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"You get the injection and it's done": qualitative findings from the first real-world implementation of long-acting cabotegravir for HIV prevention among adolescent girls and young women in Zambia
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BACKGROUND: Adolescent girls and young women (AGYW) in Zambia remain at heightened risk for HIV despite the availability of oral pre-exposure prophylaxis (PrEP). New PrEP formulations such as injectable cabotegravir (CAB-LA) offer a discrete, long-acting alternative for HIV prevention. We explored the first real-world implementation of CAB-LA among AGYW within a community-based model (Determined, Resilient, Empowered AIDS-Free, Mentored, and Safe [DREAMS] program) in Zambia.
METHODS: We conducted qualitative interviews longitudinally (December 2024 and March 2025) with 17 AGYW ages 16-24 recruited from two DREAMS centers. We purposively sampled participants who had initiated CAB-LA within 4 weeks of our first interview. Interview guides, informed by the Andersen Healthcare Utilization Model and the Practical Robust Implementation and Sustainability Model, focused on how participants learned about CAB-LA, their decision to use it, and their early user experience. Data were transcribed, translated, and brought into Atlas.ti for thematic analysis using deductive and inductive coding.
RESULTS: At the second interview, all participants (100%) had completed their second dose on schedule, consistent with 97% adherence among the 180 AGYW initiated on CAB-LA at the two DREAMS centers. Key themes facilitating CAB-LA uptake and continuation included: (1) Partners can''t be trusted ' most participants described concerns with partner''s infidelity or limited power in sexual decision-making as motivation for PrEP use; (2) Trusted providers counter community misinformation ' participants'' trust of DREAMS staff and nurses helped overcome myths and misinformation about CAB-LA in the community; (3) Discretion, selective disclosure, and PrEP stigma ' PrEP is stigmatized as for ''prostitutes,'' participants appreciated they could be discrete in use with partners and community; (4) programmatic and social support enables uptake and continuation ' friends and fellow beneficiaries of DREAMS with community outreach support uptake and continuation; (5) Freedom ' Participants associated CAB-LA with ''freedom" as they could forget about it. Most reported limited side effects.
CONCLUSIONS: This study explored the first implementation of CAB-LA in a real-world setting for AGYW within DREAMS in Zambia. We found that introducing CAB-LA into a trusted HIV prevention program facilitated uptake and adherence to CAB-LA among AGYW, who appreciate that it is long-acting, discreet, and carries few side effects.
METHODS: We conducted qualitative interviews longitudinally (December 2024 and March 2025) with 17 AGYW ages 16-24 recruited from two DREAMS centers. We purposively sampled participants who had initiated CAB-LA within 4 weeks of our first interview. Interview guides, informed by the Andersen Healthcare Utilization Model and the Practical Robust Implementation and Sustainability Model, focused on how participants learned about CAB-LA, their decision to use it, and their early user experience. Data were transcribed, translated, and brought into Atlas.ti for thematic analysis using deductive and inductive coding.
RESULTS: At the second interview, all participants (100%) had completed their second dose on schedule, consistent with 97% adherence among the 180 AGYW initiated on CAB-LA at the two DREAMS centers. Key themes facilitating CAB-LA uptake and continuation included: (1) Partners can''t be trusted ' most participants described concerns with partner''s infidelity or limited power in sexual decision-making as motivation for PrEP use; (2) Trusted providers counter community misinformation ' participants'' trust of DREAMS staff and nurses helped overcome myths and misinformation about CAB-LA in the community; (3) Discretion, selective disclosure, and PrEP stigma ' PrEP is stigmatized as for ''prostitutes,'' participants appreciated they could be discrete in use with partners and community; (4) programmatic and social support enables uptake and continuation ' friends and fellow beneficiaries of DREAMS with community outreach support uptake and continuation; (5) Freedom ' Participants associated CAB-LA with ''freedom" as they could forget about it. Most reported limited side effects.
CONCLUSIONS: This study explored the first implementation of CAB-LA in a real-world setting for AGYW within DREAMS in Zambia. We found that introducing CAB-LA into a trusted HIV prevention program facilitated uptake and adherence to CAB-LA among AGYW, who appreciate that it is long-acting, discreet, and carries few side effects.