Long-acting injectable antiretroviral therapy (LAI ART) offers an alternative to daily ART by mitigating adherence barriers such as pill fatigue and stigma. However, it introduces new challenges, including the need for continued engagement, clear communication, and understanding of the consequences of missed or delayed doses. Patient knowledge of these issues remains poorly characterized. Between June 1 and October 2, 2025, we administered a structured survey to individuals receiving LAI ART at two academic medical centers to assess sociodemographic characteristics, knowledge of key treatment concepts (injection schedules, dosing windows, oral bridging indications, and consequences of delayed or missed doses), and treatment perceptions. Eight questions were used to assess LAI ART-related knowledge among participants. Associations were evaluated using Fisher’s exact tests ( p < 0.05). A total of 119 participants completed the survey (70.6% University of Nebraska Medical Center and 29.4% University of Chicago). Mean age was 45.8 years, and most identified as male (74.8%) and White (54.6%) or Black (41.2%). Nearly all (95.0%) reported receiving pre-LAI ART education, and 89.1% were satisfied or very satisfied with their treatment. Despite this, the mean knowledge score was only 3.4/8 (42.5%; SD = 1.66). In exploratory analyses, higher education was associated with better understanding of on-time injections, treatment windows, and oral bridging thresholds, while both education and income were associated with knowledge of drug interactions. Although satisfaction with LAI ART was high, we found substantial knowledge gaps among patients receiving LAI ART despite education before treatment initiation. These findings highlight opportunities to strengthen patient education and reinforce key aspects of LAI ART management, particularly for patients with lower educational attainment and income.
Linkage to pre-exposure prophylaxis (PrEP) is critical to maximize the benefits of HIV self-testing (HIVST). However, PrEP uptake remains low after HIVST, particularly among men who have sex with men (MSM). Coupling HIVST with navigation may improve PrEP uptake. We conducted a mixed methods study of MSM who had completed an HIV self-test to explore how navigators could facilitate PrEP linkage and understand tester preferences. Participants completed a baseline survey and a 30-day follow-up survey. We purposively sampled MSM who had and had not seen a provider within 30 days after self-testing to conduct semi-structured interviews. A total of 84 MSM were enrolled in the quantitative survey. The median age was 28, 31% were Black, and 23% were Latine. In quantitative data, the most important characteristics of a navigator were having formal medical training, similar sexual orientation, and prior experience with PrEP. We interviewed a total of 21 MSM, 12 of whom had seen a provider within 30 days of self-testing. Three themes emerged in interviews: (1) Navigator knowledge: including health system knowledge and sexual health literacy while addressing PrEP misconceptions; (2) competence with MSM: understanding sexual minority identities and experiences, including through shared lived experiences; and (3) Communication skills: participants desired nonjudgmental, culturally sensitive navigators who were easily accessible. Together, these findings suggest that peer navigators with prior experience on PrEP and high sexual health literacy may be particularly effective in supporting linkage to care after self-testing. These insights can inform interventions to improve PrEP uptake after HIVST.
Women who have migrated from sub-Saharan Africa to France face a disproportionate risk of HIV acquisition yet remain underrepresented among pre-exposure prophylaxis (PrEP) users. Barriers to PrEP use have been identified including low awareness of PrEP due to limited outreach from providers and ineffective advertising campaigns. This study builds on our previous work demonstrating interest in PrEP among this population by examining how to best engage these women through PrEP education and advertising. We conducted 6 focus groups with 25 women who migrated from sub-Saharan Africa recruited from the Lariboisière Hospital Family Planning Center in Paris between October 2024 and October 2025. Using a semi-structured focus group guide, we explored participants’ knowledge and perception of PrEP and responses to advertisements. Transcripts were analyzed using thematic coding in Dedoose. Most participants (80%) had never heard of PrEP, but responses were positive when it was described. Participants identified health care providers as a trusted information source and social media as a promising channel for community outreach. Women preferred detailed, accessible medical content. Campaigns featuring Black women exclusively prompted concerns about stigmatization. Safety from HIV acquisition, especially in the context of relationship structures, was consistently cited as a motivator for PrEP use. Outreach strategies should leverage trusted provider relationships and peer networks. Content of educational initiatives should include accessible medical information and feature diverse representation without stigmatizing vulnerable groups. Framing of PrEP in advertisements should consider structural differences affecting a specific population, based on the circumstances surrounding their unique risks for HIV acquisition.
Preexposure prophylaxis (PrEP) and nonoccupational postexposure prophylaxis (nPEP) are effective HIV prevention strategies, but timely access remains challenging. In Thailand, community pharmacies may improve access, but implementation evidence is limited. This preimplementation study assessed the feasibility and implementation readiness of community pharmacy–based PrEP and nPEP services in Thailand and identified the requirements for scalable implementation. A RE-AIM–informed convergent mixed-methods study was conducted. A nationwide online survey of urban participants at increased risk of HIV acquisition from all geographic regions of Thailand ( n = 452) was integrated with in-depth interviews, focus group discussions, and stakeholder consultation meetings involving pharmacists, health care providers, policy stakeholders, health information system representatives, and civil society organizations. Quantitative data were analyzed using Stata, qualitative data using thematic analysis, and findings integrated through joint displays. PrEP and nPEP awareness were 76.4% and 71.9%, respectively; previous use was 57.7% and 29.9%, respectively. Preferred settings included private clinics (49.9%), public hospital-affiliated clinics (47.4%), public hospitals (36.7%), private hospitals (28.7%), and pharmacies (26.9%). If services were provided free of charge, 83.7% were willing to use pharmacies. Privacy and confidentiality concerns were the most common barriers (67.7%). These findings indicate conditional acceptability rather than demonstrated uptake of community pharmacy–based PrEP and nPEP services. Although community pharmacies were less preferred than several existing health care settings, high willingness under favorable conditions and stakeholder support suggest a potential complementary role, warranting pilot implementation and real-world evaluation.
