Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, Florida, USA.
Department of Human Development & Family Science, College of Human Sciences, Auburn University, Auburn, Alabama, USA.
AIDS Patient Care STDS. 2024 Jun;38(6):275-285. doi: 10.1089/apc.2024.0067. Epub 2024 Apr 30.
Long-acting injectable (LAI) cabotegravir/rilpivirine (CAB/RPV) for antiretroviral therapy (ART) could benefit many people with HIV (PWH). However, its impact will largely be determined by providers' willingness to prescribe it and PWH's willingness to take it. This study explores the perceived barriers and facilitators of LAI CAB/RPV implementation among PWH and HIV care providers in Florida, a high prevalence setting. Semi-structured qualitative interviews were conducted in English with 16 PWH (50% non-Hispanic White, 50% cis men, and 94% on oral ART) and 11 providers (27% non-Hispanic Black, 27% Hispanic, 73% cis women, and 64% prescribed LAI CAB/RPV) throughout the state. Recruitment occurred between October 2022 and October 2023 from HIV clinics. Interviews were recorded, professionally transcribed, and then double coded using thematic analysis. The Consolidated Framework for Implementation Research guided the interview guide and coding. While PWH viewed LAI CAB/RPV as effective, predominant barriers included administration via injection, challenges of attending more clinic visits, and a feeling that this made HIV the center of one's life. Providers additionally expressed concerns about the development of integrase resistance. Barriers noted by PWH and providers outside of the clinic included transportation, stigma, access inequities, and payor issues. Within clinics, providers identified the need for extra staffing and the increased burden on existing staff as barriers. These barriers decreased the perceived need for LAI CAB/RPV among PWH and providers, especially with the high effectiveness of oral ART. Many of the identified barriers occur outside of the clinic and will likely apply to other novel long-acting ART options.
长效注射型(LAI)卡替拉韦/利匹韦林(CAB/RPV)用于抗逆转录病毒治疗(ART)可能使许多 HIV 感染者(PWH)受益。然而,其影响在很大程度上将取决于提供者开处方的意愿和 PWH 服药的意愿。本研究在佛罗里达州(HIV 高发地区)探索了 PWH 和 HIV 护理提供者对 LAI CAB/RPV 实施的认知障碍和促进因素。在全州范围内,以英语对 16 名 PWH(50%非西班牙裔白人,50%顺性别男性,94%接受口服 ART)和 11 名提供者(27%非西班牙裔黑人,27%西班牙裔,73%顺性别女性,64%开 LAI CAB/RPV)进行了半结构式定性访谈。招募工作于 2022 年 10 月至 2023 年 10 月在 HIV 诊所进行。访谈进行了录音,专业转录,并使用主题分析进行双重编码。实施研究综合框架指导了访谈指南和编码。尽管 PWH 认为 LAI CAB/RPV 有效,但主要障碍包括通过注射给药、增加就诊次数的挑战,以及认为这使 HIV 成为生活中心的感觉。提供者还对整合酶耐药的发展表示担忧。PWH 和提供者在诊所外指出的障碍包括交通、耻辱感、获得机会不平等和支付者问题。在诊所内,提供者确定需要额外的人员配备和现有员工的负担增加是障碍。这些障碍降低了 PWH 和提供者对 LAI CAB/RPV 的需求,尤其是口服 ART 的高有效性。许多已确定的障碍发生在诊所之外,并且可能适用于其他新型长效 ART 选择。
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