Abstract
Abstract Background Data is limited on implementation of long-acting injectable (LAI) HIV treatment (ART) and pre-exposure prophylaxis (PrEP). We characterized “early adopters” of LAI ART and PrEP in terms of social determinants of health, using a health equity lens. Methods A retrospective cohort included patients prescribed ART or PrEP through a large urban health system (January 2021-September 2023) in the Northeastern US. We used EHR data for PrEP and ART to examine group differences between those on LAI or oral medications for each, using ANOVA, chi-square tests or Fisher’s exact tests. Bivariate logistic regression modeled associations between LAI ART or LAI PrEP and social determinants of health. Results In the PrEP group, 238 patients were prescribed LAI (n=63) or oral (n=193) PrEP. Most PrEP patients were men (80.7%), non-Hispanic (79.5%), white (60.7%) and had public insurance (83.1%). Compared to patients on oral PrEP, those on LAI less often experienced food insecurity, financial strain, depression, anxiety or substance use disorders. In bivariate models, LAI PrEP inversely correlated with female sex, current smoking, depression, anxiety, and substance use disorders. In the treatment group, 1194 patients were prescribed LAI (n=76) or oral (n=1118) ART, with median age 57.0; 63.6% were from minoritized groups. Only age was significantly associated with LAI ART (OR=0.97,95% CI=0.961-0.993, p=0.005). Conclusion In this large retrospective cohort of patients on LAI PrEP and ART, patients receiving LAI less often experienced social barriers. Public health interventions are needed to overcome health inequities tied to access of LAI for HIV prevention and treatment.
Published Version
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