Identifying Preferred Program Delivery Attributes for Long-Acting Injectable Cabotegravir-Rilpvirine in Three US HIV Clinics: A Discrete-Choice Experiment

Abstract

Background:Long-acting injectable cabotegravir and rilpivirine (CAB/RPV-LA) may overcome adherence barriers and provide treatment choice among people with HIV (PWH). However, little is known about the factors most likely to facilitate CAB/RPV-LA use.Methods:We conducted a discrete-choice experiment at three urban US HIV clinics, stratified by care engagement status (suboptimal care engagement defined as most recent HIV RNA ≥200 copies/mL or <2 primary care visits with no HIV RNA measurement in the past year). The discrete-choice experiment had 6 attributes: visit location, conversation with one's HIV provider at injection, extra support services, visit length, extended hours, and cost. We used mixed logit regression to estimate preference weights and latent class analysis to identify preference groupings. We examined associations between covariates, attribute preferences, and latent class groups and estimated shares of preference toward hypothetical scenarios.Results:Between December 2021 and May 2022, 370 PWH participated. The median age was 46 years, 34% were cisgender female/gender minority, 59% were African American/Black, 13% were Latino/a/x, 34% experienced unstable housing, 19% endorsed illicit substance use, and 27% suboptimal engagement. Cost and visit location were the most important attributes. Latent class analysis identified three groups: (1) cost conscious (44%), (2) location driven (34%), and (3) provider/support services oriented (22%). Suboptimally engaged PWH preferred extra support services. Shares of preference suggested a predicted use of CAB/RPV-LA exceeding 80% across delivery scenarios with more preferred features.Conclusions:Participants strongly preferred CAB/RPV-LA delivery at no cost and accessible at their current HIV clinic. Preferences of PWH with suboptimal engagement were heterogeneous, suggesting the need for tailored, differentiated delivery programs offering choice.