Long-Acting Injectable Antiretroviral Therapy Less Appealing to Marginalized Communities

Long-acting injectable (LAI) antiretroviral therapy (ART) was found to be an appealing method for most patients with HIV (PWH), whether administered by themselves or by family and friends. However, according to the study published in Open Forum Infectious Diseases,¹ PWH in marginalized communities were less likely to find LAI-ART to be an appealing choice for them.

LAI-ART is a novel tool that can be used to treat PWH in the United States, as only 66% of PWH in the US had achieved viral suppression as of 2021.² Intramuscular cabotegravir/rilpivirine (CAB/RPV) is an LAI that can be administered every 4 or 8 weeks at a clinic by a health care professional. However, it is possible that PWH may prefer alternatives for outside of the clinic. This study aimed to assess PWH’s attitude toward LAI-CAB/RPV that could be administered by themselves or by a family member. All PWH were from the United States.¹

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The 3 urban HIV clinics that were the focus of the study were located in San Francisco, Chicago, and Atlanta. All participants took a survey on their preferences when it came to LAI-CAB/RPV care delivery and were interviewed about their attitudes toward LAI-ART. The primary outcome of the survey was the appeal of LAI-CAB/RPV administered by oneself; the secondary outcome was how appealing it was for a family member or someone from their personal life to administer the injection. Participants answered on a scale of 1 to 5, ranging from not at all appealing to extremely appealing. Interviews were conducted once with patients who were 18 years or older and receiving primary care for HIV. The interviews included questions about attitudes toward LAI-ART, its benefits and disadvantages, and feelings on administration by either oneself or someone in their personal life.

The survey was completed by 370 PWH between December 2021 and May 2022. The median age of the population was 46 (range, 19-77) years, 26% of the population identified as cisgender female, and 59% were Black. Approximately 73% reported that they were well-engaged in care.

The odds of increasing appeal of self-administering LAI-CAB/RPV were greater in PWH who were non-Latinx White, had stable housing, identified as gay or bisexual, and had adequate health literacy in the unadjusted model. The covariate-adjusted model found that PWH who were aged 30 to 49 years (adjusted OR [aOR], 1.86; 95% CI, 1.19-2.91), non-Latinx White (aOR, 2.09; 95% CI, 1.19-3.67), and had stable housing (aOR, 2.17; 95% CI, 1.41-3.34) reported greater appeal of self-administering LAI-CAB/RPV. PWH who reported being gay, bisexual, or another identity had higher odds of appeal compared with heterosexual PWH (aOR, 1.81; 95% CI, 1.14-2.89).

A total of 60% of the PWH found the administration of LAI-CAB/RPV appealing if it was administered by someone in their personal life. Non-Latinx White participants (aOR, 1.92; 95% CI, 1.11-3.32) and PWH who had stable housing (aOR, 1.63; 95% CI, 1.05-2.54) found this option appealing compared with other racial/ethnic groups and homeless PWH, respectively.

The interviews found several key themes in assessing the appeal of LAI-CAB/RPV. Participants noted that adherence may be improved due to convenience of the medication and being in control of the medication. However, some believed self-administration could be awkward given the location that would be used for injection. Others were afraid of having to rely on someone in their personal life to administer the medication. Key requisites to using the injection at home included safe and reliable housing and privacy around their HIV status.

There were some limitations to this study. More than 95% of the participants in the study had not used LAI-CAB/RPV before taking the survey or participating in the interview. Time to explore the topic of administration outside of the clinic was limited. Participants may have been thinking of both subcutaneous and intramuscular injections when asked about LAI-CAB/RPV, which highlights the need to ask about both types of injection. Preferences by each subgroup were not explored.

The researchers concluded that the majority of those surveyed were interested in LAI-CAB/RPV administered by themselves or by a personal connection. Implementing LAI-CAB/RPV in the future relies on understanding who is interested as well as what the challenges to using the injection would be.

References

1. Collins LF, Koester KA, McNulty MC, et al. Patient attitudes toward self- or partner-, friend-, or family-administered long-acting injectable antiretroviral therapy: a mixed-methods study across 3 urban human immunodeficiency virus clinics. Open Forum Infect Dis. 2024;11(6):ofae265. doi:10.1093/ofid/ofae265
2. Fast facts: HIV in the US. CDC. 2022. Accessed June 11, 2024. https://www.cdc.gov/hiv/data-research/facts-stats/index.html