title: Implementation challenges for long-acting antivirals as treatment.
abstract: OBJECTIVE
  Long-acting injectable antiretroviral therapy (ART) formulations hold great promise in helping to close the significant gap between efficacy and effectiveness in HIV treatment by eliminating the requirement for lifelong daily pills. However, significant systems-level and individual challenges to implementation of long-acting ART in HIV treatment are anticipated.
  
  
  RESULTS
  Studies of long-acting ART formulations are burgeoning, but the drugs are still in early phases of investigation and key knowledge gaps in pharmacokinetics and pharmacodynamics, as well as their effectiveness in settings with the largest burden of HIV disease and in key populations, remain. Extrapolating from the literature on implementation barriers to using long-acting contraception on a global scale, we explore the implementation barriers to rolling-out long-acting ART, including country approval and endorsements; prioritization of patient populations for preferred use, clinic infrastructure requirements, steady supply chains, decentralization of care, provider and patient training programs, and laboratory monitoring; and the need to examine patient preferences and conduct rigorous implementation science research to effectively scale-up this intervention.
  
  
  CONCLUSIONS
  Long-acting ART for HIV treatment harbors exciting potential to shift treatment paradigms. Current knowledge gaps in the use of these agents remain, leading to multiple anticipated systems-level and individual-level barriers to implementation. Addressing these gaps and barriers will help fulfill the promise of these agents against the pandemic.
authors.affiliation: Department of Medicine, HIV/AIDS Division, University of California, San Francisco, San Francisco, California, USA.
authors.forename: Diane
authors.initials: D
authors.lastname: Havlir
authors.forename: Monica
authors.initials: M
authors.lastname: Gandhi
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage*; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D003692:Delayed-Action Preparations; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans
chemical_list: D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents; D003692:Delayed-Action Preparations