Background
Long-acting cabotegravir/rilpivirine (LA-CAB/RPV) has the potential to reduce medication burden for people with HIV (PWH) and improve outcomes in PWH who struggle to achieve or maintain viral suppression, reflected in recent guideline changes regarding use in PWH with adherence challenges. Equity in early implementation of LA-CAB/RPV is a priority.
Methods
We used electronic medical record data from 8 clinics of the Center for AIDS Research Network of Integrated Clinical Systems (CNICS), a cohort of ~15,000 PWH active in care across the US, to describe the characteristics of PWH prescribed LA-CAB/RPV from January 2021 to September 2023. We reported results stratified by viral load (VL) at time of prescription (12 months prior to 30 days after prescription data): virally suppressed (VS; VL <50 copies/mL) and virally non-suppressed (VNS).
Results
718 PWH were prescribed LA-CAB/RPV. The first prescription was in April 2021. Six clinics prescribed LA-CAB/RPV in 2021, and by 2022, all 8 clinics were prescribing LA-CAB/RPV. New prescriptions per clinic-month increased from 4 (range of new prescriptions per clinic-month: 0-13) in 2021 to 5 (range: 0-32) in 2022. Two clinics in California contributed the majority of PWH (n=325 & 248); clinics in Alabama, Maryland, Massachusetts, North Carolina, Ohio, and Washington each contributed between 10-49 PWH to the analysis. Overall median (Q1-Q3) age was 44 (35-54) years; 13% were cis women, 2% were transwomen, 28% were non-Hispanic Black, 26% were Hispanic, 56% acquired HIV via male-to-male sexual contact, and 12% acquired HIV via injection drug use (IDU; Table). The majority (71%) were VS while 24% were VNS (8% with VL 50-200 copies/mL and 15% with VL>200 copies/mL), and 6% had missing initial VL. Socio-demographics between VS and VNS PWH were similar, except that PWH who acquired HIV via IDU made up 21% of those prescribed LA-CAB/RPV with VNS compared to 9% of those with VS.
Conclusions
While each academic HIV clinic has been prescribing LA-CAB/RPV to underserved populations, including people with VNS and people who inject drugs, the rollout across clinics is uneven. Future scale-up efforts need to address access issues at the state/health system level to ensure that the diverse PWH populations that each clinic serves can benefit from LA-CAB/RPV.