Attitudes and eligibility of long-acting cabotegravir/rilpivirine treatment among youth living with HIV in a clinical and national cohort in Thailand: a cross-sectional study.

Abstract

Background: Long-acting cabotegravir/rilpivirine (LA-CAB/RPV) is the only available approved injectable antiretroviral therapy (ART) for youth living with HIV (YLHIV). However, it is not yet available through the Thai National AIDS Program (NAP). This study assessed Thai YLHIV attitudes toward LA-CAB/RPV and identified the proportion of medically eligible YLHIV within the NAP.

Methods: Two cross-sectional studies were conducted, the first study conducted in an HIV clinic in Bangkok involving YLHIV aged 13-24 years, assessing attitudes via questionnaires. The second study analyzed medical eligibility among 14,670 youth aged 12-24 years in the NAP, defined by current HIV RNA < 50 copies/ml, no prior treatment failure (HIV RNA < 1,000 copies/ml) and no suspected archived resistance to CAB/RPV. Logistic regression was performed to identify factors associated with willingness and eligibility.

Results: From April to June 2024, 100 YLHIV (median age 20 years; IQR 19.0-21.7) were enrolled, 71% had non-perinatally acquired HIV (non-PHIV). Overall, 85% expressed willingness to use LA-CAB/RPV. Non-PHIV youth showed significantly higher interest (93.0% vs. 65.5%); OR 6.9 [95% CI: 2.1-22.8], despite a shorter median treatment duration (2.7 vs. 14.3 years). LA-CAB/RPV was considered more convenient than pills by 76%, although 42% anticipated injection-site reactions. Among YLHIV in the NAP (median age 22 years; IQR 20-23), 64% were medically eligible, non-PHIV youth also had a higher eligibility proportion (70% vs. 32%) with an aOR 2.0 [95% CI: 1.7-2.4].

Conclusion: The majority of Thai YLHIV showed positive attitudes towards LA-CAB/RPV, with two-thirds meeting medical eligibility criteria. Enhancing access to generic formulations of this regimen could significantly impact lifelong HIV management.