Objective:
To analyze the uptake and persistence of long-acting injectable cabotegravir (LAI-CAB) among patients receiving HIV pre-exposure prophylaxis (PrEP) in the US.
Approach:
- Study Design: A retrospective cohort study analyzing national pharmacy and medical claims from the Symphony Health PatientSource database from January 2022 through December 2024.
- Participants: Included 781,040 patients with at least one claim for PrEP, including oral medications or LAI-CAB.
- Outcomes: Primary outcomes were uptake of LAI-CAB and persistence with injectable therapy; secondary outcome assessed overall PrEP persistence among LAI-CAB users.
Key Findings:
- LAI-CAB accounted for only 3% of all PrEP users, increasing to 4% by the end of 2024, with 24,194 patients receiving LAI-CAB during the study period.
- 50% of patients remained persistent with LAI-CAB at 1 year, declining to 23% at 2 years.
- Overall PrEP persistence was 57% at 1 year and 30% at 2 years.
- A greater proportion of LAI-CAB users were covered by Medicaid (26%) compared to oral PrEP users (14%).
- Female patients had lower long-term persistence on LAI-CAB (13% at 2 years) compared to male patients (25%).
- Older patients and Medicare beneficiaries showed higher long-term persistence than younger patients and those with commercial insurance or Medicaid.
Interpretation:
Persistence with LAI-CAB in routine clinical practice was lower than rates reported in clinical trials, suggesting structural barriers may affect uptake and persistence.
Limitations:
- The study relied on administrative claims data, which could not capture reasons for therapy discontinuation or switching.
- Excluded some closed US health care systems and required statistical imputation for nearly half of race and ethnicity data.
- Lacked information on gender identity and sexual risk behaviors.
Conclusion:
Wider availability of long-acting PrEP may not significantly increase PrEP use without addressing barriers to implementation and improving long-term persistence.
Sources:
This content is an AI-generated, fully rewritten summary based on a published scholarly article. It does not reproduce the original text and is not a substitute for the original publication. Readers are encouraged to consult the source for full context, data, and methodology.
