Agovi Afiba Manza-A, Thompson Caitlin T, Craten Kevin J, Fasanmi Esther, Pan Meng, Ojha Rohit P, Thompson Erika L
Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, 1500 South Main Street, Fort Worth, TX, 76104, USA.
Pharmacy Clinical Services Outpatient, JPS Health Network, Fort Worth, TX, USA.
Implement Sci Commun. 2024 Aug 29;5(1):93. doi: 10.1186/s43058-024-00631-7.
Long-acting injectable cabotegravir plus rilpivirine (LAI CAB/RPV) has several potential benefits over daily oral formulations for HIV treatment, including the potential to facilitate long-term adherence and reduce pill fatigue. We aimed to assess facilitators of and barriers to LAI CAB/RPV implementation and delivery through the perspectives of physicians and clinical staff, and the experiences of LAI CAB/RPV use among people living with HIV (PLWH) at a Ryan-White supported safety-net clinic in North Texas.
We conducted semi-structured interviews with recruited clinic staff (physicians, nurses, and support staff) involved with LAI CAB/RPV implementation and PLWH who switched to LAI CAB/RPV and consented to participate in individual interviews. Data were collected from July to October 2023. Our interview guide was informed by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM), and Proctor Implementation Outcomes frameworks. Qualitative data were analyzed using a rapid qualitative analysis approach to summarize key themes.
We recruited and interviewed 15 PLWH who transitioned to LAI CAB/RPV and 11 clinic staff serving these patients. PLWH conveyed that emotional and informational support from family or a trusted clinician influenced their decision to switch to LAI CAB/RPV. PLWH also reported that injectable treatment was more effective, convenient, and acceptable than oral antiretroviral therapy. Clinic staff and physicians reported that staff training, pharmacist-led medication switches, flexible appointments, refrigeration space and designated room for injection delivery facilitated implementation. Clinic staff cited medication costs, understaffing, insurance prior authorization requirements, and lack of medication access through state drug assistance programs as critical barriers.
Our study offers insights into real-world experiences with LAI usage from the patient perspective and identifies potential strategies to promote LAI CAB/RPV uptake. The barriers to and facilitators of LAI CAB/RPV program implementation reported by clinic staff in our study may be useful for informing strategies to optimize LAI CAB/RPV programs.
长效注射用卡博特韦加rilpivirine（LAI CAB/RPV）在HIV治疗方面相对于每日口服制剂具有若干潜在优势，包括有助于长期坚持治疗并减轻服药负担。我们旨在从医生和临床工作人员的角度评估LAI CAB/RPV实施和给药的促进因素及障碍，以及在北德克萨斯州一家由瑞安·怀特基金支持的安全网诊所中HIV感染者（PLWH）使用LAI CAB/RPV的体验。
我们对参与LAI CAB/RPV实施的招募诊所工作人员（医生、护士和支持人员）以及转而使用LAI CAB/RPV并同意参加个人访谈的PLWH进行了半结构化访谈。数据收集于2023年7月至10月。我们的访谈指南参考了可及性、有效性、采用、实施、维持（RE-AIM）和普罗克特实施结果框架。使用快速定性分析方法对定性数据进行分析以总结关键主题。
我们招募并访谈了15名转而使用LAI CAB/RPV的PLWH以及为这些患者服务的11名诊所工作人员。PLWH表示，来自家人或值得信赖的临床医生的情感和信息支持影响了他们转而使用LAI CAB/RPV的决定。PLWH还报告称，注射治疗比口服抗逆转录病毒疗法更有效、更方便且更易接受。诊所工作人员和医生报告称，工作人员培训、药剂师主导的药物转换、灵活的预约安排、冷藏空间和指定的注射给药室促进了实施。诊所工作人员指出，药物成本、人员配备不足、保险预先授权要求以及通过州药物援助计划无法获得药物是关键障碍。
我们的研究从患者角度提供了关于LAI使用的真实世界体验的见解，并确定了促进LAI CAB/RPV采用的潜在策略。我们研究中诊所工作人员报告的LAI CAB/RPV项目实施的障碍和促进因素可能有助于为优化LAI CAB/RPV项目的策略提供信息。
