Provider perspectives on ideal candidates for long-acting antiretroviral therapy for HIV treatment: A multi-site qualitative study in the United States
Abstract Authors
Morgan M. Philbin, Tara McCrimmon, Lauren F. Collins, Victoria A. Shaffer, Maria L. Alcaide
Author Affiliations
Philbin: UCSF, San Francisco, CA McCrimmon: Columbia University, New York, NY Collins: Emory University, Atlanta, GA Shaffer: University of Missouri, Columbia, MO Alcaide: University of Miami, Miami, FL
Background
Clinics have begun scaling-up long-acting injectable (LAI) ART, but existing inequities in treatment access may limit uptake among marginalized individuals, including women who have lower rates of viral suppression than men. HIV providers play key roles in supporting and determining patients’ LAI ART access. We therefore examined how providers determine which patients are candidates for LAI ART, and how this may influence to whom LAI ART is offered.
Methods
We interviewed 38 HIV providers at academic medical centers and private clinics across six U.S. cities (Atlanta, Miami, Pittsburgh, Brooklyn, Jackson, and Birmingham). We explored their perspectives on patients’ LAI ART candidacy, their opinions on the eligibility criteria for LAI ART as set forth by the U.S. Food and Drug Administration (FDA), and how they apply those criteria. We employed thematic content analysis to identify key findings.
Results
Providers identified three key considerations regarding who should be offered LAI ART: 1) Eligibility concerns: patients with detectable viral loads could benefit the most from LAI ART, but are not eligible per FDA label approval: “I’m not sure the label is serving those most in need”. Providers also thought that adherent patients might not want LAI ART since it required more clinic visits: “Why should I come every month if I now see my doctor every six months?”; 2) Individual patient assessment: Providers wanted to maintain autonomy and assess patients individually based on clinic attendance and co-occurring health issues versus the FDA label approval: “It’s not one size fits all.”; and 3) Sex/Gender differences: Providers described female patients as more reliable: “Women are going to show up and get it done.” However, providers were concerned about offering LAI ART to women of reproductive age since pregnant people were not included in LAI ART clinical trials.
Conclusion(s)
Providers used multiple approaches and diverse considerations to evaluate patients’ LAI ART candidacy, which may perpetuate inequities in access at the population level. This is particularly true for women who face unique barriers to medication access and adherence. This suggests a need for standardized guidance on equitably offering LAI ART to eligible patients.