Antiretroviral therapy (ART) for viral suppression in people living with HIV (PWH) improves life expectancy and interrupts transmission. And new long-acting ART injectables have become a convenient treatment, helping overcome the burden of pills and the stigma associated with taking daily medication. But while there has been a 68% reduction in AIDS-related deaths since 2010, progress in making the world AIDS-free has slowed, further impacted by the COVID-19 pandemic. Nearly half of all new HIV infections are attributable to contact with persons with HIV, who are aware of their HIV status but not receiving HIV care. That number could be as high as 75% in North Carolina.
Sarah Rutstein, MD, PhD, an implementation scientist with the Institute for Global Health and Infectious Diseases, has received an NIH R34 multi-year grant to conduct a pilot study for this population–people with HIV who have struggled to remain in care in North Carolina. Field-based care delivery is an effective strategy for reaching persons with HIV who are out of care, and community-delivered ART has been a pillar of HIV care in other parts of the world. When paired with novel longer-acting injectable (LAI) HIV treatment, dosed every two months instead of every day, HIV viral replication could be effectively suppressed.
“Ending the HIV epidemic is not going to be possible without engaging people with HIV (PWH) who are out of care and not virally suppressed, particularly in rural regions of the US where the epidemic continues to expand,” said Dr. Rutstein, an assistant professor of infectious diseases.
“This study will comprehensively evaluate the potential for field-based delivery of novel, long-acting anti-HIV medication for this high-priority population of PWH across North Carolina. Our outcomes lay the groundwork for future state-wide or regional implementation science trials.”
Leveraging longstanding community and public health collaborations, Rutstein, with co-investigators Cindy Gay, MD, MPH, and Lauren Hill, PhD, plan to conduct interviews and workshops to refine strategies for delivering field-based injectable HIV treatment, and then examine the acceptability, feasibility, and impact on HIV viral suppression in a pilot study among persons with HIV who are out of care across the state. The project will include formative work, procedural and protocol co-production, and pilot testing, while engaging key agents in the patient, clinic, community, and policymaking sectors.