Hack Jessica, Tarfa Adati, Sayles Harlan, Fadul Nada
Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
Open Forum Infect Dis. 2025 Mar 28;12(4):ofaf192. doi: 10.1093/ofid/ofaf192. eCollection 2025 Apr.
The first long-acting injectable antiretroviral therapy (LAI ART) for HIV was approved for commercial use in the United States in January 2021. Assessment of clinic characteristics and their associations with implementation outcomes and barriers is essential to developing strategies for equitable access to LAI ART.
Using validated implementation measures-acceptability of intervention measure (AIM), intervention appropriateness measure (IAM), and feasibility of intervention measure (FIM)-we conducted a cross-sectional survey of Ryan White clinics in the United States. Additionally, we gathered information on the clinics' population, LAI ART implementation status, and barriers to implementation. Data were analyzed using STATA, version 17. Open-ended responses were analyzed using an inductive thematic approach.
Forty-two clinics completed the survey, with 73% in an urban setting. Most clinics identified as either federally qualified health centers (39%) or academic medical centers (27%). The mean (SD) for each measure (maximum of 20) reflected higher AIM (17.7 [2.3]) and IAM (17.6 [2.4]) compared with FIM (16.4 [3.0]). There was a positive correlation between the percentage of patients on Medicaid and summative AIM and IAM scores. The greatest barriers were prior authorizations, drug procurement, and clinic cost of implementation.
Despite high acceptability and appropriateness, clinics' perceived feasibility of LAI ART implementation was low. Barriers to implementation include nonstandardization of prior authorizations, obtaining the medication, and cost of implementation. Clinics with a larger Medicaid-insured population reported higher acceptability and appropriateness of LAI ART, suggesting that public insurance might promote equitable access. Interventions that address structural barriers are needed to improve uptake.
2021年1月，首款用于治疗人类免疫缺陷病毒（HIV）的长效注射抗逆转录病毒疗法（LAI ART）在美国获批投入商业使用。评估诊所特征及其与实施结果和障碍之间的关联，对于制定公平获取LAI ART的策略至关重要。
我们使用经过验证的实施指标——干预措施可接受性指标（AIM）、干预措施适宜性指标（IAM）和干预措施可行性指标（FIM）——对美国的瑞安·怀特诊所进行了横断面调查。此外，我们收集了这些诊所的人群信息、LAI ART实施状况以及实施障碍。使用STATA 17版软件对数据进行分析。采用归纳主题分析法对开放式回答进行分析。
42家诊所完成了调查，其中73%位于城市地区。大多数诊所被认定为联邦合格健康中心（39%）或学术医疗中心（27%）。每项指标（满分20分）的均值（标准差）显示，与FIM（16.4 [3.0]）相比，AIM（17.7 [2.3]）和IAM（17.6 [2.4]）得分更高。接受医疗补助患者的百分比与AIM和IAM总分之间存在正相关。最大的障碍是预先授权、药品采购和诊所实施成本。
尽管LAI ART具有较高的可接受性和适宜性，但诊所认为其实施的可行性较低。实施障碍包括预先授权的不标准化、获取药物以及实施成本。拥有更多医疗补助参保人群的诊所报告称LAI ART的可接受性和适宜性更高，这表明公共保险可能有助于促进公平获取。需要采取措施解决结构性障碍以提高采用率。
