Perspectives of people with HIV on implementing long acting cabotegravir plus rilpivirine in clinics and community settings in the UK: results from the anti-sexist, anti-racist, anti-ageist ILANA study

Chloe Orkin; Rosalie Hayes; Joanne Haviland; Yuk Lam Wong; Kyle Ring; Vanessa Apea; Bakita Kasadha; Emily Clarke; Ruth Byrne; Julie Fox; Tristan J Barber; Amanda Clarke; Sara Paparini; ILANA study Group

doi:10.1093/cid/ciae523

Perspectives of people with HIV on implementing long acting cabotegravir plus rilpivirine in clinics and community settings in the UK: results from the anti-sexist, anti-racist, anti-ageist ILANA study

Clin Infect Dis. 2024 Oct 28:ciae523. doi: 10.1093/cid/ciae523. Online ahead of print.

Authors

Chloe Orkin^{1

2}, Rosalie Hayes³, Joanne Haviland⁴, Yuk Lam Wong⁴, Kyle Ring^{1

2}, Vanessa Apea^{2

3}, Bakita Kasadha⁵, Emily Clarke⁶, Ruth Byrne⁷, Julie Fox^{8

9}, Tristan J Barber^{10

11}, Amanda Clarke¹², Sara Paparini³; ILANA study Group

Collaborators

ILANA study Group:
Sadna Ullah, Nishat Halim, Chikondi Mwendera, James Hand

Affiliations

¹ SHARE Collaborative, Blizard Institute, Queen Mary University of London, London, United Kingdom.
² Barts Health NHS Trust, London, United Kingdom.
³ SHARE Collaborative, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom.
⁴ Pragmatic Clinical Trials Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom.
⁵ Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
⁶ Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom.
⁷ Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom.
⁸ School of Immunology & Microbial Sciences, Kings College London, London, United Kingdom.
⁹ Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
¹⁰ Royal Free London NHS Foundation Trust, London, United Kingdom.
¹¹ Institute for Global Health, University College London, London, United Kingdom.
¹² University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom.

PMID: 39465685
DOI: 10.1093/cid/ciae523

Abstract

Introduction: The equity-focused ILANA study evaluated feasibility, acceptability, appropriateness of delivering on-label two-monthly cabotegravir and rilpivirine (CAB+RPV) injections for HIV-1 therapy in clinics and community settings.

Methods: The study, which mandated inclusive recruitment, was conducted May-December 2022 at six UK sites. Injections were delivered in clinic (months 1-6), and in clinic or community setting according to patient choice (months 6-12). Surveys were completed at baseline, M4 and M12 using validated measures for feasibility (FIM), acceptability (AIM), and appropriateness (IAM). Primary endpoint: proportion of participants agreeing that the injection and community setting were feasible (FIM>4) at M12. Fourteen participants completed interviews at baseline and M12.

Results: Community settings offered by sites included: home visits (n=3), HIV support organisations (n=2), community clinic (n=1). Of 114 participants,54% were female, 70% racially minoritised and 40% aged >50. 27/114 chose to receive injections in community settings. FIM/AIM/IAM scores at M12 were high for the injection (79.0-87.4%) and lower for the community setting (44.2-47.4%) overall. Subgroup analyses indicated differences in scores by gender and ethnicity. Among those who attended the community, FIM/AIM/IAM scores for the community setting at M12 were high (73.1-80.8%). Concerns about stigma, inconvenience, and losing access to trusted clinicians negatively influenced perceptions of receiving injections at community settings, amongst other factors.

Conclusion: CAB+RPV injections were considered highly feasible, acceptable, and appropriate, however few chose community delivery. Those that chose community delivery found it highly acceptable and feasible. Further exploration of CAB+RPV delivery in alternative community sites not offered (e.g. primary care or pharmacies) is warranted.

Keywords: Implementation Science; cabotegravir; inclusive protocol; long-acting injectable; rilpivirine.