Real-world Rollout of Injectable Antiretrovirals for HIV Prevention and Treatment: Correlates of Early Adoption

Abstract

Background: Data are limited on implementation of long-acting injectable (LAI) HIV treatment (ART) and preexposure prophylaxis (PrEP). We characterized "early adopters"of LAI ART and PrEP in terms of social determinants of health using a health equity lens. Methods: Our retrospective cohort included patients prescribed ART or PrEP through a large urban health system (January 2021-September 2023) in the Northeastern United States. We used electronic health record data for PrEP and ART to examine group differences between those on LAI or oral medications using analysis of variance, chi-square tests, or Fisher exact tests. Bivariate logistic regression modeled associations between LAI ART or LAI PrEP and social determinants of health. Results: In the PrEP group, 238 patients were prescribed LAI (n = 63) or oral (n = 193) PrEP. Most PrEP patients were men (80.7%), non-Hispanic (79.5%), and White (60.7%) and had public insurance (83.1%). Compared with patients on oral PrEP, those on LAI less often experienced food insecurity, financial strain, depression, anxiety, or substance use disorders. In bivariate models, LAI PrEP inversely correlated with female sex, current smoking, depression, anxiety, and substance use disorders. In the treatment group, 1194 patients were prescribed LAI (n = 76) or oral (n = 1118) ART, with a median age of 57.0 years; 63.6% were from minoritized groups. Only age was significantly associated with LAI ART (odds ratio, 0.97; 95% CI, 0.961-0.993; P =. 005). Conclusions: In this large retrospective cohort of patients on LAI PrEP and ART, patients receiving LAI less often experienced social barriers to accessing care. Public health interventions are needed to overcome health inequities tied to access of LAI ART for HIV prevention and treatment.