Background
Little is known about cabotegravir (CAB) HIV pre-exposure prophylaxis (PrEP) care disparities. We characterized injectable CAB PrEP discontinuations at a safety-net, primary care center.
Methods
We extracted data from electronic health records and a dashboard (Relevant®) at Whitman-Walker Health’s peer PrEP Specialist program (Washington, D.C.) from March 2022 to March 2024. The primary outcome was the number of discontinuations defined as injections stopped before 9 months of care (verified by medical chart review by 2 providers). The secondary outcome was 9-month adherence among CAB PrEP users defined as receipt of 6 consecutive, on-time injections (+/- 14 day window). A multivariate logistic regression analysis was conducted to determine independent risk factors for discontinuation.
Results
There were 130 CAB PrEP users with 677 injections (median 3; range 1-12). Users were 52% White, 32% Black, 18% Latino, median age was 34 years (range 21- 62), 2% women, 80% men who have sex with men (MSM), 23% had public insurance, and 95% had switched to CAB from oral PrEP. There were no HIV seroconversions and there was one false positive HIV Ag/Ab test during a follow up care visit. Of the 130 CAB PrEP users, 87 (67%) were adherent to the +/-14d window, 41 (32%) were adherent to the +/-7d window, 13 (10%) received all their injections but had at least one out of the +/- 14d window, and 30 (23%) discontinued CAB. Discontinuations were higher among White (30%, 20/67) CAB users compared to Black (12%, 5/41) and Latino (21%, 5/24) CAB users. Of those who discontinued CAB and remained at risk for HIV, 93% (27/29) were transitioned to oral 2-1-1 or daily PrEP, while 7% (2/29) were lost to follow up after 5 attempts to contact them. When adjusting for race, ethnicity, age, sex, MSM, and insurance, Black CAB users had 76% lower odds of discontinuation compared to White CAB users (aOR: 0.24, 95% CI: 0.69 – 0.83). Side effects (43%, 13/30) and insurance coverage gaps (23%, 7/30) were the most common causes of discontinuations.
Conclusions
We defined 9-month discontinuation among Black, Latino, and White CAB users receiving PrEP through a peer specialist-led program. Peer specialists fostered continued PrEP use among those who discontinued CAB and potentially reduced discontinuations in populations which have a higher risk for HIV. Insurance coverage gaps continue to undermine CAB implementation efforts.