Background
On 9th February, 2024, Zambia launched the use of Cabotegravir Long-Acting (CAB-LA) for HIV prevention, as an additional layer to oral PrEP The aim was to expand HIV prevention options for high-risk individuals and address challenges with oral PrEP such as inconsistent use due to pill burden, privacy issues and stigma. However, within 6 months of implementation discontinuation on CAB LA have also been experienced. Understanding discontinuation patterns and reasons is critical for optimizing adherence and improving program outcomes. This study aimed to review discontinuation patterns among clients initiated on CAB-LA.
Methods
A cross sectional analysis was conducted on individuals initiated on CAB-LA between February and July 2024 in Kitwe and Chibombo districts. Discontinuation data, including the number and reasons for stopping CAB LA, were collected. Discontinuation reasons were categorized into nine groups: positive Hepatitis B surface antigen (HBsAg) status, missed HIV infection, severe pain, other side effects, pregnancy, relocation, parental influence, late beyond forgiveness window, and no longer at risk of HIV
Results
Out of 1,121 clients initiated on CAB LA, 164 (15%) discontinued CAB-LA (101 female and 63 male). The primary reasons for discontinuation included severe pain (55), positive HBsAg status (25), and other side effects (22). Additional reasons included missed HIV infections (4), pregnancy (6), relocation (24), parental influence (6), Late beyond forgiveness window (16), and no longer at risk of HIV (6, ). The remaining 957 clients have continued on CAB-LA giving a continuation rate of 85%.
Conclusions
The majority of CAB-LA discontinuations were due to manageable factors such as pain and relocation suggesting opportunities for specific interventions to improve retention. Positive HBsAg status also emerged as a significant reason for discontinuation, highlighting the need for comprehensive screening before CAB-LA initiation. Addressing these barriers can help increase retention and optimize the long-term success of CAB-LA for HIV prevention.