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SC29 Reasons for declining long-acting-injectable therapy in eligible PLWH: insights from the WHY-not study
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SC29 Reasons for declining long-acting-injectable therapy in eligible PLWH: insights from the WHY-not study
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SC29 Reasons for declining long-acting-injectable therapy in eligible PLWH: insights from the WHY-not study
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Journal Article
SC29 Reasons for declining long-acting-injectable therapy in eligible PLWH: insights from the WHY-not study
2025
Overview
BackgroundLong-acting injectable (LAI) therapy with cabotegravir and rilpivirine (CAB/RPV) represents a significant and innovative advancement in switch strategies for the treatment of HIV. Such an option, characterized by bimonthly intramuscular administrations received in hospital setting, may offer several advantages over conventional regimens based on daily oral drugs, mainly associated to enhanced adherence and de-stigmatization.However, a subset of people living with HIV (PLWH), who qualify for LAI and after direct proposal, decline this option. We aimed to investigate the reasons for refusal despite qualification.Material and MethodsRetrospective, multicenter, observational cohort study aimed at investigating the reasons why persons eligible for LAI treatment decline this option.From 1 January 2025 to 7 March 2025, all consecutive PLWH attending two HIV centers in northern Italy, were offered LAI therapy (if they qualified for) during routine follow-up visits and the reasons for refusal were collected by proponent physicians.Eligibility criteria were: HBsAg negativity, virological suppression for at least six months, no history of virological failures and adherence to scheduled visits (not necessarily to ART).Clinical, sociodemographic data and comedications were retrieved from medical records.ResultsA total of 432 subjects were enrolled. Reasons for LAI declination (table 1) were: logistical challenges in 272 subjects (63%). Among these reasons (multiple choices were admitted), the distance from the HIV center (34%), the number (62%) and frequency (bimonthly) (4%) of required visits by current LAI were the most frequent complaints.Other reasons werereluctance to change current and well tolerated therapy (95 pts, 22%) and fear of needles (43 pts, 10%), the impossibility of self-administration for 13 patients (3%), the absence of benefit (as they were already taking oral comedications) for 9 subjects (2%) 2 (figure 1).Only 99 subjects (23%) were aware of this LA option before the doctor’s interview.Abstract SC29 Table 1Patients‘ characteristicsAbstract SC29 Figure 1Reasons for LAI declination[Figure omitted. See PDF]ConclusionsLogistical challenges represent the main reasons for declining LAI therapy in eligible and successfully treated PLWH. In this perspective, the possibility of administering LAI therapy at longer intervals and the availability of facilities closer to home might facilitate the acceptance rate.
Publisher
BMJ Publishing Group LTD
Subject
