“The injection gives freedom” - An exploration of long-acting injectable HIV treatment acceptance among patients seeking care in two Nairobi tertiary hospitals

Background Long-acting injectable antiretroviral therapy offers an alternative to daily oral HIV treatment, potentially improving adherence and reducing stigma. While its adoption has been successful in some settings, evidence on its acceptability in sub-Saharan Africa, outside clinical trials, remains limited. Methods We conducted a mixed-methods study among people living with HIV (PLHIV) in two tertiary hospitals in Nairobi, Kenya—a public facility (Kenyatta National Hospital) and a private facility (Aga Khan University Hospital). A cross-sectional survey of 356 participants assessed awareness, willingness to switch, and predictors of acceptability. In addition, 30 participants took part in three focus group discussions (FGDs) exploring perceptions, concerns, and system-level considerations. Quantitative data were analyzed using descriptive and inferential statistics, while qualitative data were analyzed thematically. Results Overall, 72.2% of survey participants indicated a willingness to switch to LAI-ART. In the final adjusted multivariable models, prior awareness of LAI-ART was a powerful independent predictor, nearly tripling a patient’s willingness to switch (aOR = 2.851; 95% CI: 1.742–4.666; p  Conclusion These findings suggest that although LAI-ART is widely viewed as a promising treatment option, its uptake will depend on effective patient-centered communication, increased awareness, trust in the intervention, and reliable service delivery. However, successful implementation in Kenya will require more than patient willingness alone. Health system readiness must be a central consideration, with implementation strategies focused on securing dependable drug supply chains, decentralizing access through county-level clinics, and strengthening digital systems to support patient monitoring, retention, and continuity of care.