Key population perceptions and opinions about long-acting antiretrovirals for prevention and treatment: a scoping review

Abstract

Purpose of reviewKey populations are disproportionately affected by human immunodeficiency virus (HIV). Access, retention, and adherence are important barriers for the efficacy of preexposure prophylaxis (PrEP) and HIV treatment among these populations. Long-acting (LA) antiretrovirals hold the promise to solve some of these backdrops. The objective of the current review is to update the perceptions of key populations and PLWH about LA, based on their opinion, acceptability, and willingness to use it.Recent findingsAccording to the review preferences for LA vary with the population studied. Regarding people living with HIV (PLWH), male having sex with men are interested in having different options, adolescents are interested in LA (strong preference for implants), yet also perceive substantial obstacles to using biomedical prevention; transgender women aimed to nonvisible small implants, with long-lasting effects or LA injections that can be applied in other areas than buttocks, and women who experienced history of medical injections might increase preference for LA (except for history of people who inject drugs [IDU]). Female sex workers and IDU both showed interest in LA-PrEP. Regarding antiretroviral therapy, LA increased treatment satisfaction and acceptance, mainly among those receiving injections every 2 months. LA helped overcome pill fatigue, stigma, and adherence issues.SummaryKnowing preferences for biomedical interventions will contribute to better understanding and developing effective strategies for these populations.

Predictors of Human Immunodeficiency Virus Pre-Exposure Prophylaxis (PrEP) Uptake in a Sexual Health Clinic With Rapid PrEP Initiation

“…Future rapid PrEP programs in sexual health clinics should incorporate onsite PrEP initiation, ideally the same day of HIV and STI testing. Long-acting injectable PrEP is also a powerful new tool that has the potential to increase rapid PrEP initiations if properly implemented [ 31 , 32 ].…”

Considerations for long-acting antiretroviral therapy in older persons with HIV

“…It is therefore difficult to determine differences in response between younger and older (including elderly) individuals – a factor which could potentially limit the generalizability of LAI-ART's efficacy and rate of failure to older populations [60]. The median age of participants in noninferiority randomized control trials (ATLAS, FLAIR, LATTE-2) has ranged from 34–42 years (Table 3) [42,43,1–63]. Two trials (ATLAS-2 M, LATTE-2) did not report the number of enrolled participants aged 50 years or older; of other trials that did, only 228 patients enrolled were 50 years old or older, and of these, 99 were randomized to receive LAI-ART [42–45,61–63].…”

“…LAI-ART prices and healthcare costs can affect acceptance of therapies for older PWH, who may already face higher overall non-HIV related healthcare costs for other chronic comorbidities than younger counterparts. Cabotegravir-rilpivirine may be cost-prohibitive for some older underinsured or uninsured PWH [19]. In the United States, 9% of people aged 65 and older were living in poverty in 2020, and in 2016, 50% of Medicare beneficiaries had incomes below $26 200 with a quarter living on less than $15 250 [81,82].…”

“…Though CAB/RPV's novel mode of delivery holds promise in circumventing some of the issues with oral therapy, new challenges and unanswered questions remain, particularly around its use in aging populations. Some studies have explored considerations for LAI-ART acceptability, applicability, and implementation for certain subpopulations [16][17][18][19][20]. However, its benefits, risks, and applications for aging populations and their distinct needs remain understudied.…”

Long‐acting injectable cabotegravir forPrEP: A game‐changer inHIVprevention?

“…It may convince more individuals to start PrEP, increase users’ adherence, and promote PrEP persistence. Several surveys among individuals at high risk of HIV acquisition showed a strong interest in LA injectable agents, notably among those perceiving oral PrEP as too burdensome [25]. The reduction in stigma with the use of injections also appears to be a determinant in the choice to use an LA agent [26].…”