Cabotegravir-rilpivirine regimen feasible in hospitals

A once-every-two-months (Q2M) dosing regimen of cabotegravir with rilpivirine long-acting (CAB+RPV LA) can be easily implemented in hospitals and draws high levels of acceptability, appropriateness, and feasibility feedback from healthcare staff, according to a study presented at the recently concluded 2022 HIV Glasgow Conference.

Of the 18 clinics surveyed, 13 (72 percent) had had no prior experience implementing a CAB+RPV LA dosing regimen for people living with HIV-1 (PLWH). Overall, 70 hospital staff completed interviews and surveys 1 month after the regimen implementation, while 62 provided such data at month 12.

Half of the study sites were assigned to the enhanced implementation arm and received face-to-face injection training, continuous quality improvement, and education resources. The other half were allocated to standard implementation and received support in the form of educational resources and virtual trainings.

Throughout 12 months of assessments, mean scores remained high for the staffs’ perception of CAB+RPV LA acceptability. At the first month, for instance, those in the enhanced and standard arms gave an average score of 3.8 and 3.9, respectively, out of a maximum of 5.0. [HIV Glasgow 2022, abstract P069]

The same was true for appropriateness (mean scores, 3.8 and 3.9, respectively) and feasibility (mean scores, 4.0 and 4.0, respectively). Scores remained relatively constant throughout the study period.

Moreover, 56 percent of all hospital staff surveyed achieved optimal implementation within 1–3 months. More respondents in the standard vs enhanced implementation groups were still working to implement the CAB+RPV LA at 12 months. By study end, 68 percent of staff said that the time they spent in the clinic related to implementation was “very” or “extremely” acceptable.

Data for the present analysis came from CARISEL, an open-label, single-arm switch study of virologically suppressed PLWH, assessing their outcomes after Q2M CAP+RPV LA.

Appropriate for patients, too

Patient-side perception data were also presented at HIV Glasgow 2022 from CARISEL. In 379 PLWH, a 17-item study-specific questionnaire was used to assess barriers and facilitators for optimal regimen implementation. Meanwhile, a 5-point Likert scale measured perception levels.

PLWHs scored noticeably higher than hospital staff across all perception measures. At the first month of dosing implementation, the mean score for acceptability was 4.56, while those for appropriateness and feasibility were 4.47 and 4.51, respectively. These increased slightly over time, reaching 4.66, 4.60, and 4.58 at 12 months, respectively. [HIV Glasgow 2022, abstract P123]

Moreover, scores in the HIV Treatment Satisfaction Questionnaire showed that while patients had a slightly negative perception of their regimen at 1 month (mean change, –0.73), satisfaction improved greatly at both months 4 (mean change, 3.06) and 12 (mean change, 2.84).

By the 12th month of follow-up, more than 91 percent of PLWHs viewed the CAB+RPV LA regimen as either “extremely” or “very” positive.

The survey also revealed important barriers or difficulties that participants experienced during treatment, including pain or soreness from the injection (55.9 percent) and having to miss work for treatment (12.7 percent). Meanwhile, 31.4 percent agreed that “nothing makes this treatment difficult.”