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Low Uptake of Long-Acting Injectables in the First 2.5 Years Following Approval Among a Cohort of People Living With HIV
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Open Forum Infectious Diseases 16 May 2024
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We evaluated uptake of LAI among participants in the DC Cohort.
The median age was 59 (interquartile range: 49-66) and the most common mode of HIV transmission male to male sexual contact (554 [37.7%]). We found that 23 (1.6%) of these participants had begun LAI 31 December 2020.
Specifically, those who started LAI were significantly younger and more likely to receive care at a hospital site than those who did not start LAI (median age: 50 vs 59; % hospital site: 60.9% vs 25.7%) (Table 1)
We found that among PLWH in the DC Cohort eligible for LAI per initial labeling, there was very low uptake of LAI. Those who began LAI were significantly younger and more likely to receive HIV care from a hospital site compared with those who did not start LAI. This age discrepancy is concerning given that tenofovir/nucleoside reverse transcriptase inhibitor-sparing regimens, such as cabotegravir/rilpivirine, may benefit older PLWH with reduced renal function or osteoporosis/osteopenia [21]. Providers have previously described younger PLWH and people who do not take other pills as more appropriate candidates for LAI [22]. Older age has also been associated with increased ARV adherence, which also may explain why this population has not been targeted for LAI [23, 24]. Although not an absolute necessity, LAI may be especially beneficial to older PLWH; therefore, it is important that providers are made aware of these gaps to ensure older patients are not being overlooked for LAI initiation.
In summary, LAI ARV regimens provide an effective alternative to maintaining long-term VS for those who may find it difficult to adhere to oral ARVs [13, 36, 37]. We found that younger PLWH and participants receiving care at a hospital-based clinics were more likely to have initiated LAI. These differences may be due to discrepancies in which patients are being offered LAI, which clinics have the resources to support the regimen and/or administrative logistics. Successful implementation of LAI will depend substantially on coordinating stakeholder engagement and fostering partnerships, especially for implementation within communities that have faced systemic racism and prior negative healthcare experiences [29]. As we strive to meet benchmarks for the EHE initiative, it is imperative we take on the implementation challenges of LAI and seek to increase access for patients who would benefit from this innovative ARV regimen.
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