Long-acting Injectable Antiretroviral Therapy in South African Adolescents and Young Adults – Week 48 results from the AFINAty Study
- 1Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine and the Department of Medicine, University of Cape Town, Cape Town, South Africa
- 2HIV and other Infectious Diseases Unit, South African Medical Research Council, Cape Town, South Africa
Abstract
BACKGROUND: Long-acting injectable antiretroviral therapy (LAI-ART) with cabotegravir and rilpivirine offers a promising alternative to daily oral ART, particularly for young people living with HIV (YLHIV). However, there are limited data on the feasibility, acceptability and efficacy of LAI-ART delivery in lower- and middle-income countries. METHODS: We conducted a 48-week, community-based study of cabotegravir and rilpivirine LAI-ART among YLHIV aged 12-24 years in Cape Town, South Africa. Participants (virally suppressed, struggling with adherence or ART naïve) were required to be virally suppressed (<50 copies/ml) on first-line ART at the end of the screening phase before switching to cabotegravir and rilpivirine LAI-ART every 8 weeks for 48 weeks. Feasibility, retention, adherence to injection schedules, viral suppression and safety were assessed. Virological failure was defined as two consecutive viral loads ≥200 copies/ml. RESULTS: Between December 2022 and December 2023, 172 participants were screened and 134 (77·9%) switched to LAI-ART. The median age was 20 years and 62·7% were assigned female at birth. Nearly one quarter (23·1%) were under 18 years of age. Overall, 47% had prior NNRTI exposure. Retention at week 48 was 98·5% with 97·5% of all injections given on schedule. Viral suppression, as indicated by VL <50 copies/ml, at week 48 was achieved by 95·5% with no confirmed virological failures. All participants who completed week 48 opted to remain on LAI-ART. INTERPRETATION: LAI-ART was safe, highly acceptable and effective among YLHIV. These findings support the feasibility of implementing LAI-ART through community-based models in sub-Saharan Africa.
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BibTeX
@article{schreuder2026longacting,
title = {{Long-acting Injectable Antiretroviral Therapy in South African Adolescents and Young Adults – Week 48 results from the AFINAty Study}},
author = {Chantel Schreuder and Nyiko Mashele and Rufaro Mvududu and Millicent Atujuna and Linda-Gail Bekker and Catherine Orrell and Lauren Jennings},
journal = {Journal of acquired immune deficiency syndromes (1999)},
year = {2026},
month = sep,
doi = {10.1097/qai.0000000000003973},
url = {https://doi.org/10.1097/qai.0000000000003973},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Long-acting Injectable Antiretroviral Therapy in South African Adolescents and Young Adults – Week 48 results from the AFINAty Study
AU - Chantel Schreuder
AU - Nyiko Mashele
AU - Rufaro Mvududu
AU - Millicent Atujuna
AU - Linda-Gail Bekker
AU - Catherine Orrell
AU - Lauren Jennings
PY - 2026
DA - 2026/09/24
JO - Journal of acquired immune deficiency syndromes (1999)
DO - 10.1097/qai.0000000000003973
UR - https://doi.org/10.1097/qai.0000000000003973
AB - BACKGROUND: Long-acting injectable antiretroviral therapy (LAI-ART) with cabotegravir and rilpivirine offers a promising alternative to daily oral ART, particularly for young people living with HIV (YLHIV). However, there are limited data on the feasibility, acceptability and efficacy of LAI-ART delivery in lower- and middle-income countries. METHODS: We conducted a 48-week, community-based study of cabotegravir and rilpivirine LAI-ART among YLHIV aged 12-24 years in Cape Town, South Africa. Participants (virally suppressed, struggling with adherence or ART naïve) were required to be virally suppressed (<50 copies/ml) on first-line ART at the end of the screening phase before switching to cabotegravir and rilpivirine LAI-ART every 8 weeks for 48 weeks. Feasibility, retention, adherence to injection schedules, viral suppression and safety were assessed. Virological failure was defined as two consecutive viral loads ≥200 copies/ml. RESULTS: Between December 2022 and December 2023, 172 participants were screened and 134 (77·9%) switched to LAI-ART. The median age was 20 years and 62·7% were assigned female at birth. Nearly one quarter (23·1%) were under 18 years of age. Overall, 47% had prior NNRTI exposure. Retention at week 48 was 98·5% with 97·5% of all injections given on schedule. Viral suppression, as indicated by VL <50 copies/ml, at week 48 was achieved by 95·5% with no confirmed virological failures. All participants who completed week 48 opted to remain on LAI-ART. INTERPRETATION: LAI-ART was safe, highly acceptable and effective among YLHIV. These findings support the feasibility of implementing LAI-ART through community-based models in sub-Saharan Africa.
SN - 1525-4135
SN - 1944-7884
ER -