Development of a Home-Based Pre-Exposure Prophylaxis Care Delivery System for Long Acting Injectable Cabotegravir: A Formative Exploration of Patient Preferences Público

Abstract

Background: CAB-LA – the only FDA-approved injectable PrEP – is effective and has the potential to address PrEP inequities impacting Black and Latino sexual minority men (SMM). Uptake of CAB-LA may require the development of innovative care delivery strategies, including home-based settings.   

 

Objective: We aim to explore SMM perceptions on a future home-based CAB-LA PrEP care service delivery which will serve as guidance for the adaptation of an existing home-based oral PrEP system into an intervention that includes injectable PrEP.      

 

Methods: We conducted 14 IDIs on SMM ages 20-29 who were current or prior participants of a clinical trial evaluating the efficacy of a home-based system for oral PrEP care (PrEP@Home). We explored their overall acceptability of a home-based injectable PrEP system, communication preferences, and specific pre-visit , in-visit , and post-visit logistics.

 

Results: The home-based CAB-LA delivery system was well accepted. We identified that convenience and comfortability were the main drivers of acceptability of the home-based system. Factors influencing acceptability included clinical teams’ affiliation with a healthcare system, a two-person team with certified credentials, and being able to verify the staff’s identity. Logistical preferences included receiving complete information prior to the visit, flexible scheduling hours, and text message communication for user information. Concerns to privacy, safety, and potential costs were also identified.

 

Conclusions: Our findings demonstrate the acceptability of home-based injectable PrEP delivery system among SMM and highlight influencing factors of acceptability, logistical considerations, and concerns for implementation. These insights can inform future implementation methods for CAB-LA and contribute to the adoption of a home-based delivery system ensuring equitable access to injectable PrEP. 

Table of Contents

Table of Tables and Figures

Abbreviations

Chapter 1: Introduction 1

Background Information: 1

Problem Statement: 2

Research Objective: 2 

Significance Statement: 3

Chapter 2: Literature Review 4

HIV 4

PrEP 5

PrEP Disparities 7

PrEP Barriers 10 

National Non Clinic-Based PrEP Delivery Services 13

Global Non Clinic-Based PrEP Delivery Services 15

Home-Based Care: 15

CAB-LA PrEP 18

CAB-LA Implementation Barriers 20

Home-Based CAB-LA PrEP Care 21

Chapter 3: Manuscript 22

ABSTRACT 23

INTRODUCTION 24 

METHODS 25

RESULTS 27

DISCUSSION 40 

Chapter 4: Conclusion & Recommendations 43

References 45 

Appendices 50 

Appendix I: Semi-structured Interview Guide 50

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Palavra-chave	Injectable PrEP Home-based system Patient preferences CAB-LA PrEP Sexual minority men
Committee Chair / Thesis Advisor	Cantos, Valeria, Emory University Rebolledo, Paulina, Emory University

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