Bridging the Gap: Identifying Barriers and Strategies for Widespread Implementation of Long-acting Injectable Antiretroviral ART in Sub-Saharan Africa: A Scoping Review

ABSTRACT Background Long-acting injectable antiretroviral therapy (LAI ART) presents a new approach to HIV treatment and addressing the challenges of daily oral ART in Sub-Saharan Africa (SSA) remains paramount. This review collates existing literature on barriers and strategies for implementing LAI ART in the SSA region, identifying knowledge gaps and research priorities. Methods We performed a thorough literature search, encompassing electronic databases and grey literature sources. Our review included 18 studies published between 2014 and 2023, focusing on the acceptability, feasibility, effectiveness, and cost-effectiveness of LAI ART in SSA. Data extraction involved study characteristics, population, intervention, outcomes, and context, with findings synthesized using a narrative approach. Results The results indicate high demand and acceptability of LAI ART among people living with HIV in SSA, particularly those facing stigma and discrimination. LAI ART can improve adherence, retention, and viral suppression while reducing pill burden and frequent clinic visits. Implementation challenges include lack of regulatory approval, high cost, limited supply chain, health system capacity, trained staff, and cold storage facilities. Further evidence on safety and efficacy, advocacy, policy, and community engagement are needed to ensure accessibility and equity. Conclusion Knowledge gaps and research priorities include dosing regimens, long-term outcomes, drug resistance, impact on sexual and reproductive health, interactions with other medications and co-infections, and preferences and experiences of different subgroups.