Background:
Long-acting injectable (LAI) antiretroviral therapy (ART) may help address barriers to treatment adherence among people with HIV. Due to cost and operational issues, low-income individuals, including clients of the federal Ryan White HIV/AIDS Program (RWHAP), may face greater challenges in accessing LAI ART. Of 1.09 million people with diagnosed HIV in the US, 301K (28%) access treatment through state AIDS Drug Assistance Programs (ADAPs) funded by the RWHAP. State ADAPs are required to cover at least one drug from each therapeutic class of HIV antiretrovirals (ARVs). They are not required to cover long-acting formulations of drugs from existing therapeutic classes, such long-acting cabotegravir/rilpivirine (Cabenuva). We sought to determine the extent of access to Cabenuva through state ADAPs, and to describe the population of ADAP clients without access to Cabenuva.
Methods:
Data on state ADAP medication formularies were collected by the National Association of State and Territorial AIDS Directors (NASTAD) in January 2023. Data on the characteristics of ADAP clients were obtained from the 2020 RWHAP ADAP Annual Client-Level Report. Data on the characteristics of all people with diagnosed HIV were obtained from the US Center for Disease Control and Prevention’s AtlasPlus Tool. We compared the characteristics of ADAP clients in states with and without ADAP coverage of Cabenuva, and of ADAP clients vs. non-clients in states without ADAP coverage of Cabenuva.
Results:
In contrast to the 2 oral ARVs most recently approved by the US Food and Drug Administration, which were listed on 92-98% of state ADAP medication formularies in January 2023, Cabenuva (approved in January 2021) was covered by 78% of state ADAPs. Nearly two thirds (64%) of the 56,020 ADAP clients in states without ADAP coverage of Cabenuva were living at or below the federal poverty level, compared to 43% of the 221,539 ADAP clients in states that did cover Cabenuva. In states that did not cover Cabenuva, ADAP clients were more likely than non-clients to be Black (36% vs. 34%) or Hispanic (30% vs. 26%).
Conclusions:
Gaps in coverage of Cabenuva affect large numbers of people who access ART through state ADAPs, and disproportionately affect low-income and racially minoritized people with HIV. States should consider expanding access to Cabenuva, including working to reduce supply and payment chain barriers, to promote equitable access to LAI ART. Future work should examine access to Cabenuva using patient-level data.