Long-Acting Injectable ART in Practice: A Mixed Methods Implementation Study Assessing the Feasibility of Using LAI...

Area of Science:

• Infectious Diseases
• Public Health
• Pharmacology

Background:

• Long-acting injectable (LAI) antiretroviral therapy (ART) offers a novel approach for managing HIV.
• Equitable access to advanced HIV treatments is crucial, especially for individuals facing social determinants of health (SDoH).
• Challenges with adherence to traditional oral ART necessitate exploring alternative treatment modalities.

Purpose of the Study:

• To assess the feasibility and acceptability of administering Cabotegravir Rilpivirine Long Acting (CAB/RPV LA) in diverse settings.
• To evaluate CAB/RPV LA adherence among individuals with challenging SDoH compared to those in traditional clinics.
• To identify barriers and facilitators for LAI ART implementation in real-world scenarios.

Main Methods:

• Mixed-methods approach combining quantitative adherence data and qualitative interviews.
• Data collection from individuals eligible for and receiving CAB/RPV LA at both alternative street-based and traditional HIV clinics.
• Post-implementation interviews with participants and healthcare providers to gather experiences and perceptions.

Main Results:

• Adherence to CAB/RPV LA was significantly lower in the alternative clinic setting (1/5 participants) compared to the traditional clinic (17/18 participants).
• Participants and providers recognized LAI ART's potential to simplify adherence but noted lifestyle conflicts and medical system interaction challenges.
• Concerns were raised regarding the risk of resistance with sub-optimal adherence and the high resource requirements for LAI implementation.

Conclusions:

• LAI ART presents significant potential benefits for high-risk individuals living with HIV (PLWH).
• Successful implementation requires balancing these benefits against practical complexities and resource needs.
• Addressing SDoH and substance use remains critical for improving overall treatment outcomes for PLWH, even with advanced therapies like LAI ART.