners to work jointly in improvising and putting mechanisms in place to avoid a looming health crisis in the fight against HIV/AIDS.

HIV in focus

This news story has been published as part of our HIV in focus news network. This is a network of writers and journalists from focus countries, dedicated to delivering news on HIV and sexual health. The network aims to amplify the voices of communities most affected by HIV and share the stories that matter to them.

About the writer

Aaron is an award-winning freelance journalist based in Uganda. He is the team leader of Rise News Uganda, a media network focusing on in-depth storytelling tackling unreported and underreported issues in the community