573. Discontinuation of Cabotegravir for PrEP: Challenges and Opportunities

TL;DR

This study examines why people stop using Cabotegravir for HIV prevention and whether they follow guidelines for continuing protection.

Contribution

The study identifies challenges in adherence to post-discontinuation guidelines for Cabotegravir PrEP in an urban clinic.

Findings

36% of those who discontinued CAB-LA transitioned to oral PrEP.

Only 11% of those who did not switch to oral PrEP followed HIV testing recommendations.

Geographical relocation was the main reason for discontinuation, suggesting a need for a national referral network.

Abstract

Guidelines recommend that individuals stopping long-acting injectable Cabotegravir (CAB-LA) pre-exposure prophylaxis (PrEP) who remain at risk for HIV acquisition take oral PrEP and complete quarterly HIV testing for 1 year after last injection; but, adherence to these guidelines is unknown. We describe the characteristics of individuals who discontinue CAB-LA and their adherence to post-discontinuation guidelines at an urban PrEP program in Atlanta.Table 1.Patient Demographic and Clinical Characteristics

Patient Demographic and Clinical Characteristics

This table shows sociodemographic characteristics of all the patients that started CAB-LA and of those that discontinued CAB-LA within the PrEP clinic in urban Atlanta safety-net hospital.

Through retrospective chart review, we abstracted the sociodemographic and social determinants of health (SDOH) characteristics of individuals who discontinued CAB-LA from 12/1/2022 - 11/1/2024. We calculated the number of doses before discontinuation, reasons for discontinuation, proportion of individuals who transitioned to oral PrEP, and adherence to HIV testing schedule post-discontinuation.

This chart shows the percentage breakdown for why patients in our clinic discontinued CAB-LA.

Of 225 individuals who initiated CAB-LA during the study period, 44 (19.6%) discontinued it, with 30 (68%) of all discontinuations occurring early after initiation (1 to 3 doses). The most common reasons for CAB-LA discontinuation were: 23% (10) patient relocation, 20% (9) side effects, 11% (5) risk profile change, 9% (4) insurance change, and 9% (4) incarceration. Common side effects included injection site reactions (4) and rash/urticaria (2). Of individuals who discontinued CAB-LA, 36% transitioned to oral PrEP. Of patients who did not transition to oral PrEP, 11% received subsequent HIV testing. There was one documented HIV seroconversion 3 months after incarceration related discontinuation.

CAB-LA PrEP discontinuation in an urban PrEP program in Atlanta was similar to other PrEP programs in the US (Spinelli et al. 2024). Most individuals who discontinued CAB-LA neither transitioned to oral PrEP nor followed HIV testing recommendations post-discontinuation. With geographical relocation as the main reason for discontinuation, future interventions to develop a national CAB-LA PrEP clinic referral network are needed.

All Authors: No reported disclosures

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