Can LAI-CAB Sustain Long-Term PrEP Use? - Summary - MDSpire
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Can LAI-CAB Sustain Long-Term PrEP Use?
A national claims analysis found modest uptake and declining persistence over 2 years despite increasing use of injectable HIV pre-exposure prophylaxis.
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.
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