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Patient attitudes toward self- or partner-, friend-, or family-administered long-acting injectable antiretroviral therapy
A mixed-methods study across 3 urban human immunodeficiency virus clinics
Collins, L. F., Koester, K. A., Mcnulty, M. C., Montgomery, E. T., Johnson, M. O., Neilands, T. B., Dilworth, S. E., Sauceda, J. A., Dance, K., Erguera, X., Tsuzuki, M. D., Gutierrez Jr, J., Christopoulos, K. A., & Colasanti, J. A. (2024). Patient attitudes toward self- or partner-, friend-, or family-administered long-acting injectable antiretroviral therapy: A mixed-methods study across 3 urban human immunodeficiency virus clinics. Open Forum Infectious Diseases, 11(6), Article ofae265. https://doi.org/10.1093/ofid/ofae265
Background Long-acting injectable (LAI) cabotegravir/rilpivirine (CAB/RPV) offers a novel drug delivery option for persons with human immunodeficiency virus (PWH) but requires administration every 4 or 8 weeks by a medical professional.Methods To facilitate LAI antiretroviral therapy (ART) scale-up, we evaluated patient interest in alternative administration approaches via a mixed-methods, serial cross-sectional study across 3 US HIV clinics. We surveyed PWH (December 2021 to May 2022) on appeal of self- or partner/friend/family-administered LAI-CAB/RPV; multivariable ordinal logistic regression explored associated characteristics. To contextualize survey results, we thematically analyzed semi-structured interview data collected from PWH (August 2020 to July 2021) on attitudes toward out-of-clinic LAI-ART administration.Results Among 370 surveyed PWH (median age, 46 years; 26% cisgender female, 59% Black, 56% sexual minority, 34% housing instability), self-administering LAI-CAB/RPV appealed to 67%. PWH who were White (adjusted odds ratio [aOR], 3.30 [95% confidence interval {CI}, 1.42-7.64]), stably housed (aOR, 2.16 [95% CI, 1.30-3.59]), or gay/bisexual (aOR, 1.81 [1.14-2.89]) were more likely to endorse self-administration. Fewer PWH (60%) reported partner/friend/family administration as appealing; adjusted models revealed similar sociodemographic preferences for this outcome. In 72 interviews, PWH noted that acceptability of out-of-clinic LAI-ART administration was qualified by convenience, prior injection experience, and potential fear of self-inflicted pain, dependence on others, and/or HIV disclosure.Conclusions In a multisite sample of PWH, self- and, to a lesser extent, partner/friend/family-administration of LAI-CAB/RPV appealed to most; however, was less appealing among populations more impacted by health disparities. Innovative LAI-ART delivery options could free up in-clinic resources to focus scale-up among marginalized populations.In this mixed-methods US multisite study, self- or partner/friend/family-administered long-acting injectable cabotegravir/rilpivirine appealed to 67% and 60% of 370 persons with HIV surveyed, respectively. Semi-structured interviews among 72 individuals expanded on the appeal or apprehension of these novel delivery options.
