How place, trust, and care location influence rural and non-metropolitan patients' preferences for decentralized...

Long-acting injectable antiretroviral therapy (LAI-ART) offers an alternative to daily oral ART and may reduce pill fatigue, stigma, and daily treatment burden. However, its implementation in rural and non-metropolitan settings is challenged by travel burden, limited local healthcare infrastructure, and privacy concerns. This study evaluated interest in, and preferences for cabotegravir/rilpivirine (CAB + RPV LA) among people with HIV (PWH) living outside a metropolitan area and identified factors influencing uptake.

From March 2024 through December 2024 we conducted a cross-sectional mixed-methods study, using an explanatory sequential mixed-methods design. We surveyed 102 PWH receiving care at a Midwestern HIV specialty clinic, followed by qualitative interviews with approximately 10% of respondents. Surveys assessed sociodemographic characteristics, knowledge of CAB + RPV LA, perceived appropriateness, facilitators, barriers, and location preferences. Quantitative analyses used chi-square, Wilcoxon, and Kruskal-Wallis tests. Interviews were thematically analyzed through iterative deductive and inductive coding.

Participants had a median age of 51; 83.3% were male, 72.5% non-Hispanic White, and 44% self-identified as rural. Awareness of CAB + RPV LA was high (72.5%), and 63.7% expressed interest in switching. Interest was associated with younger age, shorter duration since HIV diagnosis, higher perceived appropriateness, and benefits such as reduced pill burden. Barriers included injection fear, concerns about prolonged side effects, and increased clinic visits. Most participants (63.7%) preferred local injection sites, influenced strongly by travel time, convenience, and feeling safe in their community. Qualitative interviews emphasized pill fatigue, trust in providers, and privacy considerations as major drivers of acceptability.

High interest in CAB + RPV LA among non-metropolitan PWH underscores the need for flexible, decentralized delivery models that reduce logistical barriers while maintaining trusted provider relationships.