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CAB-LA for PrEP Earns High Satisfaction Rates (90%) in Rural Kenya and Uganda
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AIDS 2024, July 22-26, 2024, Munich
Mark Mascolini
More than 90% of rural Kenyan and Ugandan women and men claimed to be satisfied or very satisfied with injected long-acting cabotegravir (CAB-LA) for pre-exposure prophylaxis (PrEP) against HIV after 48 weeks of use in the SEARCH Dynamic Choice HIV Prevention trial [1]. Results proved similar in people 15 to 24 years old and those 25 or older.
SEARCH offered CAB-LA, oral PrEP, or postexposure prophylaxis (PEP) in a dynamic choice prevention (DCP) model or standard of care to 984 people at risk for HIV infection in Kenya and Uganda [2]. Average prevention coverage time proved significantly higher in the DCP group than the standard-of-care group (70% vs 13%, P < 0.001). The DCP group acquired no HIV infections through 48 weeks, whereas 1.8% randomized to standard of care got infected (P = 0.01).
An extension study analysis of SEARCH presented at AIDS 2024 evaluated knowledge, awareness, feasibility, and acceptability of CAB-LA among people who chose CAB-LA in the trial [1]. Participants had to be at least 15 years old, HIV-negative by rapid test, and at risk for HIV by self-report, and all got at least 1 CAB-LA dose.
During the trial participants could switch prevention strategy based on changing preference or HIV risk. DCP participants received "person-centered care," which meant structured assessment of barriers to HIV prevention, personalized plans, phone access to a clinician, and psychosocial support. Participants came from government antenatal and outpatient clinics and from the community at large. They completed a structured survey before starting the study and 24 and 48 weeks after their first CAB-LA injection.
Almost all eligible participants opting for CAB-LA, 98% (269 of 274), completed the baseline survey, and similar high proportions completed the week-24 survey (99%, 207 of 209) and the week-48 survey (98%, 185 of 188). Among the 274 people using CAB-LA, 183 (67%) were women and 91 (33%) men. Similarly high proportions of women (70%) and men (73%) were 25 or older. And high proportions of women (86%) and men (78%) were married and living together rather than single or divorced.
The most frequent reasons for picking CAB-LA over oral PrEP or PEP were the greater ease of getting a shot than taking pills (64%) and difficulty remembering to take pills (49%). (Respondents could choose more than one reason.) Other factors inclining people toward CAB-LA were avoiding pills because others would know you are taking them (30%), side effects of pills (18%), and partners or friends not letting you take pills (16%).
Almost all participants, 99%, had basic or no knowledge about CAB-LA when they entered the study, regardless of gender or age (25 or older vs younger). When SEARCH began, about 90% of both women and men said none of their friends knew about CAB-LA. But by week 24, more than 70% of participants had "few to some" or "many to most" friends who heard about the long-acting HIV prevention shot.
After 24 weeks in the trial, about 30% of women and men cited side effects as the biggest barrier to starting CAB-LA (compared with 40% to 50% who feared side effects before starting CAB-LA). About 30% of women and 15% of men listed forgetting appointments as their greatest challenge at week 24. About 20% of men and 10% of women cited travel as a barrier after 24 weeks.
At 24 weeks, 9 in 10 women and men rated taking CAB-LA easy to very easy. Those results did not differ much by age group (25 or older vs younger). Over 90% of women and men at both week 24 and week 48 felt satisfied or very satisfied with CAB-LA. Again, that high response rate differed hardly at all by age group. More than 90% of women and men called themselves likely or extremely likely to recommend CAB-LA to friends, and age group did not affect that response rate.
The SEARCH investigators summarized their findings as showing that CAB-LA was a popular HIV prevention choice among both women and men in rural Kenya and Uganda. Offered in a person-centered HIV prevention model, CAB-LA proved a highly feasible and acceptable PrEP for both women and men and both young adults and those 25 or older. Participants' experience with CAB-LA (anticipated versus actual side effects, ease of use) got better over time, as participant and community awareness of this HIV prevention tactic grew.
Knowledge, awareness, feasibility, and acceptability of long-acting Cabotegravir for HIV prevention: results from the SEARCH Dynamic Choice HIV prevention trial - (07/28/24)
References
1. Kakande E, Balzer L, Kabami J, et al. Knowledge, awareness, feasibility, and acceptability of long-acting cabotegravir for HIV prevention: results from the SEARCH Dynamic Choice HIV prevention trial. AIDS 2024, July 22-26, 2024, Munich. Abstract OAE1203.
2. Kamya MR, Balzer LB, Ayieko J, et al. Randomized trial of SEARCH Dynamic Choice HIV Prevention including injectable cabotegravir (CAB-LA). CROI 2024.March 3-6, 2024, Denver. Abstract 172.
https://www.croiconference.org/abstract/randomized-trial-of-search-dynamic-choice-hiv-prevention-including-injectable-cabotegravir-cab-la/
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