Lowenthal ED, Chapman J, Baltrusaitis K, et al; IMPAACT 2017 Collaborators for the IMPAACT 2017 Team.  Acceptability and tolerability of long-acting injectable cabotegravir-rilpivirine in adolescents with HIV-1 (IMPAACT 2017/MOCHA): 48-week results of a multicentre, open-label, non-comparative phase 1/2 trial.  Lancet HIV.  2026 Jan 14:S2352-3018(25)00241-3.  doi:10.1016/S2352-3018(25)00241-3.

Trial collaborators describe patient-reported acceptability and tolerability data prospectively collected from adolescents receiving long-acting injectable cabotegravir plus rilpivirine for 48 weeks.  Outcomes included a Faces Scale pain assessment with each injection, preferred treatment method, and Quality of Life Inventory.  U.S. participants also completed a Medication Satisfaction Questionnaire, and a subset underwent in-depth interviews.  142 adolescents completed study questionnaires; 11 adolescents and parents/caregivers completed in-depth interviews.  At week 8, 138/142 (97%) preferred long-acting injectable ART to oral – by week 48, 100% (140/140) preferred injectable ART.  Reasons fell into two main categories: convenience (e.g., no need for daily dosing, uninterrupted lifestyle) and burden reduction (e.g., increased privacy, less trouble with adherence).  More pain was reported with IM rilpivirine than cabotegravir; although the mean level of reported pain for IM cabotegravir decreased over the study period, there were no significant changes in level of pain for IM rilpivirine.  In-depth interview data indicated consistently positive assessments of participant/caregiver experience with injectable ART.  However, adolescent participants did not always understand and internalize instructions (“they were generally so excited… they did not pay attention to the details of the pre-injection counseling”).  Parents also identified that, noting adolescents “were counseled but misunderstood or discounted some of what was said.”

Similar to adults, adolescents on long-acting intramuscular cabotegravir plus rilpivirine strongly preferred this to previous daily oral ART out to 48 weeks.  Almost three-quarters of participants (most of whom had perinatally acquired HIV) said they preferred this option because they would no longer have to worry about others seeing them take daily medications, decreasing fears of accidental disclosure.  Information gathered from in-depth interviews underscores the importance of thoughtfully developing teaching materials to effectively convey key information about injectable ART as this intervention is implemented and scaled up for adolescent populations.