Long-acting HIV therapies promise greater convenience, but fewer doses alone may not solve adherence or access challenges. Lloyd Bibby and Pooja Goyal, MS(Pharm), discuss patient choice, weekly oral and injectable therapies, health system capacity, equitable access, and the real-world measures that will define success.
HIV treatment has undergone a remarkable transformation, moving from complex regimens focused primarily on survival to highly effective therapies capable of achieving durable viral suppression. Now, the next phase of innovation is increasingly focused on a different challenge: making lifelong treatment and prevention easier to sustain.
At the International AIDS Conference 2026 in Rio de Janeiro, much of the conversation centered on long-acting options, including injectable therapies and emerging once-weekly oral regimens. Although reducing dosing frequency could help address treatment fatigue and adherence challenges, convenience alone does not guarantee success. Clinic capacity, cost, access, stigma, patient preferences, and health care infrastructure can all influence whether an effective therapy works in the real world.
In this Q&A with Infection Control Today® (ICT®), Lloyd Bibby, a consultant with
ICT: For years, adherence has been one of the biggest challenges in HIV care. Do you think reducing dosing frequency alone is enough to improve long-term adherence, or are there other barriers that long-acting therapies still won't solve?
Pooja Goyal, MS(Pharm), and Lloyd Bibby: Reducing dosing frequency is an important step, but it's unlikely to be sufficient on its own. Long-acting therapies can remove the burden of remembering a daily medication, reduce treatment fatigue, and lessen the stigma some people experience from taking a daily pill.
However, adherence is influenced by many factors beyond dosing frequency. Patients have different preferences, lifestyles, and health care needs. For some, injectable therapies may create new barriers, such as regular clinic visits or needle anxiety, while others may prefer the autonomy of a once-weekly oral regimen. Ultimately, improving adherence will require expanding treatment options so therapy can better align with individual patient circumstances rather than assuming 1 approach fits everyone.
ICT: Long-acting injectables require regular clinic visits, while once-weekly oral therapies shift much of that responsibility back to the patient. From a health care systems perspective, which approach do you think is more sustainable, particularly for resource-limited clinics?
PG and LB: Long-acting oral therapies may integrate more easily into existing health care systems, particularly where resources are limited. Weekly oral regimens preserve familiar pharmacy distribution models, avoid the need for clinic-administered injections, and eliminate additional demands on clinic capacity and staffing. On the other side of this, injectable therapies require trained personnel, scheduling infrastructure, and regular patient visits, which may be challenging for resource-constrained health systems. That said, sustainability will ultimately depend on the specific health care setting, and both approaches are likely to have an important role depending on patient and system needs.
ICT: Infection prevention professionals often think in terms of reducing transmission and improving patient outcomes. How could wider adoption of long-acting treatment and PrEP influence HIV prevention efforts at the population level?
PG and LB: Long-acting therapies and PrEP have the potential to strengthen prevention by addressing one of the biggest limitations of current approaches: adherence. Daily oral PrEP is highly effective when taken consistently, but maintaining daily adherence remains challenging for many individuals. Longer-acting options, including injectable and once-weekly oral approaches, could reduce reliance on consistent daily behavior, potentially increasing persistence with prevention strategies. However, the population-level impact will depend not only on efficacy, but also on real-world implementation, including health care capacity, patient acceptance, and access.
ICT: We've heard a great deal about "patient choice" at AIDS 2026. What factors are patients prioritizing when deciding between daily pills, weekly oral regimens, and injectable therapies, and are those priorities different from what clinicians or manufacturers expect?
PG and LB: Patient choice is becoming the defining feature of the next era of HIV care because different patients value different aspects of treatment. Some prioritize freedom from daily medication, while others prefer avoiding injections or regular clinic appointments. Other important considerations include discretion, stigma, treatment flexibility while traveling or changing providers, injection-site tolerability, and needle acceptance. Rather than 1 technology emerging as the clear winner, the future is likely to be defined by offering a range of options that allow treatment to be tailored to individual lifestyles and preferences.
ICT: Many of the newest HIV therapies are technologically impressive, but innovation doesn't always translate into equitable access. What barriers do you see preventing these treatments from reaching underserved populations, both globally and within the US?
PG and LB: We see several practical barriers that could limit adoption even when therapies demonstrate strong clinical performance. These include health care infrastructure requirements for injectable therapies, clinic capacity, trained personnel, pricing and reimbursement considerations, and health care system implementation. These challenges can be particularly pronounced in underserved populations, where there may already be gaps in access to specialist care, insurance coverage, and consistent health care infrastructure. Globally, resource constraints and differences in health system capacity can further widen these disparities.
Clinical efficacy alone is therefore unlikely to determine success, with equitable access depending heavily on how well new therapies can be integrated into existing care pathways and reimbursement models.
ICT: Clinical trials demonstrate safety and efficacy under controlled conditions. What real-world metrics should health care systems and clinicians be watching over the next several years to determine whether long-acting HIV therapies truly deliver on their promise?
PG and LB: Health care systems and clinicians should look beyond clinical efficacy to understand how long-acting therapies perform in real-world settings. Key measures will include treatment persistence and adherence; rates of virologic suppression and breakthrough; missed or delayed doses; discontinuation and switching patterns; and patient satisfaction and preferences. It will also be important to assess how effectively therapies are implemented in routine care, including clinic capacity and whether additional infrastructure or resources are required.
Finally, access and uptake across different patient populations will be important in determining whether the benefits of long-acting therapies are being realized equitably.
ICT: If we were having this conversation at the International AIDS Conference 5 years from now, what do you think would define success in HIV treatment and prevention? Would it be fewer injections, longer dosing intervals, broader access, improved adherence, or something entirely different?
PG and LB: Success will not be defined by a single technology or the longest possible dosing interval. Instead, the greatest achievement would be providing patients and health care systems with a broader range of effective options that can be matched to individual needs, lifestyles, and care pathways. The next chapter of HIV innovation is expected to focus less on whether one modality "wins" and more on expanding personalized choice while making lifelong treatment and prevention more convenient, acceptable, and sustainable.
ICT: Many experts have described HIV care as moving from "survival to simplicity." Do you think the next major breakthrough in HIV will come from better drugs, better delivery systems, or better health care models—and why?
PG and LB: The next breakthrough is likely to come from the combination of effective therapies with delivery models that better fit patients' lives. HIV treatment has already evolved from focusing on survival to achieving durable viral suppression. The next phase of innovation is centered on optimizing the patient experience through greater convenience, flexibility, and personalization. Rather than one new drug or delivery platform dominating, success will likely come from offering multiple approaches, including injectable and oral long-acting therapies, that allow care to be tailored to individual preferences and health care settings.
