Patient Attitudes Toward Self- or Partner-, Friend-, or Family-Administered Long-acting Injectable Antiretroviral Therapy: A Mixed-Methods Study Across 3 Urban Human Immunodeficiency Virus Clinics

Lauren F Collins; Kimberly A Koester; Moira C McNulty; Elizabeth T Montgomery; Mallory O Johnson; Torsten B Neilands; Samantha E Dilworth; John A Sauceda; Kaylin Dance; Xavier Erguera; Manami Diaz Tsuzuki; José I Gutierrez Jr; Katerina A Christopoulos; Jonathan A Colasanti

doi:10.1093/ofid/ofae265

Patient Attitudes Toward Self- or Partner-, Friend-, or Family-Administered Long-acting Injectable Antiretroviral Therapy: A Mixed-Methods Study Across 3 Urban Human Immunodeficiency Virus Clinics

Open Forum Infect Dis. 2024 May 13;11(6):ofae265. doi: 10.1093/ofid/ofae265. eCollection 2024 Jun.

Authors

Lauren F Collins^{1

2}, Kimberly A Koester³, Moira C McNulty^{4

5}, Elizabeth T Montgomery^{6

7}, Mallory O Johnson³, Torsten B Neilands³, Samantha E Dilworth³, John A Sauceda³, Kaylin Dance^{1

2}, Xavier Erguera^{8

9}, Manami Diaz Tsuzuki¹⁰, José I Gutierrez Jr¹¹, Katerina A Christopoulos^{8

9}, Jonathan A Colasanti^{1

2}

Affiliations

¹ Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
² Ponce de Leon Center, Grady Health System, Atlanta, Georgia, USA.
³ Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA.
⁴ Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, Illinois, USA.
⁵ Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA.
⁶ Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California, USA.
⁷ Women's Global Health Imperative, RTI International, Berkeley, California, USA.
⁸ Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
⁹ Department of Public Health, Zuckerberg San Francisco General Hospital, San Francisco, California, USA.
¹⁰ School of Medicine, University of California, San Francisco, San Francisco, California, USA.
¹¹ Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, California, USA.

Abstract

Background: Long-acting injectable (LAI) cabotegravir/rilpivirine (CAB/RPV) offers a novel drug delivery option for persons with human immunodeficiency virus (PWH) but requires administration every 4 or 8 weeks by a medical professional.

Methods: To facilitate LAI antiretroviral therapy (ART) scale-up, we evaluated patient interest in alternative administration approaches via a mixed-methods, serial cross-sectional study across 3 US HIV clinics. We surveyed PWH (December 2021 to May 2022) on appeal of self- or partner/friend/family-administered LAI-CAB/RPV; multivariable ordinal logistic regression explored associated characteristics. To contextualize survey results, we thematically analyzed semi-structured interview data collected from PWH (August 2020 to July 2021) on attitudes toward out-of-clinic LAI-ART administration.

Results: Among 370 surveyed PWH (median age, 46 years; 26% cisgender female, 59% Black, 56% sexual minority, 34% housing instability), self-administering LAI-CAB/RPV appealed to 67%. PWH who were White (adjusted odds ratio [aOR], 3.30 [95% confidence interval {CI}, 1.42-7.64]), stably housed (aOR, 2.16 [95% CI, 1.30-3.59]), or gay/bisexual (aOR, 1.81 [1.14-2.89]) were more likely to endorse self-administration. Fewer PWH (60%) reported partner/friend/family administration as appealing; adjusted models revealed similar sociodemographic preferences for this outcome. In 72 interviews, PWH noted that acceptability of out-of-clinic LAI-ART administration was qualified by convenience, prior injection experience, and potential fear of self-inflicted pain, dependence on others, and/or HIV disclosure.

Conclusions: In a multisite sample of PWH, self- and, to a lesser extent, partner/friend/family-administration of LAI-CAB/RPV appealed to most; however, was less appealing among populations more impacted by health disparities. Innovative LAI-ART delivery options could free up in-clinic resources to focus scale-up among marginalized populations.

Keywords: cabotegravir/rilpivirine; implementation science; long-acting injectable antiretroviral therapy; persons with HIV; self-administered injection.

Abstract

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