Background
Cabotegravir/Rilpivirine (CAB/RPV) demonstrated superiority to oral ART in persons living with HIV (PWH) with adherence challenges. We evaluate an innovative support services program, including home administration of injections, to support CAB/RPV adherence in PWH.
Methods
In 2016, Whitman-Walker Health initiated the Mobile Outreach Retention and Engagement Program (MORE) to support adult PWH with adherence challenges (viremia and/or no medical visits in 6 months). The MORE program offers mobile care navigators, transportation and Physician Assistant-led home medical/phlebotomy visits. In 2023, MORE integrated home administration of maintenance CAB/RPV injections. To evaluate this strategy, we are conducting an effectiveness-implementation hybrid type-2 study comparing the MORE group to a 2:1 matched comparison group of PWH receiving CAB/RPV without MORE support. The primary outcome is viral suppression at 4 months with a secondary outcome of 4-month injection adherence (+/-7 day window). Data was collected from EHR extraction and medical chart review.
Results
To date, 44 PWH have initiated CAB/RPV through MORE and 33/44 have >4 months since initiation. The median age is 44 years (range 24-74), and MORE PWH are 39% female, and 93% Black/AA. The comparison group (n=88) was matched for age, race and sex and has similar rates of public insurance (76% control vs. 82% MORE), but significantly fewer PWH with baseline viremia (≥200 c/mL) than MORE (6% vs. 27%), χ2 (1, n=17) = 12.1, p<0.001. Within MORE, 63% (28/44) of PWH accepted home injections, and those with public insurance were more likely to accept, χ2 (2, n=44) =7.2, p=0.028. Adherence at 4-months was similar between MORE (88%; 29/33) and the comparison group (83%; 55/66), χ2 (1, n=99) =0.39, p=0.533), but reasons for non-adherence differed. PWH in MORE had 2 ISR-related discontinuations and 2 missed injections (>14d late), due to insurance lapse with restart. The comparison group had 4 late injections, 3 missed injections with restart, and 4 missed injections with discontinuation. At 4 months, 100% (33/33) of PWH in MORE and 98% (65/66) of PWH in the comparison group had maintained or achieved viral suppression.
Conclusions
Among a population of PWH with adherence challenges, we demonstrate that an enhanced care navigation program offering home CAB/RPV administration can achieve acceptability, high adherence and 100% viral suppression, during early the early phases of this study. Implementation strategies including at-home ART injections can help achieve national goals to end the HIV epidemic.