Monthly intravenous infusion of broadly neutralizing monoclonal antibodies (bNAbs) may be an attractive alternative to daily oral antiretroviral treatment (ART) for children. Acceptability by caregivers remains unknown.
We evaluated monthly infusion of dual bNAbs (VRC01LS and 10-1074) as a treatment alternative to ART among children participating in the Tatelo Study in Botswana. Eligible children aged 2-5 years received 8-32 weeks of bNAbs overlapping with ART, and up to 24 weeks of bNAbs alone, at monthly intravenous infusion visits. Using closed-ended questionnaires, we evaluated the acceptability of each treatment strategy among caregivers prior to first bNAb administration visit (pre-intervention) and after completion of final bNAb administration visit (post-intervention).
Twenty-five children completed all study phases, and acceptability data were available from 24 caregivers at both time points (1 primary caregiver was unavailable at pre-intervention visit). Responses were provided by the child’s mother at both visits (60%), an extended family member at both visits (28%), or a combination of mother and extended family member (12%). Caregiver acceptance of bNAbs was extremely high both pre-and post-intervention, with 21/24 (87.5%) preferring bNAbs to ART pre-intervention, and 21/25 (84%) preferring bNAbs post-intervention (9/21 cared for a child who remained virally suppressed, 12/21 for a child with a viral rebound on bNAbs) (Fig 1). No caregivers preferred ART pre-intervention; however, 2/25 preferred it post-intervention (1 cared for a child who remained virally suppressed, 1 for a child with viral rebound on bNAbs). Pre-intervention, 3 (13%) caregivers had no preference between bNAbs or ART, and 2 (8%) had no preference post-intervention. Pre-intervention, the most common reasons for preferring bNAbs over ART were “if infusions were better at suppressing the virus than ART” (n=10) and “if infusions continued to be once monthly compared to daily ART” (n=9). Post-intervention, no dominant reason for preferring bNAbs over ART emerged from caregivers.
Monthly intravenous bNAb infusions were highly acceptable to caregivers of children with HIV in Botswana and preferred over standard ART by most. Our findings suggest that caregiver acceptability is an unlikely barrier to bNAb uptake and eventual programmatic use for children living with HIV.
Figure 1. Pre- and post-intervention preferences by caregivers for monthly bNAb infusions vs. daily ART (if medical benefit were equal)