Background:
Long-acting injectable (LAI) ART has the potential to improve suboptimal medication adherence and health outcomes for people with HIV, yet studies of patient interest and acceptance are mixed and may differ by sex. We surveyed U.S. women to examine factors associated with preferences for LAI vs oral ART.
Methods:
From Sept. 2020- Nov. 2021, we administered a cross-sectional survey to 1,078 women with HIV across MACS/WIHS Combined Cohort Study sites in Atlanta, GA; Birmingham, AL/Jackson, MI; Bronx, NY; Brooklyn, NY; Chapel Hill, NC; Chicago, IL; Miami, FL; San Francisco, CA; and Washington, DC. The survey assessed demographic characteristics and ART modality preferences. Multinomial logistic regression assessed factors associated with preference for LAI vs oral ART vs undecided, controlling for age, education, race/ethnicity, income, adherence and site.
Results:
Median age was 54, the majority of women were Black (72%) and Hispanic (13%), and most (58%) had an annual income of ≥$12K. Over one-third (37%) of women finished more than high school while 88% reported ≥95% oral ART adherence. In the sample, 43% preferred LAI ART, 36% oral ART, and 21% were undecided. In adjusted models, women who reported ≥95% oral ART adherence (relative risk (RR): 0.39; CI: 0.24-0.63) and older age (RR: 0.98 per year; CI: 0.97-1.00) were less likely to prefer LAI ART vs oral ART. Compared with women in Miami, those in other sites (RR: 2.12-3.05) preferred LAI to oral ART. Comparing women who preferred LAI ART vs being undecided, women with ≥95% oral ART adherence were less likely to prefer LAI ART (RR: 0.58; CI:0.33-0.99) whereas Hispanic women were more likely (RR: 2.30; CI:1.01-4.87). When comparing oral ART vs undecided, women whose racial category was ‘other’ were more likely to prefer oral ART (RR: 3.32; CI: 1.17-9.46) whereas women whose income was ≥$12K were less likely to prefer oral ART (RR: 0.58; CI: 0.39-0.86). Women in sites other than Miami (RR: 0.26-0.32) were less likely to prefer oral ART vs undecided.
Conclusions:
In a geographically diverse cohort of US women, we found a preference for LAI vs oral ART, while about 20% remained undecided. Findings suggest potential differences in ART preference by adherence, age, site, income and race/ethnicity. To maximize the benefits of LAI ART and ensure equitable access to treatment for all women across the US and globally, it is critical to tailor education and support around LAI ART that is specific to each patient’s unique needs and experiences.
