The Long-Acting Cabotegravir Tail as an Implementation Challenge: Planning for Safe Discontinuation

Kathrine Meyers; Nadia Nguyen; Jason E. Zucker; Bryan A. Kutner; Caroline Carnevale; Delivette Castor; Magdalena E. Sobieszczyk; Michael T. Yin; Sarit A. Golub; Robert H. Remien

doi:10.1007/s10461-022-03816-0

The Long-Acting Cabotegravir Tail as an Implementation Challenge: Planning for Safe Discontinuation

Kathrine Meyers, Nadia Nguyen, Jason E. Zucker, Bryan A. Kutner, Caroline Carnevale, Delivette Castor, Magdalena E. Sobieszczyk, Michael T. Yin, Sarit A. Golub, Robert H. Remien

Research output: Contribution to journal › Comment/debate › peer-review

2 Scopus citations

Abstract

The long-acting feature of cabotegravir, an integrase-inhibitor highly effective in preventing acquisition of HIV in adolescents and adults, is both its greatest strength and a challenge to its implementation. Cab-LA is administered at 8-week intervals (after an initial loading dose) but has a long, variable drug “tail” that may leave users vulnerable to future drug resistance if they contract HIV during this critical period. The potential for cab-LA to meaningfully contribute to ending the HIV Epidemic is hindered by, among other factors, limited resources to guide patients and providers on how to safely discontinue injections. We suggest three key strategies to overcome this specific challenge: (1) Comprehensive patient education and counseling about the drug tail; (2) Training and coaching PrEP care teams, including clinical and non-clinical staff, on communication around the tail; (3) Adherence support strategies, including monitoring of cabotegravir drug levels after discontinuation, for a personalized medicine approach to safe discontinuation.

Original language	English (US)
Pages (from-to)	4-9
Number of pages	6
Journal	AIDS and Behavior
Volume	27
Issue number	1
DOIs	https://doi.org/10.1007/s10461-022-03816-0
State	Published - Jan 2023
Externally published	Yes

Keywords

PrEP
cabotegravir
drug level monitoring
implementation

ASJC Scopus subject areas

Social Psychology
Public Health, Environmental and Occupational Health
Infectious Diseases

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s10461-022-03816-0

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title = "The Long-Acting Cabotegravir Tail as an Implementation Challenge: Planning for Safe Discontinuation",

abstract = "The long-acting feature of cabotegravir, an integrase-inhibitor highly effective in preventing acquisition of HIV in adolescents and adults, is both its greatest strength and a challenge to its implementation. Cab-LA is administered at 8-week intervals (after an initial loading dose) but has a long, variable drug “tail” that may leave users vulnerable to future drug resistance if they contract HIV during this critical period. The potential for cab-LA to meaningfully contribute to ending the HIV Epidemic is hindered by, among other factors, limited resources to guide patients and providers on how to safely discontinue injections. We suggest three key strategies to overcome this specific challenge: (1) Comprehensive patient education and counseling about the drug tail; (2) Training and coaching PrEP care teams, including clinical and non-clinical staff, on communication around the tail; (3) Adherence support strategies, including monitoring of cabotegravir drug levels after discontinuation, for a personalized medicine approach to safe discontinuation.",

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T2 - Planning for Safe Discontinuation

AU - Meyers, Kathrine

AU - Nguyen, Nadia

AU - Zucker, Jason E.

AU - Kutner, Bryan A.

AU - Carnevale, Caroline

AU - Castor, Delivette

AU - Sobieszczyk, Magdalena E.

AU - Yin, Michael T.

AU - Golub, Sarit A.

AU - Remien, Robert H.

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N2 - The long-acting feature of cabotegravir, an integrase-inhibitor highly effective in preventing acquisition of HIV in adolescents and adults, is both its greatest strength and a challenge to its implementation. Cab-LA is administered at 8-week intervals (after an initial loading dose) but has a long, variable drug “tail” that may leave users vulnerable to future drug resistance if they contract HIV during this critical period. The potential for cab-LA to meaningfully contribute to ending the HIV Epidemic is hindered by, among other factors, limited resources to guide patients and providers on how to safely discontinue injections. We suggest three key strategies to overcome this specific challenge: (1) Comprehensive patient education and counseling about the drug tail; (2) Training and coaching PrEP care teams, including clinical and non-clinical staff, on communication around the tail; (3) Adherence support strategies, including monitoring of cabotegravir drug levels after discontinuation, for a personalized medicine approach to safe discontinuation.

AB - The long-acting feature of cabotegravir, an integrase-inhibitor highly effective in preventing acquisition of HIV in adolescents and adults, is both its greatest strength and a challenge to its implementation. Cab-LA is administered at 8-week intervals (after an initial loading dose) but has a long, variable drug “tail” that may leave users vulnerable to future drug resistance if they contract HIV during this critical period. The potential for cab-LA to meaningfully contribute to ending the HIV Epidemic is hindered by, among other factors, limited resources to guide patients and providers on how to safely discontinue injections. We suggest three key strategies to overcome this specific challenge: (1) Comprehensive patient education and counseling about the drug tail; (2) Training and coaching PrEP care teams, including clinical and non-clinical staff, on communication around the tail; (3) Adherence support strategies, including monitoring of cabotegravir drug levels after discontinuation, for a personalized medicine approach to safe discontinuation.

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The Long-Acting Cabotegravir Tail as an Implementation Challenge: Planning for Safe Discontinuation

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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