The Expand Study-Pharmacist Administered Long Acting Cabotegravir + Rilpivirine to Expand Access for People With HIV

The EXPAND study will involve three phases:

Phase 1 A care delivery model incorporating pharmacist administered CAB+RPV LA at satellite pharmacies will be developed using codesign. A core group of stakeholders will be engaged in codesigning the intervention. Stakeholders will include HIV physicians, HIV nurses, electronic health record informatics experts, pharmacists, and 3 PWH who are currently receiving CAB+RPV LA. Engaging with patients in codesign ensures patient experience and input is incorporated since the primary goal is improving their health. Bringing stakeholders together to generate solutions ahead of the implementation significantly impacts buy-in.

Codesign team meetings will be convened as hybrid one hour meetings, i.e., in person with option for attendance via virtual platform - Webex or Zoom. There will be 5-6 design team meetings. Number of meetings will depend on progress towards producing a process map outlining the pharmacist administered CAB+RPV LA model of care. Content of meetings will include: introduction to codesign and EXPAND; establishment of current workflow for CAB+RPV LA administration by nurse in clinic; determination of essential components; production of process map outlining pharmacist administered CAB+RPV LA work flow; outlining changes from prior work flow to inform clinical staff education, make changes to electronic health record tools. The final process map will be sent to design team members for verification and additional recommendations.

After the design team work is complete, semi-structured interviews with design team members will be conducted to evaluate the codesign process to improve codesign internally and disseminate findings to inform best practices for conducting codesign activities for models of HIV care delivery and treatment for HIV. These interviews will be performed by trained interviewers from the Population Health Institute at MH. Interviews will take place by phone or in a private room, and audio recordings will later be transcribed verbatim.

Phase 2 After completion of codesign process, a single arm, pilot study of the pharmacist administered CAB+RPV LA model will be performed at a pilot site. Four patient participants with diverse backgrounds will be enrolled and all will receive their CAB+RPV LA in the pharmacist administered CAB+RPV LA model. After 1 dose of CAB+RPV LA are administered by a pharmacist at a satellite MetroHealth pharmacy, semi-structured in-depth qualitative interviews with each participant, pharmacist, and nurse post-pilot will inform the final pharmacist administered CAB+RPV LA model.