Long-Acting Injectable Antiretrovirals for HIV Treatment: A Multi-Site Qualitative Study of Clinic-Level Barriers to Implementation in the United States

Authors

Tara McCrimmon, Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA.
Lauren F. Collins, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Amaya Perez-Brumer, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Angela R. Bazzi, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA.
Victoria A. Shaffer, Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA.
Deanna Kerrigan, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA.
Maria L. Alcaide, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA.
Morgan M. Philbin, Division of Vulnerable Populations, Department of Medicine, University of California San Francisco, San Francisco, California, USA.

Document Type

Journal Article

Publication Date

2-1-2024

Journal

AIDS patient care and STDs

Volume

38

Issue

2

DOI

10.1089/apc.2023.0248

Keywords

HIV treatment; clinic-level barriers; implementation science; long-acting injectable ART; qualitative

Abstract

Long-acting injectable antiretroviral therapy (LAI ART) has the potential to address adherence obstacles associated with daily oral ART, leading to enhanced treatment uptake, adherence, and viral suppression among people living with HIV (PLWH). Yet, its potential may be limited due to ongoing disparities in availability and accessibility. We need a better understanding of the organizational context surrounding the implementation of LAI ART, and to inform its widespread rollout, we conducted 38 in-depth interviews with medical and social service providers who offer HIV care at private and hospital-based clinics across six US cities. Our findings highlight real-world implementation barriers outside of clinical trial settings. Providers described ongoing and anticipated barriers across three stages of LAI ART implementation: (1) Patient enrollment (challenges registering patients and limited insurance coverage), (2) medication delivery (insufficient personnel and resources), and (3) leadership and management (lack of interprofessional coordination and a lack of programming guidelines). Providers described how these barriers would have a disproportionate impact on under-resourced clinics, potentially exacerbating existing disparities in LAI ART access and adherence. Our findings suggest strategies that clinic leadership, policymakers, and other stakeholders can pursue to promote rapid and equitable LAI ART implementation in clinics across the United States. Resource and staffing investments could support clinics to begin, sustain, and scale up LAI ART delivery; additionally, the establishment of guidelines and tools could facilitate wider adoption of LAI ART across clinical settings. These efforts are crucial to promote resourced, standardized, and equitable implementation of LAI ART and maximize its potential to help end the HIV epidemic.

APA Citation

McCrimmon, Tara; Collins, Lauren F.; Perez-Brumer, Amaya; Bazzi, Angela R.; Shaffer, Victoria A.; Kerrigan, Deanna; Alcaide, Maria L.; and Philbin, Morgan M., "Long-Acting Injectable Antiretrovirals for HIV Treatment: A Multi-Site Qualitative Study of Clinic-Level Barriers to Implementation in the United States" (2024). GW Authored Works. Paper 4399.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4399

Department

Prevention and Community Health