Co-designing a Blueprint for Home Delivery of Long-Acting Injectable Pre-exposure Prophylaxis for Sexual Minority Men in Chicago.

Abstract

Reducing HIV incidence requires effective implementation of evidence-based prevention practices. Long-acting injectable cabotegravir (CAB-LA) offers a new form of effective prevention, but maximizing uptake requires co-designing implementation strategies with impacted populations. In Chicago, where HIV disproportionately impacts sexual minority men (SMM), a community-focused innovation tournament identified home-based CAB-LA delivery as the top strategy. Through a partnership with key constituents, this research aimed to operationalize this strategy for SMM (≥ 13 years) in Chicago, with particular attention to Black SMM and Latino SMM populations, through human-centered design (HCD). A four-hour, in-person workshop convened 19 transdisciplinary participants (e.g., SMM, clinicians, public health leadership, community-based organization leadership, implementation scientists) to co-create a preliminary blueprint for home-based delivery. Virtual follow-up semi-structured interviews with 10 workshop participants elicited feedback on the blueprint. Rapid qualitative analysis refined the blueprint, and final materials were produced in English and Spanish. Key phases of the home-based delivery strategy included: pre-implementation (e.g., outreach; procurement of shots), implementation (e.g., identification of staffing; administration in homes), and maintenance (e.g., post-administration and re-engagement). Patient actions focused on indicating preferences for visit, preparing home for visit, and scheduling follow-up care. Clinician actions emphasized prescribing CAB-LA, sharing financing information, and administration procedures. This research produced a blueprint for a co-designed strategy of "low-barrier PrEP." Future efforts will develop complementary implementation strategies and will test the success of home-based delivery on increasing the uptake of CAB-LA among SMM. The HCD approach can also provide a framework for co-design approaches across the HIV care continuum.