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Real-world implementation of long-acting injectable cabotegravir and rilpivirine: healthcare providers' perspectives and experiences
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EACS 2025 Oct 15-18 Paris
Abstract
Purpose: Evidence on the real-world implementation of long-acting (LA) injectable cabotegravir (CAB) and rilpivirine (RPV) in clinical settings remains limited. This mixed-methods study sought to explore healthcare providers' perceptions and experiences delivering LA-CAB/RPV, with the aim of informing best practices and facilitating evidence-based adoption of injectable antiretroviral therapy.
Method: In-depth, semi-structured, qualitative focus groups were conducted with UK healthcare providers involved in the delivery of LA-CAB/RPV. Verbatim pseudonymised transcripts were analysed using reflexive thematic analysis. Likert scales were used to assess satisfaction.
Results: Five focus groups were conducted with healthcare professionals (n = 19) from 5 UK HIV services involved in delivering LA-CAB/RPV. This included: 8 (42%) nurses, 6 (32%) pharmacists and 5 (26%) HIV physicians. Five main themes were identified: 1) Perceived clinical and psychosocial benefits - healthcare providers described LA-CAB/RPV as a transformative option that enhances adherence, reduces stigma and improves psychosocial wellbeing for certain people; 2) Navigating service delivery challenges - the integration of LA-CAB/RPV into routine care revealed tensions between clinical potential and structural limitations, including staffing, and scheduling constraints; 3) Clinical vigilance and the management of uncertainty - providers relied upon clinical judgement and careful monitoring amid concerns about resistance, tolerability and limited evidence in certain populations; 4) Developing confidence through practice, collaboration, and process - professional confidence in delivering LA-CAB/RPV evolved through hands-on training, multidisciplinary teamwork and structured pathway development; and 5) Engagement in context: awareness, demand, and decision-making - interest in LA-CAB/RPV was shaped by treatment fatigue, stigma, community narratives, and structural inequities, prompting reflection on how and to whom the regimen is offered. Median Likert score was 6/7 demonstrating high levels of satisfaction.
Conclusions: This study underscores the transformative potential of LA-CAB/RPV while revealing the practical, individual, and structural complexities of real-world implementation and the need for adaptable systems and sustained support to optimise delivery and uptake.
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