P-381. Veterans on Cabotegravir-Rilpivirine Long Acting Treatment for HIV are Younger and More Urban Than Those Who Continue Oral ART

TL;DR

This study shows that younger and urban HIV patients in the US Veterans Health Administration are more likely to use a long-acting injectable HIV treatment than older or rural patients.

Contribution

The study provides new insights into demographic and geographic disparities in the adoption of a novel long-acting HIV treatment within a national healthcare system.

Findings

CAB+RPV LA uptake increased from 6 in 2021 to 441 in 2024.

Exposed patients were younger and more urban compared to unexposed patients.

High complexity, urban facilities prescribed CAB+RPV LA more frequently.

Abstract

In 2021, the US Food and Drug Administration approved the first complete long-acting (LA) injectable antiretroviral therapy (ART) regimen, cabotegravir plus rilpivirine (CAB+RPV LA), for use in people with HIV (PWH) to maintain viral suppression. The Veterans Health Administration (VHA) is the largest provider of HIV care in the US and creates an opportunity to examine CAB+RPV LA uptake in a national cohort with uniform ART access. We aimed to describe demographic, temporal and geographic trends of CAB+RPV LA use in VHA nationwide.

Using the VHA’s Corporate Data Warehouse, we identified PWH who initiated CAB+RPV LA between January 2021 and December 2024. Those with documented receipt of at least 3 CAB+RPV LA injections were categorized as ‘exposed’. We defined ‘unexposed’ as those who did not receive CAB+RPV LA in the pre-defined study period, were virally suppressed at entry into the study and had at least one oral ART fill. We described the nationwide uptake in CAB+RPV LA, summarizing patient characteristics, and geographic trends over time. We compared the exposed and unexposed groups using Chi-squared and Wilcoxon rank sum tests and summarized the prescribing trend across states and VHA facilities.

We identified 1004 exposed patients who initiated CAB+RPV LA from January 2021 to December 2024, while 23,688 patients were unexposed. Exposed patients were younger (mean age 49 years vs. 60 years; p< 0.001) and more likely to live in an urban area (88% vs. 84%, p=0.0024) than unexposed. The exposed group included higher proportions of Black (53% vs. 48%), Hispanic (10% vs. 8.7%) and female patients (4.9% vs. 3.6%) than the unexposed cohort. Uptake increased from 6 initiations nationally in 2021 to 441 in 2024. The number of VHA facilities that had prescribed CAB+RPV LA increased from 5 in 2021 to 81 in 2024, representing 58% of all VHA facilities treating eligible PWH. Patients at high complexity facilities, which are generally located in large metropolitan areas, were overrepresented in the exposed cohort (66% vs. 58%).

Uptake of CAB+RPV LA has increased in the VHA since FDA approval in 2021 with greater uptake in large, high complexity, urban facilities. Further studies should evaluate barriers to implementation at smaller, rural serving clinics and older patients.

Puja Van Epps, MD, ViiV Healthcare: Grant/Research Support

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