A groundbreaking study from the Medical University of South Carolina (MUSC) has demonstrated that long-acting injectable antiretroviral therapy (ART) for HIV can be safely and effectively administered in patients' homes, potentially removing significant barriers to treatment access.
The research, published in Clinical Infectious Diseases, found that home administration by healthcare professionals achieved the same safety, efficacy, and patient satisfaction levels as traditional clinic-based administration.
Addressing Treatment Access Barriers
"This project was designed at the time that injectable treatment for HIV infection received approval, and so we were inspired to try to think of new ways for the persons we care for to be able to access it," explained Dr. Eric Meissner, associate professor in the MUSC College of Medicine and lead investigator.
Transportation challenges represent a significant barrier to healthcare access in the United States. According to the American Hospital Association, approximately 3.6 million Americans miss necessary medical care due to transportation issues—including lack of vehicle access, inadequate infrastructure, long distances to healthcare facilities, and associated costs.
For HIV patients specifically, these barriers can impact adherence to antiretroviral therapy, which is crucial for achieving viral suppression and preventing disease progression.
Study Design and Patient Demographics
The non-randomized, observational study enrolled 33 patients prescribed injectable cabotegravir plus rilpivirine (CAB/RPV) at MUSC's Infectious Diseases clinic between August 2021 and December 2022.
The cohort was 64% Black and 73% male, with a median age of 46 years. Participants were offered the choice of receiving their injections either at the clinic (18 patients) or at home (15 patients). Most participants maintained their initial treatment setting preference throughout the study period.
Implementation and Logistics
For home administration, the research team coordinated with pharmacies to mail medications directly to patients, who stored them in their refrigerators until a licensed practical nurse (LPN) visited to administer the injection. Notably, the same nurse typically administered treatments to the same patients, creating continuity of care that contributed to high satisfaction rates.
"Convenience was far and away the most commonly stated reason driving the preference for where to receive treatment," Dr. Meissner noted. "I think that relates to the fact that a significant percentage of our cohort doesn't live right next to our clinic. Many may have difficulty with the time and the logistics of transportation required to come to our downtown clinic."
Equivalent Outcomes Between Settings
The study results were definitive: after 12 months of treatment, all patients in both groups achieved virologic suppression. There were no significant differences in safety profiles between the two administration settings.
Approximately 52% of patients in both groups experienced injection site pain or soreness, but no serious adverse events were reported. Patient satisfaction scores were equally high across both treatment settings.
Three patients discontinued CAB/RPV during the study period and switched to oral ART due to allergy, loss of virologic suppression, and visit adherence challenges.
Evolution of HIV Treatment
The development of long-acting injectable ART represents a significant advancement in HIV care. Traditional oral ART requires daily medication, which can be burdensome for some patients and may lead to adherence challenges.
Long-acting injectable formulations, initially administered monthly but now available as bimonthly injections, have been shown to improve adherence and clinical outcomes for patients who struggle with daily oral medications.
According to the Centers for Disease Control and Prevention, fewer than 65% of people living with HIV in the U.S. achieved undetectable viral loads in 2022, highlighting the need for alternative treatment approaches that can improve adherence.
Implementation Challenges
Despite the promising results, implementing home-based administration of long-acting injectable HIV therapy faces significant hurdles. The process requires substantial coordination between healthcare providers, pharmacies, and nursing staff.
"As to administering injectable HIV treatment in someone's home, we found it to be safe, feasible and associated with high satisfaction for the people who elected to receive it there," said Dr. Meissner. "And so I'm enthusiastic for continued systematic and infrastructure-based efforts to provide people with more choices about where to receive this treatment."
A major obstacle to widespread adoption is the lack of insurance reimbursement for the additional logistical steps required for home administration. Without financial support for these services, healthcare providers may be unable to offer this option to patients who could benefit from it.
Future Implications
The study demonstrates that home-based administration of long-acting injectable HIV therapy is a viable alternative to clinic-based care, potentially expanding treatment access for patients facing transportation or other logistical barriers.
If reimbursement and logistical challenges can be addressed, this approach could help increase the percentage of HIV patients achieving viral suppression, ultimately improving individual health outcomes and reducing community transmission rates.
The findings also suggest that similar home-based approaches might be beneficial for other chronic conditions requiring regular injectable medications, potentially transforming care delivery models beyond HIV treatment.
