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Factors Associated With Preference for Long-Acting Injectable Versus Daily Oral Antiretroviral Therapy Among People With HIV: Findings From the SELIGO Study
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Although LAI-ART was approved by the US FDA in 2021, we found that a low (<3%) percentage of participating PWH were using LAI-ART in the context of ongoing care at the time of the survey (2022–2023), which is also consistent with the literature.18,20
The SELIGO Study used a 1-time, 20-minute survey of 801 PWH from the Center for AIDS Research Network of Integrated Clinical Systems cohort in 3 US cities (Boston, MA; Chapel Hill, NC; San Diego, CA)
Most participants were cisgender men (82.3%); 57.0% identified as racial and/or ethnic minorities; mean years of age, 52.2; mean years living with HIV, 18.1;
2.8% were using LAI-ART.
Compared with daily oral ART, 56.9% preferred LAI-ART administered monthly, and 68.0% preferred LAI-ART administered every 2 months.
We also found that persons with a detectable viral load had 4.55 times greater odds of having a strong LAI-ART preference when delivered monthly.
Factors associated with greater odds of LAI-ART preference included medication/contraception injection experience, pill burden, no medication other than ART, 4 or more clinic visits per year, detectable viral load, reporting a higher number of HIV treatment considerations, and identifying as Black. Factors associated with decreased odds of LAI-ART preference included older age, identifying as neither gay nor straight, living > 1 hour from the clinic, and considerable/extreme needle fear.
To date, LAI-ART uptake has been slow, with only 1.44% of all PWH18 or approximately 15,000 people19 in the United States on LAI-ART after 2 years since its availability in routine clinical settings.,20 Cost and navigating insurance coverage can impede uptake of LAI-ART, and these, combined with a lack of awareness of this treatment option among PWH and their providers, as well as bias influencing the offering of the medication, may also play a role.21,22 Given ongoing inequities in viral suppression rates across sociodemographic and behavioral subgroups of PWH, increasing attention is being paid to who is able to access and benefit from LAI-ART.23
In multinomial models for LAI-ART delivered monthly, factors positively associated with some interest in monthly LAI-ART included having medication/contraceptive injection experience (aOR 2.91; 95% CI: 1.02 to 8.31) and having 4 or more HIV care clinic visits per year (aOR 2.28; 95% CI: 1.27 to 4.11). Factors negatively associated with some interest in monthly LAI-ART included age, with each increasing year of age being associated with lower odds of some LAI-ART preference (aOR 0.96; CI: 95% 0.94 to 0.99). Each unit increase on the HIV treatment considerations scale (aOR 0.96; CI: 95% 0.92 to 0.99) was marginally associated with a lower odds of some interest in monthly LAI-ART.
In multinomial models considering LAI-ART delivered every 2 months, only age was associated with some preference for LAI-ART, with each increasing year of age associated with lower odds of some preference in LAI-ART (aOR 0.97; 95% CI: 0.94 to 0.99).
Needle fear was negatively associated with strong interest in monthly LAI-ART (aOR 0.27; 95% CI: 0.13 to 0.57).
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