Table 2 Individual level barriers to LA ART implementation and proposed solutions

 Adherence to frequent injection appointment

“Attending 6-12 times/year instead of 2-3 and costs/inconvenience associated with this.” (Australian provider)

Flexible scheduling, less frequent dosing

“Longer opening hours, patient auto-injection, take it every 8 weeks.” (Swedish provider)

“Having a 2 monthly injection would be better for patients to work into their timeline/lifestyle/work schedule” (Australian provider)

“The patient needs to come more often compared to oral ART” (Swedish provider)

“Having to come for injection during regular opening hours (from 8h00 to 16h00 for example).” (Canadian provider)

Increased access through multiple locations

“Develop pharmacies with injectable ARV management capacity, similar to vaccinations.” (Argentinian provider)

“Health centers close to patients' homes for medication administration.” (Spanish provider)

“Having to comply with injection window” (Argentinian provider)

“The need to meet fixed administration deadlines” (Spanish provider)

Patient education, support and guidance

“Appropriate patient education on the treatment to ensure commitment to scheduled visits.” (French provider)

“Getting patients with unstable lifestyles to come to clinic” (U.S. provider)

“Recall [smart phone] application for injection date.” (French provider)

“Concerns over resistance in lost to follow up patients” (U.S. provider)

“Making sure clear communication with patient on what is required for medication.” (U.S. provider)

Information on bridging between LA and oral ART

“Know better how to go from the oral route to the I.M. and vice versa in periods of different duration to better adapt ART to the needs of patients” (Spanish provider)

“Flexibility to bridge with oral therapy when unable to come in for injection.” (U.S. provider)

 Tolerability of injections

“Injection site pain, mostly related to RPV LA.” (Canadian provider)

Train clinic staff on how to minimize reactions

“Reporting in detail local side effects of development studies and facilitating administration guidelines to prevent them (if known).” (Spanish provider)

“Possible local sequelae of the accumulation of IM injections for life.” (Argentinian provider)

Advise patients on how to manage injection site reactions

“Appropriate injection technique and patient education for pain management.” (U.S. provider)

“Drug-drug interactions, injection-related side effects” (Italian provider)

“Fear of long-term effects at the puncture sites” (German provider)

Patient-provider communication and patient support

“Since I have had experience with patients afraid of the injections and have helped them successfully deal with this, I can share this with other patients who may want to go on the injectables but are afraid of the shots.” (U.S. provider)

“Fear of injections” (Russian provider)

“Talking the patient through the whole process and what to expect”(Australian provider)

“Needle shy patients, buttock injections” (U.S. provider)

“Offer a support platform for patients.” (Spanish provider)

 Determining appropriate candidates

“Selecting appropriate patients” (Australian provider)

Patient-provider communication and decision-making

“To ensure patient is very well informed & has been given plenty of time to consider this change.” (Australian provider)

“High virus suppression rate for long-term candidates” (South Korean provider)

“Communication with the patient” (Russian provider)

“Adequate selection of patient profile” (Spanish provider)

“Patient choice” (Argentinian provider)

“Ensure proper choice of candidates” (Russian provider)

“Patient counselling & careful selection of appropriate patients.” (South African provider)

U.S. “ Determination of which patient populations to prioritize, both in resource-rich and constrained settings, based on patient characteristics, adherence level, inadequate virologic suppression rates, cost constraints, and accurate cost projections” (U.S. provider)

“Carefully discuss options and benefits and challenges to determine suitability” (U.S. provider)

“Respect patient preferences.” (Canadian provider)

“Clinicians will likely be hesitant because of their concerns regarding the potential to do harm, which may make them less likely to want to offer the drug to their patients. Need to take the practitioner comfort level out of the equation.” (Canadian provider)

Resources to support provider-patient communication and decision-making

“Patient-doctor guide” (French provider)

“Provider resources for coming off LA” (U.S. provider)

“Well screener observant and available patients before proposing the injections and propose a provisional schedule of injections established in advance” (French provider)