Engagement in Care, Awareness, and Interest in Long-Acting Injectable Anti-Retroviral Therapy

Abstract

Long Acting Injectable (LAI) therapy to treat HIV is an alternative to daily oral medications. The success of early roll-out of LAI to eligible patients requires a better understanding of patients' awareness and interest in this novel therapy. We administered an electronic survey to patients attending an urban HIV clinic in the US South. Eligible participants were 18 + years old with a most recent HIV-1 viral load < 200 copies/ml, without any evidence of genotypic resistance to LAI components or chronic hepatitis B. Survey recipients were asked about current treatment, engagement in care, and knowledge of LAI. Between January-April 2023, 480 patients were screened; 319 were eligible, and 155 (49%) completed the survey. The majority (119, 77%) were aware of, and 87 (56%) were interested in LAI. In regression analysis, only age was associated with interest in LAI (OR 0.95, 95% CI 0.92,0.99). Among proposed benefits of injectables, ease of travel without pills, lack of daily pill-taking, and fewer medication interactions were most appealing. Among proposed concerns with injectables, higher cost and insurance coverage of the new medicine were most worrisome. A large majority of people with HIV (PWH) are aware of the newest treatment available, and just over half of our sample expressed interest in LAI. Older age was associated with lower interest in LAI. LAI is appealing for its convenience, privacy, and avoidance of drug interactions, while the increased costs associated with LAI need to be addressed.

Keywords: Anti-retroviral therapy; HIV; Long-acting injectables; Treatment preferences.

Fig. 1

This figure depicts the relationship between level of education and participants’ awareness of LAI as a treatment option for HIV. Response options were the following: not aware of injectables, aware of injectables but unable to accurately name medication, and aware of injectables and able to accurately name medication

Fig. 2

The response rates are summarized for the questions asking participants to rate their likelihood of changing medication at their next visit. Notably, the first question asked participants about their likelihood of changing medicines generally, while the second question asked specifically about changing to LAI at the next visit

Fig. 3

Participants were asked to rate the appeal or concern associated with each of the listed factors related to LAI. Responses options were 0 = Not at all appealing/worrisome, 1 = Slightly appealing/worrisome, 2 = Moderately appealing/worrisome, 3 = Extremely appealing/worrisome. The average rating for each factor was calculated among individuals interested in LAI and those disinterested for comparison between groups