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

Abstract

Background Long-acting injectable (LAI) cabotegravir/rilpivirine (CAB/RPV) offers a novel drug-delivery option for persons with HIV (PWH), but requires administration every 4-or-8-weeks by a medical professional, thus increasing demand for clinical services amid workforce shortages. Methods With the goal of facilitating LAI-antiretroviral therapy (ART) scale-up, we evaluated patient interest in alternative administration approaches via a mixed-methods, serial cross-sectional study across three U.S. urban HIV clinics. From 12/2021-05/2022, we surveyed PWH on appeal of self- or partner/friend/family-administered LAI-CAB/RPV; multivariable ordinal logistic regression explored characteristics associated with appeal. To contextualize survey results, we thematically analyzed semi-structured interview data collected from PWH between 08/2020-07/2021 on attitudes towards out-of-clinic LAI-ART administration. Results Among 370 surveyed PWH (median age 46 years, 26% cis-female, 59% Black, 56% sexual minority, 34% housing instability), self-administering LAI-CAB/RPV appealed to 67%. PWH who were White (aOR 3.30 [95%CI 1.42,7.64]), stably housed (aOR 2.16 [1.30,3.59]) or gay/bisexual (aOR 1.81, [1.14,2.89]) had higher odds of endorsing self-administration as appealing. Slightly fewer PWH (60%) reported partner/friend/family-administration as appealing; adjusted models revealed similar sociodemographic preferences for this outcome. In 72 interviews, PWH noted 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 the majority, however, appeal was greater for populations less impacted by health disparities. Innovative LAI-ART delivery options could potentially free up in-clinic resources to focus scale-up among marginalized populations.