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Only Half Prescribed CAB PrEP Get at Least 1 Shot in US Outpatient Network
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IDWeek 2023, October 11-15, 2023, Boston
Mark Mascolini
Among 293 HIV-negative adults prescribed injectable cabotegravir (CAB) PrEP in a US outpatient network, only 155 (53%) got at least one shot [1]. Researchers from CAN Community Health attributed that low rate to "limitations in use and access to injectable CAB for PrEP" and declined further comment while they review these cases. Among people who got at least one shot, more than 80% continued getting regular injections and none of them picked up HIV infection.
To determine rates and reasons for injectable CAB PrEP uptake and persistence, researchers from CAN Community Health Network checked electronic medical records of the system's 26 outpatient clinics in 6 states (Arizona, Florida, New Jersey, Texas, South Carolina, Virginia, https://www.cancommunityhealth.org/). They defined discontinuation as switching back to oral PrEP or going more than 67 days since the last CAB shot. CAB PrEP should be used every 2 months after the first 2 injections given 1 month apart.
Of the 293 people prescribed CAB PrEP, median age stood at 36 years; 239 (82%) were assigned male at birth and 54 assigned female (including 222 cisgender males, 49 cisgender females, 3 transgender males, 8 transgender females, 4 genderqueer, 6 others, and 1 who did not disclose gender identity). While 167 (57%) defined their sexual orientation as same sex, 53 (18%) called themselves heterosexual and 48 (16%) bisexual. The group included 97 white non-Hispanics (33%), 86 black non-Hispanics (29%), 60 white Hispanics (20%), and 6 black Hispanics (2%).
Checking records from December 2021 through April 2023, CAN Community Health researchers found that 138 of 293 people (47%) prescribed CAB PrEP never got a shot, a result the investigators attributed to "limitations in use and access to injectable CAB for PrEP." When NATAP asked for further details, researcher Jessica Altamirano said these 138 people are "under review" and they "expect to report [additional information] in the near future."
Among the 155 people who got at least 1 shot, median number of shots in the study period was 3. Of those who got at least 1 shot, 117 (75.5%) had used oral PrEP (either Truvada or Descovy). Of these 117 people, 93 (79.5%) had their last injection within 67 days, as prescribed. Among the 24 people who stopped CAB injections, 16 went back to oral PrEP, 2 did not switch back, and 6 were lost to care. The investigators attributed most CAB PrEP discontinuations to insurance coverage gaps or side effects, and less often to work schedule conflicts.
Among 38 people who got at least 1 CAB shot but had not used oral PrEP, 33 (87%) got their last shot within 67 days. Among the 138 people prescribed CAB PrEP but never getting a shot, 122 (88%) had used oral PrEP and the rest had not.
Of the 155 people who got at least one shot, 57 (37%) were non-Hispanic white, 39 (25%) non-Hispanic black, 35 (23%) Hispanic white, and 2 (1.3%) Hispanic black. (The rest did not specify race or ethnicity, or that information was not available.) Of the 138 people prescribed CAB PrEP but never getting a shot, 40 (29%) were non-Hispanic white, 47 (34%) non-Hispanic black, 25 (18%) Hispanic white, and 4 (3%) Hispanic black.
Reference
1. Altamirano JA, Shukla P, Barnett SK. Early real-world experience in long-acting cabotegravir (CAB) for HIV pre-exposure prophylaxis (PrEP) in a large community-based clinic network (CAN Community Health): utilization and PrEP persistence. IDWeek 2023, October 11-15, 2023, Boston.
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