Significant Barriers Keep Patients from Adopting Injectable PrEP

Though injectable versions of pre-exposure prophylaxis (PrEP) can be more convenient than a daily pill, a new qualitative study of patient perceptions suggests physicians have a key role to play in educating patients and overcoming potential barriers to usage.

The report was published in Open Forum Infectious Diseases.

It has been a decade since the FDA gave approval to emtricitabine/tenofovir disoproxil fumarate (Truvada) as a method to reduce the risk of HIV infection in high-risk individuals. The drug, which was originally approved as part of an HIV therapy combination in 2004, was found to significantly reduce the risk of HIV infection when taken as a once-daily pill.

In the years since, PrEP has become an important part of HIV mitigation strategies in many jurisdictions. Yet, the high adherence stakes of a once-daily pill have prompted drug developers to seek different formulations that might make it easier for patients to gain the protections of PrEP without the burden of daily adherence.

Just last year, the FDA granted approval to a cabotegravir extended-release injectable suspension (Apretude), which became the first-ever injectable version of PrEP to receive the agency’s go-ahead. The prophylactic is administered in two initiation doses one month apart, and then patients only need one injection every two months in order to sustain protection.

In the new report, Seth Welles, PhD, ScD, of Drexel University, and colleagues, sought to find out which factors and characteristics might cause patients to be more or less receptive to an injectable version of PrEP. They specifically focused on a group considered to be at high risk of HIV infection, men who have sex with men.

The authors recruited 28 men who lived in the Philadelphia area, 8 of whom were Black, 10 of whom were Latinx, and 10 of whom were White. The participants were asked to participate in a mix of semi-structured interviews and focus groups.

“Focus groups were kept racially and ethnically homogenous to identify differences in emerging themes related to PrEP willingness and preferences for specific prevention modalities,” the authors said.

The investigators found a diversity of opinions with regard to daily oral pills versus long-acting injectable versions of PrEP.

“The main perceived facilitator for PrEP included convenience of use such as having fewer concerns with adhering to daily pills,” Welles and colleagues wrote.

Patients were less willing to try the injectable version if they disliked needles, and some patients worried about potential side effects or whether the treatment might be less effective.

Notably, Welles and colleagues said Black and Latinx participants were more likely to report experiencing racism and discrimination in the healthcare system, but the investigators said those groups were also more open to injectable PrEP provided they were given in-depth information by their healthcare providers.

“Our findings provide important guidance for the development and promotion of future strategies to enhance the uptake of long-acting injectable PrEP to address the HIV epidemic among MSM,” they wrote.

The main takeaway, they said, is that providers have a key role to play, not only in educating high-risk patients about PrEP in general, but also in helping them understand the options available to them, including the dosing, efficacy, and safety of the different options.