P-340. Adaptation of a Pharmacist-Led Long-Acting Injectable (LAI) Antiretroviral Therapy (ART) Program to Increase Use of LAI ART in Arkansas, an Ending the HIV Epidemic (EHE) Jurisdiction

TL;DR

This study adapts a pharmacist-led program for long-acting injectable HIV treatment in Arkansas to improve access and overcome barriers.

Contribution

The study successfully adapts a pharmacist-led LAI ART program to a new health system and location, demonstrating feasibility in a Federally Qualified Health Center.

Findings

A pharmacist-led LAI ART program was implemented at ARcare with a Collaborative Practice Agreement.

Qualitative feedback showed program acceptability and improvements in care coordination and eligibility verification.

Persistent barriers included limited clinic capacity and insurance approval challenges.

Abstract

Barriers to adherence to daily oral ART can lead to poor clinical outcomes and propagation of HIV transmission. LAI ART is a promising alternative for persons with HIV (PWH) who struggle with adherence or prefer a non-oral option. Access to LAI ART for PWH has been complicated by administrative, clinical, and logistical barriers. The Miriam Hospital Infectious Diseases & Immunology Center (TMH ID Center) in Providence, Rhode Island established a successful pharmacist-led LAI ART program overcoming implementation barriers. This study sought to adapt and pilot a similar program at ARcare, a Ryan White-funded Federally Qualified Health Center (FQHC) with multiple HIV clinics in Arkansas, an EHE-designated jurisdiction.

This was a two-year study supported by the Providence/Boston Center for AIDS Research (P30AI042853). Leveraging the procedures and insights from the TMH ID Center LAI ART Program, we adapted a pharmacy-led LAI ART program (Figure 1) through the development of a Collaborative Practice Agreement (CPA) between pharmacists and providers across ARcare clinics. Implementation was supported by weekly meetings between ARcare and TMH to discuss clinical and logistical challenges. Guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) and Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) frameworks, we used quantitative and qualitative data to assess program reach, adherence, effectiveness, maintenance, and implementation barriers/facilitators.

Since CPA approval in January 2024, 65 patients were referred. Figure 2 describes quantitative results. Key differences between programs included health system structure, staffing, and LAI ART eligibility criteria. Qualitative interviews with leadership and staff found the program acceptable and feasible, with improvements in overall care coordination, verification of clinical eligibility, and benefits investigation. Persistent barriers included limited clinic capacity and insurance approval.

A pharmacist-led LAI ART model is feasible and sustainable in FQHCs and adaptable to diverse health system and staffing structures. Broader replication, implementation, and evaluation across a larger sample of clinics are warranted.

Jure Baloh, PhD, ViiV Healthcare: Grant/Research Support Gabriella A. Douglass, PharmD, AAHIVP, BCACP, Gilead - FOCUS Partnership: Grant/Research Support Ashlyn Curry, PharmD, AAHIVP, Focus Program - Gilead Sciences: Grant/Research Support Elma Abdullah, PharmD, Gilead/FOCUS: Grant/Research Support

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