Background:
Long-acting cabotegravir (CAB-LA) is the first FDA-approved injectable agent for HIV PrEP. However, limited data exist on its use in a real-world setting. We describe clinical characteristics and outcomes of CAB-LA for PrEP at a federally qualified health center and the largest PrEP clinic in the Midwest US.
Methods:
We conducted a single-center retrospective cohort study of all patients without HIV who received at least one dose of CAB-LA at Howard Brown Health between July 1, 2022 and December 31, 2023. Demographics and clinical characteristics were collected; associations between delays in initiation as well as therapy interruption and discontinuation were assessed by logistic regression.
Results:
A total of 270 patients met the inclusion criteria with median age 33, 80.4% cisgender men, 54.1% White, 23.7% Hispanic, 60.4% with private insurance, and 29.6% residing in a high HIV vulnerability community area. The majority (90.4%) had been on oral PrEP in the past, 72.2% transitioned directly from oral PrEP, 2.2% had a CAB oral lead-in, and 31.1% had a BMI >30kg/m². Patients experienced a median delay of 24 days (IQR 11-51) between a provider initiating a CAB-LA prescription and their first injection, 41.9% of patients experienced delays >30 days. The median number of CAB-LA doses received was 4 (range, 1-12); 8.1% experienced at least one delayed or missed injection and 10% of patients discontinued CAB-LA of which 25.9% were placed on an oral PrEP regimen after discontinuation. While on CAB-LA, 67% had HIV screening by viral load assay at every injection visit; 49.6% had STI screening at the recommended 4-6 month intervals with 26.3% testing positive for an STI during the study period. Insurance status was the only variable associated with delays in initiation. Compared to patients with private insurance, those without insurance were significantly more likely to experience delays while those with public insurance were significantly less likely to experience delays >30 days in initiating CAB-LA (OR 1.97 vs 0.60, p=0.03).
Conclusions:
CAB-LA for PrEP was successfully implemented at a large urban community health center. Most patients experienced delays in initiation which were associated with insurance type; interruptions and discontinuation of injections were less common without any significant associations. More work is needed to support patients and health systems with challenges specific to long-acting agents, particularly regarding insurers and payors.