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.