INTRODUCTION Daily antiretroviral treatment (ART) can be challenging for some people living with HIV (PLHIV). Longacting injectable regimens (LAR) allow for non-daily dosing. We explored unmet needs associated with daily ART dosing and examined PLHIV's preference for LAR in the Netherlands, a country that has made enormous strides in improving HIV care; and 11 other European countries. METHODS Data were from the second wave of the Positive Perspectives survey of PLHIV on ART conducted in 2019 (Europe-wide, n=969 including Netherlands, n=51). Within four domains of ART-related challenges (emotional, psychosocial/stigma, physical, adherence), we used multivariable logistic regression to examine the relationship between the extent of unmet needs (tertiles) and LAR preference (p<0.05). RESULTS In pooled Europe-wide analysis, within each domain of unmet need, LAR preference increased with an increasing number of challenges. By the extent of ART-related emotional challenges, LAR preference odds were 1.76 (95% CI: 1.45-2.13) among those with a 'moderate' burden, and 4.05 (95% CI: 3.26-5.03) among those with a 'high' burden, compared to those with a 'low' burden. For anticipated stigma, LAR preference odds were 1.50 (95% CI: 1.11-2.04) for moderate and 2.33 (95% CI: 1.68-3.21) for high versus low. For adherence barriers, LAR preference odds were 1.53 (95% CI: 1.14-2.04) and 2.06 (95% CI: 1.45-2.91) among those with moderate and high levels of adherence barriers, respectively, compared to low. LAR preference odds were 1.71 (95% CI: 1.25-2.34) higher among PLHIV with 2+ non-HIV comorbidities versus HIV only, and 1.57 (95% CI: 1.12-2.34) higher among those on 2+ co-medications versus on ART exclusively. Of Dutch participants, 58.8% (30/51) indicated LAR preference, and 32.2% ranked LAR as the single most important ART improvement. Regarding daily oral ART dosing, 11.8% (6/51) of Dutch participants felt that it limited their daily life; 3.9% (2/51) were stressed by it, and 35.3% (18/51) said that it reminded them of HIV. Furthermore, 23.5% (12/51) hid/disguised their HIV medication to prevent unwanted disclosure of their HIV status. Also, 13.7% (7/51) reported adherence anxiety, 37.2% (19/51) missed ART 1+ times during the past month, and 13.7% (7/51) had difficulty swallowing pills. CONCLUSIONS PLHIV's preference for LAR can be for a variety of reasons other than clinical indications. LAR preference was associated with different domains of unmet needs, including emotional, psychosocial, physical, and adherencerelated challenges.
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