Long-Acting Antiretroviral Therapy for HIV via Drop-in Community-Based Care
By
Nicky J. Mehtani
Stephen J. Matzat
Kathleen B. O’Connor
Laura Cordoba
Sarah Strieff
Alix Strough
Morgan M. Philbin
Mallory O. Johnson
Monica Gandhi
Barry Zevin
June 26, 2026
Clinical Scorecard: Community-Based Approaches to Long-Acting Antiretroviral Treatment for HIV in Individuals Experiencing Homelessness
At a Glance
Category Detail
Condition HIV Key Mechanisms Long-acting antiretroviral therapy (LA-ART) using cabotegravir and rilpivirine administered via intramuscular injection. Target Population Individuals experiencing homelessness (PEH) with HIV. Care Setting Community-based clinics providing transitional primary and urgent care.
Key Highlights
PEH in the US have over 3 times the HIV prevalence of the general population. LA-ART has shown effectiveness in patients with viremia facing challenges to oral ART adherence. The MXM Health Resource Center serves as a low-barrier clinic for PEH, providing essential medical services. Guideline-Based Recommendations
Diagnosis
No requirement for baseline viral suppression; patients with low CD4 and viremia prioritized. Management
Direct-to-inject initiation of cabotegravir and rilpivirine without oral lead-in. Monitoring & Follow-up
Weekly multidisciplinary huddles to monitor upcoming and overdue injections. Risks
Potential injection site reactions and long pharmacokinetic tail. Patient & Prescribing Data
4424 adults experiencing homelessness or housing instability, predominantly covered by Medicaid or other publicly funded programs.
Fewer than 5% declined oral ART due to adherence challenges or competing priorities.
Clinical Best Practices
Streamlined eligibility criteria to expand access for individuals unable to maintain oral ART. Proactive reminders to patients or associates for injection appointments. Related Resources & Content
