Despite high levels of perceived acceptability and appropriateness for implementing long-acting injectable cabotegravir/rilpivirine (CAB/RPV)-based antiretroviral (ART) regimens, a majority of HIV clinics were not prepared for widescale implementation. These study findings were published in Open Forum Infectious Diseases.
Researchers conducted a cross-sectional survey between December 2020 and January 2021 to assess readiness and barriers associated with the implementation of long-acting injectable CAB/RPV-based ART regimens at Ryan White-funded clinics in the United States. Data on participating clinics, HIV practice characteristics, and measures related to readiness and barriers to implementation were collected via 48-item self-administered questionnaires. Readiness for implementation was evaluated via the Acceptability of Intervention Measure (AIM), the Intervention Appropriateness Measure (IAM), and the Feasibility of Intervention Measure (FIM). Spearman rank correlations were used to examine associations between these measures and characteristics of the participating clinics. A 5-point Likert scale was used to rank potential barriers to implementation responses. A deductive thematic approach was used to analyze the results for open-ended questions.
Among a total of 44 clinics included in the analysis, 38% were federally qualified health centers, 36% were academic medical centers, 20% were AIDS service organizations/community-based organizations, 14% were outpatient clinics, and 9% were nonprofit clinics.
In regard to the implementation of long-acting injectable ART, 20% of respondents indicated their clinic as not ready at all, 32% as slightly ready, 20% as somewhat ready, 20% as fairly ready, and 7% as extremely ready.
The AIM measure was significantly associated with the percentage of patients insured by Medicare (⍴ =.312; P =.050). Of note, AIDS service organizations/community-based organizations consistently scored the highest across all readiness measures, including AIM, IAM, and FIM.
The top 5 barriers to implementation were concerns about drug resistance for patients who miss monthly injection appointments, adherence to monthly injection appointments, costs associated with long-acting injectable ART, transportation to monthly appointments, and tracking patients who do not attend appointments.
Overall, respondents indicated general acceptability and enthusiasm for the approval of long-acting injectable CAB/RPV-based ART.
This study is limited by its small sample size and the possibility that the surveys sent to participating clinics contained outdated information. In addition, long-acting injectable CAB/RPV was not FDA-approved at the time of this study.
According to the researchers, “The success of LAI [long-acting injectable] CAB/RPV implementation is highly dependent on the readiness of clinics to provide the novel therapy.”
Tarfa A, Sayles H, Bares SH, Havens JP, and Fadul N. Acceptability, feasibility, and appropriateness of implementation of long-acting injectable antiretrovirals: a national survey of Ryan White clinics in the United States. Open Forum Infect Dis. Published online July 7, 2023. doi.org/10.1093/ofid/ofad341
This article originally appeared on Infectious Disease Advisor