Projected benefits of long-acting antiretroviral therapy in non-suppressed people with HIV experiencing adherence barriers

Abstract Background In a demonstration project, long-acting, injectable antiretroviral therapy (LA-ART) with cabotegravir-rilpivirine (CAB-RPV) achieved viral suppression in high proportion of people HIV (PWH) who were virologically non-suppressed due to adherence barriers. We projected the long-term impact CAB-RPV for PWH unable adhere oral ART. Methods Using CEPAC model, we compared three strategies: 1) Standard care using integrase inhibitor-based ART (INSTI), 2) INSTI-based supportive social services (‘wraparound services,’ [WS]) (INSTI/WS), 3) WS (CAB-RPV/WS). Model outcomes included (%) and engagement at 3y, life expectancy (life years, LYs). Base case cohort characteristics included: mean age 47y (SD 10y), 90% male birth, baseline CD4 150/µl 75/µl). Viral 3 m was 13% 28% 60% Mean loss follow-up without 28/100PY 2/100PY) 16/100PY 1/100PY) WS. Results Projected 3y would vary widely: 16% 38% 44% (CAB-RPV/WS); be 7.4LY 9.0LY 9.4LY benefits over greater initiating CAB-RPV/WS lower counts. improve INSTI strategies when key parameters varied within plausible ranges. Conclusions These model-based results support that long-acting extensive barriers is likely increase survival. A prospective study provide further evidence needed.