Eligibility and factors associated with long-acting injectable cabotegravir-rilpivirine initiation in an urban academic HIV clinic.

Abstract

Objectives: This study aimed to assess eligibility for long-acting injectable (LAI) cabotegravir/rilpivirine among people with HIV (PWH), identify factors associated with initiation and examine provider prescribing patterns in an urban academic clinic in the USA.

Patients and methods: We conducted a retrospective cohort analysis among PWH at the University of Chicago HIV clinic from 1 January 2021 to 31 May 2023. Eligibility criteria for LAI cabotegravir/rilpivirine included HIV-1 RNA <50 copies/mL for ≥3 months, no active hepatitis B, no resistance to rilpivirine or cabotegravir and no treatment failure history. Logistic regression identified factors associated with initiation among eligible PWH as well as prescribing patterns of providers.

Results: Of 657 PWH, 413 (63%) were eligible for LAI cabotegravir/rilpivirine. Median age was 45, 33% were women, 84% Black, 70% had permanent housing, 52% employed, 56% on Medicaid, 9% had active substance use and 26% had psychiatric comorbidities. Among those eligible, 64 PWH (15%) initiated LAI cabotegravir/rilpivirine. In multivariate analysis, younger age was the only factor associated with LAI cabotegravir/rilpivirine initiation [OR 0.96, 95% CI (0.94, 0.99), P = 0.01]. Prescribing patterns varied widely among the 13 providers, with initiation rates ranging from 0% to 33% (P < 0.001). Two providers, covering 40% of eligible patients, were responsible for 70% of initiations.

Conclusions: In our urban HIV clinic, 63% of PWH were eligible for LAI cabotegravir/rilpivirine, and 15% initiated it within 2.5 years post-approval. Age and provider patterns significantly influenced LAI cabotegravir/rilpivirine uptake. Understanding factors driving LAI cabotegravir/rilpivirine uptake is key to expanding its reach.