Identifying Implementation Determinants and Strategies for Long-Acting Injectable Cabotegravir–Rilpivirine in People With HIV Who Are Virally Unsuppressed

作者：Matthew D. Hickey, Janet Grochowski, Francis Mayorga‐Munoz, Jon Oskarsson, Elizabeth Imbert, Matthew A. Spinelli, John D. Szumowski, Ayesha Appa, Kimberly A. Koester, Emily Dauria, Moira McNulty, Jonathan Colasanti, Diane V. Havlir, Monica Gandhi, Katerina Christopoulos · 发表于：JAIDS Journal of Acquired Immune Deficiency Syndromes · 年份：2024 · DOI：10.1097/qai.0000000000003421 · 被引用次数：28 · 研究领域：HIV/AIDS Research and Interventions、HIV/AIDS drug development and treatment、HIV, Drug Use, Sexual Risk

BACKGROUND: Early evidence suggests long-acting injectable cabotegravir and rilpivirine (LA-CAB/RPV) may be beneficial for people with HIV (PWH) who are unable to attain viral suppression (VS) on oral therapy. Limited guidance exists on implementation strategies for this population. SETTING: Ward 86, a clinic serving publicly insured PWH in San Francisco. METHODS: We describe multilevel determinants of and strategies for LA-CAB/RPV implementation for PWH without VS, using the Consolidated Framework for Implementation Research. To assess patient and provider-level determinants, we drew on pre-implementation qualitative data. To assess inner and outer context determinants, we undertook a structured mapping process. RESULTS: Key patient-level determinants included perceived ability to adhere to injections despite oral adherence difficulties and care engagement challenges posed by unmet subsistence needs; strategies to address these determinants included a direct-to-inject approach, small financial incentives, and designated drop-in days. Provider-level determinants included lack of time to obtain LA-CAB/RPV, assess injection response, and follow-up late injections; strategies included centralizing eligibility review with the clinic pharmacist, a pharmacy technician to handle procurement and monitoring, regular multidisciplinary review of patients, and development of a clinic protocol. Ward 86 did not experience many outer context barriers because of rapid and unconstrained inclu...