Early Implementation of Long-Acting Injectable Cabotegravir for HIV Prevention in a Safety Net Hospital-based Primary Care Center in U.S. South.

Abstract

Background: Long-acting injectable cabotegravir (CAB-LA), approved in 2021, is a more effective HIV prevention method than daily oral PrEP. CAB-LA expansion addresses key HIV prevention gaps, especially in the Southern United States (U.S.), to support national Ending the HIV Epidemic (EHE) goals. However, complex implementation requirements hinder CAB-LA expansion, highlighting the need for real-world data to guide effective and equitable scale-up.

Objective: Describe the implementation and early outcomes of implementing CAB-LA in a large safety-net primary care center in the Southern U.S.

Design: We described the integration of CAB-LA into an existing oral PrEP program. We manually abstracted individual sociodemographic and clinical data. We developed a CAB-LA care continuum and reported early outcomes among CAB-LA initiators.

Participants: Individuals referred to the CAB-LA program from 12/1/2022 to 8/1/2023, with outcomes assessed through 12/1/2023.

Main measures: Development of a CAB-LA care continuum from linkage, eligibility assessment, program enrollment, initiation, and persistence. We reported the sociodemographic and clinical characteristics of individuals referred for and initiated on CAB-LA, the total number and timing of injections administered, self-reported adverse events, CAB-LA discontinuations, and HIV seroconversions.

Key results: Integration of CAB-LA into an existing oral PrEP program required multidisciplinary team adaptation, protocol development for drug procurement and care coordination, and adapting an existing population health registry to the CAB-LA workflow to monitor and track individuals. Of 221 referred individuals, 77 (35%) initiated CAB-LA. Initiation barriers included program intake scheduling delays (29%), individuals declining CAB-LA (19%), and delayed medication procurement (16%). Among CAB-LA initiators, 275 injections were administered, 94% were administered on time, six individuals (8%) reported adverse effects, and eight (10%) discontinued CAB-LA. No HIV seroconversions occurred.

Conclusions: We successfully implemented a CAB-LA PrEP program in a safety-net primary care center in the U.S. South, using an approach designed to address structural barriers to PrEP uptake and persistence.