Background
Long-acting Cabotegravir and Rilpivirine (LA-CAB/RPV), approved in January 2021, is the first complete injectable regimen for virologically suppressed patients with HIV-1 without a history of resistance. The availability of LA-CAB/RPV offers a significant opportunity to expand the landscape of care for people with HIV. However, data on its implementation outside of early phase clinical trials remain limited, often excluding adolescents. The objective of our survey was to assess implementation strategies, barriers, and practices with LA-CAB/RPV among front-line HIV clinicians who are members of and/or credentialed by the American Academy of HIV Medicine (AAHIVM).
Methods
A 25-question survey was distributed electronically to 5223 members and/or credentialees of AAHIVM through the weekly newsletter as well as two standalone emails sent out biweekly from July 8 to August 1, 2024. Data was collected using Research Electronic Data Capture (RedCap) and statistical analysis was conducted with Stata 17.
Results
A total of 325 responses were received. Respondents included physicians (37 %), pharmacists (29%), nurse practitioners (24 %), and physician assistants (10%). Most (91%) had implemented LA-CAB/RPV and worked primarily in Academic Health Centers (33%) and Federally Qualified Health Centers (34%). The main barrier to implementation was insurance and third-party approval processes. Of the clinicians caring for adolescents (62%), half had prescribed LA-CAB/RPV in this population, with just 26% prescribing it to cis-gender females. For patients with resolved Hepatitis B (defined by anti-HBs, anti-HBc, HBsAg -), 77% of clinicians would prescribe LA-CAB/RPV; however, if the patient had isolated anti-HBc, only 54% would prescribe it. For cis-gender females of child-bearing age not on contraception, half of clinicians would not use LA-CAB/RPV. Regarding patients with elevated BMI, clinicians were comfortable (91%) using LA-CAB/RPV for patients with a BMI of > 30 kg/m2 but that decreased to 65% and 42% with BMI ≥40 kg/m2 and > 50 kg/m2, respectively.
Conclusions
While most clinicians surveyed have incorporated LA-CAB/RPV into their practices, key challenges remain, particularly among adolescents, cis-gender female patients, those with resolved Hepatitis B, and those with higher BMIs. Addressing barriers related to insurance and approval processes, along with continued education, is crucial to expanding access and optimizing the use of LA-CAB/RPV.