Early Implementation and Outcomes Among People with HIV who Accessed Long Acting Injectable-Cabotegravir/Rilpivirine at Two Ryan White Clinics in the U.S. South.

Abstract

Using long-acting injectable cabotegravir/rilpivirine (LAI-CAB/RPV) as maintenance therapy for persons with HIV (PWH) may improve treatment access and outcomes, though real-world data on uptake are limited. Two Ryan White clinics in Atlanta, Georgia Methods: Among PWH referred from 4/1/2021-9/15/2022 to switch to LAI-CAB/RPV, characteristics were ascertained at time of referral; and disposition (initiated; ineligible; uninterested; pending) was recorded as of 9/15/2022. Among patients initiated on CAB/RPV, we assessed the drug procurement process and clinical outcomes through 6/1/2023. Among 149 PWH referred, 74/149 (50%) initiated CAB/RPV as of 9/15/2022, of whom, characteristics were: median age 47 (Q1-Q3 36-55) years, 16% cisgender female, 72% Black race, median HIV duration 15 (Q1-Q3 9-19) years, and 64% had commercial health insurance. Of the 75 PWH not initiated, 35 were ineligible due to a clinical concern (n=16) or insurance issue (n=19); 15 patients changed their mind about switching; and 25 were pending eligibility review or therapy initiation. Median time from CAB/RPV prescription to initiation was 46 (Q1-Q3 29-78) days. Of 731 total injections administered (median 11 injections/patient), 95% were given within 7 days of the target treatment date. Nearly all patients were virally suppressed upon referral and remained suppressed through follow-up. At two clinics in the U.S. South, half of patients referred for LAI-CAB/RPV successfully accessed therapy nearly two years after U.S. drug approval. We identified barriers to uptake at the patient- and structural-levels, highlighting key areas to invest resource and personnel support to sustain and scale long-acting antiretroviral therapy programming.