Implementation challenges for long-acting antivirals as treatment

Abstract

Purpose of review 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. Recent findings 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. Summary 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.

Who Wants to Switch? Gauging Patient Interest in Novel Antiretroviral Therapies

“…As patients become more aware of the availability of these treatment options, formation of preferences may change, especially as the attendant risks of the novel ART delivery options are better understood. In addition, Havlir et al describe clinic-level implementation challenges for long-acting antivirals, namely prioritization of patient populations for preferred use, clinic infrastructure requirements, and provider and patient training programs [ 9 ]. There are analogies with, and lessons may be learned from, oral contraceptive administration techniques, which require considerable patient education on delivery techniques and the critical role of clinic follow-up.…”

Modeling the health impact and cost threshold of long-acting ART for adolescents and young adults in Kenya

“…Policymakers need to weigh the projected cost and benefits of LA-ART in order to make programmatic decisions. LA-ART will likely cost more than oral ART due in part to logistical challenges such as maintaining the transportation and storage cold chain, additional provider training and laboratory monitoring, and ensuring a steady supply [23] . The threshold at which LA-ART would be considered cost-effective has not been evaluated in SSA.…”

Perceptions of Long-Acting Injectable Antiretroviral Treatment Regimens in a United States Urban Academic Medical Center

“…This suggests high likelihood of acceptability among some PLWH after medication approval, and indicates that providers should anticipate adoption of these medications into practice. 25 …”