Background
Little is known about experiences with long-acting injectable cabotegravir/rilpivirine (LA-CAB/RPV) in underserved people with HIV (PWH), particularly PWH initiating with viremia due to adherence challenges.
Methods
In a cross-sectional survey of PWH with ≥3 injections at Ward 86 (San Francisco), Grady Ponce de Leon (Atlanta), and the University of Chicago, we assessed treatment satisfaction (HIVTSQ), burden compared to oral ART, and interest in alternate delivery locations and modalities. We summarized responses overall and stratified by viral load (VL) < vs. ≥50 copies/mL at LA-CAB/RPV initiation, using chi-square tests to assess for differences by viremic status. Multivariable logistic regression investigated characteristics of PWH who experienced reduction in effort to remember to take LA-CAB/RPV vs. oral ART (reduction from somewhat/very/extremely difficult to not/a little bit difficult).
Results
From 9/2023–7/2024, we surveyed 206 PWH (30% initiating with viremia) with median age 46, 23% cis/trans women, 47% Black, 21% Latine, 36% with housing instability, and 22% with substance use. Median number of injections was 9 (IQR 5,14). Mean (SD) satisfaction using LA-CAB/RPV was 61.5/66 (5.3), and 74% reported mental well-being as better with LA-CAB/RPV. Worry about inadvertent HIV disclosure on oral ART existed for 66% compared to 13% with LA-CAB/RPV. While 35% found remembering both treatment modalities low effort, 62% experienced a substantial reduction in effort with LA-CAB/RPV. In adjusted analyses, unstable housing (AOR = 2.33, 95% CI 1.18, 4.60) and substance use (AOR = 2.42, 95% CI 1.13, 5.19) were associated with reduced effort. Among all PWH surveyed, only 4% found clinic visits more of a problem with LA-CAB/RPV. Preferences for injection location (not mutually exclusive) were their HIV clinic (91%), place where they sleep (32%), community pharmacy (19%), mobile clinic (15%), and community organization (12%). A majority (63%) were at least moderately interested in self-injection and 55% at least moderately interested in injection from someone in their personal life. About half (47%) would prefer another LA modality, e.g. oral, patch. Results were similar stratified by VL at initiation.
Conclusions
In a diverse sample of early LA-CAB/RPV adopters, satisfaction was high and treatment burden reduced compared to oral ART, particularly among PWH with unstable housing or substance use. The HIV clinic was the preferred location. However, ~50% would opt for a different LA modality.
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