Experiences of people living with and without HIV with long-acting injectable HIV treatment and prevention in a safety-net hospital in Cleveland – a cross-sectional thematic analysis

While long-acting injectables (LAIs) offer alternatives to daily oral regimens by improving adherence and reducing stigma, patient perspectives – especially in low-income settings – remain underexplored. This qualitative study explores people living with (PWH) and without HIV (PWoH)’s experiences with LAI HIV medications for treatment (LAI-ART) and prevention (LAI-PrEP) in a safety-net hospital, which provides care regardless of insurance status or ability to pay. Participants were recruited using a convenience sampling approach; patients who presented for routine care or injection visits at the clinic who had been taking LAI-PrEP or LAI-ART for more than two months were offered participation. In depth one-on-one semi-structured interviews were conducted with 30 patients (ages 25–66) between May and November of 2024, including both LAI-ART and LAI-PrEP users. Thematic analysis (TA) guided by Braun and Clarke’s six-step framework was applied to analyze the data collected. Twenty two out of 30 participants were on LAI-ART. Median age was 42; 73.3% identified as Black or African American, 96.6% as non-Hispanic, and 53.3% as male. The TA revealed key benefits: greater convenience, fewer daily reminders of HIV status, and improved emotional well-being. Participants also identified challenges, including injection site pain, side effects, inflexible appointment schedules, and reduced autonomy in care decisions. Trust in healthcare providers and effective communication were critical to uptake and ongoing use. By amplifying voices of PWH and PWoH, this study reveals both the potentials and limitations of LAI HIV medications. Findings underscore the importance of patient-centered approaches and can inform implementation strategies and public health efforts aimed at improving adherence and health outcomes among vulnerable populations.