Long-Acting Injectable ART and PrEP Among Women in Six Cities Across the United States: A Qualitative Analysis of Who Would Benefit the Most

Philbin, Morgan M.; Bergen, Sadie; Parish, Carrigan; Kerrigan, Deanna; Kinnard, Elizabeth N.; Reed, Sarah E.; Cohen, Mardge H.; Sosanya, Oluwakemi; Sheth, Anandi N.; Adimora, Adaora A.; Cocohoba, Jennifer; Goparaju, Lakshmi; Golub, Elizabeth T.; Vaughn, Michael; Gutierrez, José I.; Fischl, Margaret A.; Alcaide, María L.; Metsch, Lisa R.

doi:10.1007/s10461-021-03483-7

Cited by 18 publications

(11 citation statements)

References 62 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…By adding the option of LAI-CAB/RPV for HIV-1 treatment within the current healthcare system structure, critical resources may be diverted away from PWH who need the most support for adherence and retention to PWH already doing well on therapy. Similarly, the current label use of LAI-CAB/RPV may not match those PWH with the greatest needs, and it is important to consider which patients may stand to benefit the most from this novel therapeutic option [ 10–12 , 22 ]. We used a centralized approach to implement our pilot program to ensure that accessing LAI-ART was in reach for eligible patients from a variety of backgrounds considering age, sex, race, and payor source; however, careful attention to equitable impact is needed beyond basic demographics upon LAI-ART scale-up and should include dedicated resources to support PWH who have traditionally been at highest risk of poor clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Early Experience Implementing Long-Acting Injectable Cabotegravir/Rilpivirine for Human Immunodeficiency Virus-1 Treatment at a Ryan White-Funded Clinic in the US South

Collins

Corbin-Johnson

Asrat

et al. 2022

Open Forum Infectious Diseases

View full text Add to dashboard Cite

Background Long-acting injectable (LAI) antiretroviral therapy (ART) has the potential to improve medication adherence, reduce HIV stigma, and promote equity in care outcomes among people with HIV (PWH). We describe our early experience implementing LAI-cabotegravir/rilpivirine (CAB/RPV) for maintenance HIV-1 treatment. Methods We launched a pilot LAI-ART program at a large Ryan White-funded clinic in the Southeast, accepting provider-initiated referrals from 4/14/2021—12/1/2021. Our interdisciplinary program team (Clinician-Pharmacy-Nursing) verified clinical eligibility and pursued medication access for eligible patients. We describe demographic and clinical variables of PWH referred and enrolled, and early outcomes among those accessing LAI-CAB/RPV. Results Among 58 referrals, characteristics were median age 39 (Q1-Q3 30.25-50) years, 74% male, 81% Black, and payor source distribution was 26% Private, 21% Medicare, 19% Medicaid, and 34% ADAP. Forty-five patients (78%) met clinical eligibility for LAI-CAB/RPV; ineligibility concerns included evidence of confirmed or possible RPV resistance (n = 8), HIV non-suppression (n = 3), possible RPV hypersensitivity (n = 1), and pregnancy (n = 1). Among 45 eligible PWH, 39 (87%) enrolled and 15 (38%) initiated LAI-CAB/RPV after a median of 47 (Q1-Q3 31-95) days since enrollment. Conclusions Implementing LAI-ART at a Southern U.S. Ryan White-funded clinic has been challenged by substantial human resource capital to attain drug, administer injections, support enrolled patients; delayed therapy initiation due to insurance denials; patient ineligibility primarily due to possible RPV resistance; and inability to provide drug regardless of payor source. These barriers may perpetuate disparities in ART access and outcomes among PWH and should be urgently addressed so that LAI-ART can be offered equitably.

show abstract

Section: Discussionmentioning

confidence: 99%

Early Experience Implementing Long-Acting Injectable Cabotegravir/Rilpivirine for Human Immunodeficiency Virus-1 Treatment at a Ryan White-Funded Clinic in the US South

Collins

Corbin-Johnson

Asrat

et al. 2022

Open Forum Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…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].…”

Section: Long-acting Injectable- Antiretroviral Therapy Biologic Chal...mentioning

confidence: 99%

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

O'Shea,

Cholli,

Heil

et al. 2023

Aids

View full text Add to dashboard Cite

People with HIV (PWH) can now enjoy longer, healthier lives due to safe and highly effective antiretroviral therapy (ART), and improved care and prevention strategies. New drug formulations such as long-acting injectables (LAI) may overcome some limitations and issues with oral antiretroviral therapy and strengthen medication adherence. However, challenges and questions remain regarding their use in aging populations. Here, we review unique considerations for LAI-ART for the treatment of HIV in older PWH, including benefits, risks, pharmacological considerations, implementation challenges, knowledge gaps, and identify factors that may facilitate uptake of LA-ART in this population.

show abstract

“…Potential pathways through which socioeconomic status, race and ethnicity, sexuality, and gender may affect ART and PrEP access and uptake in the United States include whether providers offer them [67 ▪ ]; healthcare and insurance access (e.g., Medicaid expansion) [68]; medical mistrust [69]; perceived risk [70]; clinical support and wrap-around services [71]; caregiving demands [71,72]; food insecurity [73]; drug use [74]; stigmatization [75,76]; and transportation and employment [24,25,77,78]. Patients’ social contexts are unlikely to change alongside the advent of new biomedical modalities; many barriers to access and uptake of oral formulations will still exist for long-acting modalities [72,77,78,79 ▪▪ ,80]. These systemic barriers may also be perpetuated by LAI ART eligibility criteria − namely viral suppression − as this differs by age [81], race and ethnicity [82 ▪ ], public insurance [83], and gender [84].…”

Section: Existing Perils Jeopardize the Promise Of Long-acting Modali...mentioning

confidence: 99%

Promise, perils and cautious optimism: the next frontier in long-acting modalities for the treatment and prevention of HIV

Philbin

Perez-Brumer

2022

Current Opinion in HIV and AIDS

Self Cite

View full text Add to dashboard Cite

Purpose of reviewThis paper provides a critical review of recent therapeutic advances in long-acting (LA) modalities for human immunodeficiency virus (HIV) treatment and prevention. Recent findingsLA injectable antiretroviral therapy (ART) has been approved in the United States, Canada and Europe; the United States also has approved LA injectable preexposure prophylaxis (PrEP) and the World Health Organization has recommended the vaginal PrEP ring. Current LA PrEP modalities in clinical trials include injections, films, rings, and implants; LA ART modalities in trials include subcutaneous injections and longterm oral pills. Although LA modalities hold incredible promise, global availability is inhibited by longstanding multilevel perils including declining multilateral funding, patent protections and lack of political will. Once available, access and uptake are limited by factors such as insurance coverage, clinic access, labor markets, stigma, and structural racism and sexism. These must be addressed to facilitate equitable access for all. SummaryThere have been tremendous recent advances in the efficacy of LA ART and PrEP modalities, providing renewed hope that 'ending the HIV epidemic' is within reach. However, pervasive socio-structural inequities limit the promise of LA modalities, highlighting the need for cautious optimism in light of the embedded inequities in the trajectory of research, development, and population-level implementation.

show abstract

Long-Acting Injectable ART and PrEP Among Women in Six Cities Across the United States: A Qualitative Analysis of Who Would Benefit the Most

Cited by 18 publications

References 62 publications

Early Experience Implementing Long-Acting Injectable Cabotegravir/Rilpivirine for Human Immunodeficiency Virus-1 Treatment at a Ryan White-Funded Clinic in the US South

Early Experience Implementing Long-Acting Injectable Cabotegravir/Rilpivirine for Human Immunodeficiency Virus-1 Treatment at a Ryan White-Funded Clinic in the US South

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

Promise, perils and cautious optimism: the next frontier in long-acting modalities for the treatment and prevention of HIV

Contact Info

Product

Resources

About