# Optimizing the patient journey: Insights from early implementation of long‐acting cabotegravir and rilpivirine in four urban Ryan White‐funded clinics in the United States

## TL;DR

This study explores how to improve the real-world use of long-acting HIV treatment by analyzing patient experiences and identifying key areas for better support.

## Contribution

The study provides new insights into optimizing service delivery for long-acting HIV treatment through patient-centered themes.

## Key findings

- Three key themes were identified to enhance patient-centered service delivery for LAI-CAB/RPV.
- Patients may experience depressive feelings after discontinuing the treatment, even if they consider it the right decision.
- A specialized support framework is needed for LAI-CAB/RPV that differs from traditional oral ART protocols.

## Abstract

Long‐acting injectable (LAI) cabotegravir/rilpivirine (CAB/RPV) represents a breakthrough in HIV treatment. However, understanding how to optimize real‐world service delivery and user experiences among people with HIV (PWH) remains limited.

Between August 2022 and December 2024, we conducted semi‐structured interviews with PWH at four academic Ryan White‐funded HIV clinics in Atlanta, Chicago and San Francisco. Eligibility criteria were current LAI‐CAB/RPV use with ≥3 injections or having discontinued. Interviews were analysed using thematic analysis grounded in descriptive phenomenology.

Among 69 participants, 48 of whom were receiving LAI‐CAB/RPV and 21 who had discontinued, we identified three themes that highlighted opportunities to enhance patient‐centred service delivery of LAI‐CAB/RPV: (1) enhancing knowledge and self‐efficacy in using oral antiretroviral therapy (ART) in cases of missed or late injections; (2) improving patient comfort and confidence, particularly regarding injection anxiety, pain management and blood draws; (3) attending to the potential evolution of patient‐provider relationships, as in most cases injection visits outnumber primary care visits. In addition, PWH may experience depressive feelings upon discontinuation, even if they view it as the right decision.

Optimizing the LAI‐CAB/RPV patient journey requires developing a specialized support framework that is distinct from oral ART protocols. This new treatment modality requires a tailored approach that addresses unique challenges, including facilitating candid discussions about adherence contingencies, managing the physical and psychological aspects of injection experiences, ensuring meaningful and consistent provider relationships amid changing care patterns and providing enhanced support during treatment transitions.