Journal of acquired immune deficiency syndromes (1999) · 2026
Impact of implementation process on long-acting cabotegravir/rilpivirine prescription at 9 HIV clinics, 2021-2024.
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Lujintanon Sita, Lesko Catherine R, Haw Nel Jason L, Hickey Matthew D, Zalla Lauren C, Kilcrease Christin, Grochowski Janet, Hill Lucas A, Cachay Edward R, Budak Jehan Z, Crane Heidi M, Fleming Julia, Mayer Kenneth H, Rutstein Sarah E, Turner Barbarajean, Nevin Christa, Burkholder Greer A, Wang Nan, Yendewa George A, Moss Ryan, Pettit April, Rodriguez Allan E, Johnson Mallory O, Christopoulos Katerina A
Аннотация
BACKGROUND: Implementation of long-acting cabotegravir/rilpivirine (LA-CAB/RPV) has been challenging and may limit its uptake. We describe the number of people with HIV (PWH) prescribed LA-CAB/RPV at 9 US academic HIV clinics in the Center for AIDS Research Network of Integrated Clinical Systems and clinic-level variation in LA-CAB/RPV prescriptions.
METHODS: Using a sequential explanatory mixed methods design, we analyzed clinical cohort data of PWH prescribed LA-CAB/RPV, then conducted key informant surveys to ascertain each clinic's Exploration-Preparation-Implementation-Sustainment phase in conjunction with implementation determinants mapped to the Consolidated Framework for Implementation Research. We stratified the cohort analysis by phase.
RESULTS: Between 21-Jan-2021 and 30-Sep-2024, 1,451 (6%) of 22,379 PWH in care were prescribed LA-CAB/RPV. Among those prescribed, 15% had baseline viral load ≥200 copies/mL (200/1,451). Two sustainment-phase clinics that experienced fewer insurance-related barriers, planned prior to LA-CAB/RPV availability, had a pharmacy team coordinating LA-CAB/RPV services, and customized the electronic health record (EHR) system to track insurance approvals and/or injection appointments prescribed LA-CAB/RPV to 16% (924/5,638) of PWH in care. Four sustainment-phase clinics that had a mix of payor coverage and insurance plans, and adequate staffing prescribed to 3% (213/8,154). Three implementation-phase clinics with difficulty procuring LA-CAB/RPV due to restrictive insurance coverage and/or hospital policy and staffing challenges prescribed to 4% (314/8,587).
CONCLUSIONS: Barriers related to insurance coverage and drug procurement impacted the number of PWH prescribed LA-CAB/RPV as did processes to plan for, and adapt to, these barriers. Scale-up efforts should consider team coordination and EHR-facilitated tracking to support the growing number of PWH on LA-CAB/RPV.
METHODS: Using a sequential explanatory mixed methods design, we analyzed clinical cohort data of PWH prescribed LA-CAB/RPV, then conducted key informant surveys to ascertain each clinic's Exploration-Preparation-Implementation-Sustainment phase in conjunction with implementation determinants mapped to the Consolidated Framework for Implementation Research. We stratified the cohort analysis by phase.
RESULTS: Between 21-Jan-2021 and 30-Sep-2024, 1,451 (6%) of 22,379 PWH in care were prescribed LA-CAB/RPV. Among those prescribed, 15% had baseline viral load ≥200 copies/mL (200/1,451). Two sustainment-phase clinics that experienced fewer insurance-related barriers, planned prior to LA-CAB/RPV availability, had a pharmacy team coordinating LA-CAB/RPV services, and customized the electronic health record (EHR) system to track insurance approvals and/or injection appointments prescribed LA-CAB/RPV to 16% (924/5,638) of PWH in care. Four sustainment-phase clinics that had a mix of payor coverage and insurance plans, and adequate staffing prescribed to 3% (213/8,154). Three implementation-phase clinics with difficulty procuring LA-CAB/RPV due to restrictive insurance coverage and/or hospital policy and staffing challenges prescribed to 4% (314/8,587).
CONCLUSIONS: Barriers related to insurance coverage and drug procurement impacted the number of PWH prescribed LA-CAB/RPV as did processes to plan for, and adapt to, these barriers. Scale-up efforts should consider team coordination and EHR-facilitated tracking to support the growing number of PWH on LA-CAB/RPV.