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Agovi AMA, Thompson CT, Craten KJ, Fasanmi E, Pan M, Ojha RP, Thompson EL. Patient and clinic staff perspectives on the implementation of a long-acting injectable antiretroviral therapy program in an urban safety-net health system. Implement Sci Commun 2024; 5:93. [PMID: 39210473 PMCID: PMC11363636 DOI: 10.1186/s43058-024-00631-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Long-acting injectable cabotegravir plus rilpivirine (LAI CAB/RPV) has several potential benefits over daily oral formulations for HIV treatment, including the potential to facilitate long-term adherence and reduce pill fatigue. We aimed to assess facilitators of and barriers to LAI CAB/RPV implementation and delivery through the perspectives of physicians and clinical staff, and the experiences of LAI CAB/RPV use among people living with HIV (PLWH) at a Ryan-White supported safety-net clinic in North Texas. METHODS We conducted semi-structured interviews with recruited clinic staff (physicians, nurses, and support staff) involved with LAI CAB/RPV implementation and PLWH who switched to LAI CAB/RPV and consented to participate in individual interviews. Data were collected from July to October 2023. Our interview guide was informed by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM), and Proctor Implementation Outcomes frameworks. Qualitative data were analyzed using a rapid qualitative analysis approach to summarize key themes. RESULTS We recruited and interviewed 15 PLWH who transitioned to LAI CAB/RPV and 11 clinic staff serving these patients. PLWH conveyed that emotional and informational support from family or a trusted clinician influenced their decision to switch to LAI CAB/RPV. PLWH also reported that injectable treatment was more effective, convenient, and acceptable than oral antiretroviral therapy. Clinic staff and physicians reported that staff training, pharmacist-led medication switches, flexible appointments, refrigeration space and designated room for injection delivery facilitated implementation. Clinic staff cited medication costs, understaffing, insurance prior authorization requirements, and lack of medication access through state drug assistance programs as critical barriers. CONCLUSIONS Our study offers insights into real-world experiences with LAI usage from the patient perspective and identifies potential strategies to promote LAI CAB/RPV uptake. The barriers to and facilitators of LAI CAB/RPV program implementation reported by clinic staff in our study may be useful for informing strategies to optimize LAI CAB/RPV programs.
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Affiliation(s)
- Afiba Manza-A Agovi
- Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, 1500 South Main Street, Fort Worth, TX, 76104, USA.
| | - Caitlin T Thompson
- Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, 1500 South Main Street, Fort Worth, TX, 76104, USA
| | - Kevin J Craten
- Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, 1500 South Main Street, Fort Worth, TX, 76104, USA
| | - Esther Fasanmi
- Pharmacy Clinical Services Outpatient, JPS Health Network, Fort Worth, TX, USA
| | - Meng Pan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Rohit P Ojha
- Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, 1500 South Main Street, Fort Worth, TX, 76104, USA
| | - Erika L Thompson
- Department of Quantitative and Qualitative Health Sciences, The University of Texas School of Public Health San Antonio, San Antonio, TX, USA
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Moreno C, Izquierdo R, Alejos B, Hernando V, Pérez de la Cámara S, Peraire J, Macías J, Bernal E, Albendín-Iglesias H, Alcaraz B, Suárez-García I, Moreno S, Jarrín I. Acceptability of Long-Acting Injectable Antiretroviral Treatment for HIV Management: Perspectives of Patients and Physicians in Spain. AIDS Patient Care STDS 2024; 38:305-314. [PMID: 38916077 DOI: 10.1089/apc.2024.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
We assessed the prevalence and factors associated with HIV-infected patients' interest in trying long-acting injectable antiretroviral treatment (LAI-ART) along with its expected benefits and concerns, and evaluated physicians' opinions about LAI-ART. This study was set within the multi-center prospective CoRIS cohort, comprising HIV-positive adults, naïve to antiretroviral treatment (ART) at study entry, recruited from 2004 onward in 48 centers in Spain. In June 2022, we conducted a 2-day cross-sectional survey among patients across 34 CoRIS centers and sent an online questionnaire to all physicians prescribing ART in 39 CoRIS centers. Of the 271 patients included, 83.3% [95% confidence interval (CI)]: 78.0 - 87.0%) expressed interest in receiving LAI-ART. This interest was higher among men (adjusted odds ratio: 2.96; 95% CI: 1.4-6.12), those aged <50 years (2.41; 1.23 - 4.73), and individuals inconvenienced by oral ART (5.03; 1.47 - 17.15), daily intake (14.65; 3.44-62.46), carrying HIV pills constantly (7.19; 2.88 - 17.96), and taking multiple medications (3.94; 1.58 - 9.85). Among the 154 physicians surveyed, 45.5% believed LAI-ART would be the preferred option for patients. Although most physicians (92.9%) thought LAI-ART could improve patients' quality of life (QoL), concerns were raised by 37.7% and 44.2% of them regarding injection site pain and visit rescheduling, respectively. Interest in LAI-ART was higher among men, those aged <50 years, and individuals finding their oral ART inconvenient. Physicians believed LAI-ART could improve QoL and overcome treatment challenges, yet concerns were raised about its potential usage difficulties. Although most patients were interested in receiving LAI-ART, only less than half of the physicians considered it their preferred option, likely owing to concerns about missed visits and injection site pain.
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Affiliation(s)
- Cristina Moreno
- National Centre for Epidemiology, Carlos III Health Institute, Madrid, Spain
- CIBERINFEC, Carlos III Health Institute, Madrid, Spain
| | - Rebeca Izquierdo
- National Centre for Epidemiology, Carlos III Health Institute, Madrid, Spain
- CIBERINFEC, Carlos III Health Institute, Madrid, Spain
| | | | - Victoria Hernando
- National Centre for Epidemiology, Carlos III Health Institute, Madrid, Spain
- CIBERINFEC, Carlos III Health Institute, Madrid, Spain
| | | | - Joaquim Peraire
- CIBERINFEC, Carlos III Health Institute, Madrid, Spain
- Pere Virgili Institute for Health Research (IISPV), Joan XXIII University Hospital, Rovira and Virgili University, Tarragona, Spain
| | - Juan Macías
- CIBERINFEC, Carlos III Health Institute, Madrid, Spain
- Department of Medicine, Institute of Biomedicine of Seville (IBiS), University of Seville, Virgen of Valme University Hospital, Seville, Spain
| | - Enrique Bernal
- Department of Infectious Diseases, Reina Sofía General University Hospital, Murcia, Spain
| | - Helena Albendín-Iglesias
- HIV and STI Unit, Internal Medicine Department, Virgen of Arrixaca University Hospital, Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Begoña Alcaraz
- Infectious Diseases Unit, Internal Medicine Department, Santa Lucía General University Hospital, Cartagena, Spain
| | - Inés Suárez-García
- CIBERINFEC, Carlos III Health Institute, Madrid, Spain
- Infectious Diseases Group, Department of Internal Medicine, Infanta Sofía Hospital, Infanta Sofia University Hospital and Henares University Hospital Foundation for Biomedical Research and Innovation (FIIB HUIS HHEN), European University of Madrid, Madrid, Spain
| | - Santiago Moreno
- CIBERINFEC, Carlos III Health Institute, Madrid, Spain
- Department of Infectious Diseases, University Hospital Ramón y Cajal, Ramón y Cajal Health Research Institute (IRYCIS), University of Alcalá, Madrid, Spain
| | - Inma Jarrín
- National Centre for Epidemiology, Carlos III Health Institute, Madrid, Spain
- CIBERINFEC, Carlos III Health Institute, Madrid, Spain
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Pierone Jr G, Brunet L, Fusco JS, Henegar CE, Sarkar S, Van Wyk J, Vannappagari V, Wohlfeiler MB, Fusco GP. Switching to Dolutegravir/Lamivudine Two-Drug Regimen: Durability and Virologic Outcomes by Age, Sex, and Race in Routine US Clinical Care. HIV AIDS (Auckl) 2024; 16:133-140. [PMID: 38645753 PMCID: PMC11032131 DOI: 10.2147/hiv.s452130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/13/2024] [Indexed: 04/23/2024] Open
Abstract
Purpose Two-drug regimens (2DR) may address drug-drug interactions and toxicity concerns. Dolutegravir/lamivudine (DTG/3TC) 2DR was approved in the US for both treatment-naïve and treatment-experienced individuals with a viral load <50 copies/mL. This study describes real-world DTG/3TC 2DR treatment outcomes among treatment-experienced individuals, stratified by age, sex, and race. Methods From the OPERA® cohort, people with HIV with a viral load <50 copies/mL who switched from a commonly used three-drug regimen to DTG/3TC 2DR as per the label between April 8, 2019 and April 30, 2021 were included. Incidence rates (Poisson regression) for loss of virologic control (first viral load ≥50 copies/mL), confirmed virologic failure (2 viral loads ≥200 copies/mL or discontinuation after 1 viral load ≥200 copies/mL), and DTG/3TC 2DR discontinuation were estimated overall and stratified by age, sex, and race. Results The 787 individuals included were followed for a median of 13.6 months (IQR: 8.2, 22.3). Confirmed virologic failure occurred in ≤5 individuals. Loss of virologic control occurred at a rate of 14.0 per 100 person-years (95% CI: 11.7, 16.8). DTG/3TC 2DR discontinuation occurred at a rate of 17.5 per 100 person-years (95% CI: 15.0, 20.3); 4% discontinued for treatment-related reasons (viremia, adverse diagnosis, side effect, lab abnormality). For all outcomes, incidence rates were comparable across strata of age, sex, and race. Conclusion This descriptive study demonstrates that DTG/3TC 2DR is an effective and well-tolerated treatment option for people with HIV with a viral load <50 copies/mL at switch, regardless of their age, sex, or race.
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Affiliation(s)
- Gerald Pierone Jr
- Department of Adult Primary Care, Whole Family Health Center, Vero Beach, FL, USA
| | | | | | - Cassidy E Henegar
- Epidemiology and Real World Evidence, ViiV Healthcare, Research Triangle Park, NC, USA
| | - Supriya Sarkar
- Epidemiology and Real World Evidence, ViiV Healthcare, Research Triangle Park, NC, USA
| | | | - Vani Vannappagari
- Epidemiology and Real World Evidence, ViiV Healthcare, Research Triangle Park, NC, USA
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Rodriguez Gonzalez H, Volcan AI, Castonguay BJU, Carda-Auten J, Ruiz C, Peretti M, Suarez A, Kerrigan D, Wohl DA, Barrington C. "What Is the Benefit?": Perceptions and Preferences for Long-Acting Injectable Antiretroviral Therapy Among People Living With HIV. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:467-483. [PMID: 38096455 PMCID: PMC10785827 DOI: 10.1521/aeap.2023.35.6.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Long-acting injectable antiretroviral therapy (LA-ART) expands treatment options for people living with HIV (PLWH). This qualitative study characterizes LA-ART awareness, perceptions, and preferences among PLWH engaged in HIV care. From 2019 through 2021, we conducted semistructured in-depth interviews with 71 PLWH sampled from three clinics in three U.S. settings (North Carolina, Washington, DC, Massachusetts). Transcripts were analyzed using narrative and thematic techniques. Participant mean age was 46 years (range 24-72); most were cisgender men (55%) and virally suppressed (73%). Most participants had not heard of LA-ART and reacted with a mix of excitement and cautiousness. Potential LA-ART benefits included easier adherence, privacy, and effectiveness; concerns included effectiveness, side effects, costs, and increased clinic visits. Participants appreciated that LA-ART could support achieving and sustaining viral suppression. To inform their decision, participants wanted more information and convenient access and administration. Findings indicated that a shared decision-making approach and economic and logistical support for PLWH could facilitate LA-ART uptake.
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Affiliation(s)
- Humberto Rodriguez Gonzalez
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina
| | - Andrea Isabel Volcan
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, North Carolina
| | - Breana Jae Uhrig Castonguay
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, North Carolina
| | - Jessica Carda-Auten
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, North Carolina
| | - Carolina Ruiz
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina
| | - Matteo Peretti
- Fenway Institute at Fenway Health, Boston, Massachusetts
| | - Angela Suarez
- Program Integration and Evaluation, La Clinica Del Pueblo, Washington, D.C
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, D.C
| | - David Alain Wohl
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, North Carolina
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina
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