Interest, Preference, and Uptake of Long Acting ART among PLWH in Florida

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Project Summary A newly approved long-acting injectable (LAI) form of antiretroviral therapy (ART) is now available, and several other long-acting formulations are in development. These provide new tools to achieve the ambitious goals described in the initiative to End the HIV Epidemic in the United States by helping more people living with HIV (PLWH) achieve durable viral suppression. Because alcohol use is associated with decreased adherence, these treatments may be especially helpful among PLWH who drink. The impact of these exciting new treatments will be proportional to their uptake, which will be affected by both individual preferences and systemic factors. Previous studies have shown high levels of interest in LAI-ART but have not generally accounted for systemic factors that may hinder LAI-ART uptake. The long-term goal of the proposed research is to inform programs to improve ART adherence for PLWH. To help achieve this goal, the aims of this F31 grant are to: 1) determine which individual- and interpersonal-level factors are associated with preferences for a quarterly LAI-ART over taking daily pills in PLWH, focusing on populations with lower ART adherence and at- risk drinking, using existing data from the Florida Cohort study; 2) describe PLWH’s preferences for long-acting ART (LA-ART) formulations and determine which treatment attributes drive these preferences by implementing a best-best discrete choice experiment and explore whether preferences vary by drinking status and viral suppression; and 3) to conduct in-depth qualitative interviews with 20 stakeholders involved in HIV medication procurement and prescribing (e.g., HIV-care providers and clinician administrators) to gain insight into their attitudes towards and prescribing preferences of different LA-ART formulations, how these are impacted by patients’ alcohol use, systems-level barriers and facilitators of prescribing LA-ART, and how these visits can be used to increase the accessibility of alcohol-related care. Conducting this study will help me develop cross- cutting skills to achieve my long-term career goals of designing programs to improve health outcomes for PLWH, especially those who drink by focusing on: 1) measuring of individual preferences and decision-making related to health, 2) obtaining expertise in qualitative data collection and analysis, 3) gaining a better understanding of public healthcare financing related to HIV treatment and substance use, 4) learning skills related to professional and career development, and 5) responsible conduct of research. This study will leverage the ongoing Florida Cohort study, which is enrolling a diverse population of adult PLWH, and collaborations between Southern HIV and Alcohol Research Consortium and the Florida Department of Health and HIV care providers. These data can inform funding allocation and policy changes to support these ART preferences and can be extrapolated to treatments for alcohol and other substance use disorders to help focus development of novel medications or develop programs to help better integrate HIV care and alcohol-related treatment.