Accelerating Implementation of Long-Acting Injectables

Background

FDA approval of the first long-acting injectable (LAI) antiretroviral (ARV) medication formulation heralds a new era of HIV treatment. LAI ARV formulations have the potential to dramatically transform HIV care delivery by providing a treatment option that is discrete, long acting, does not require adherence to a daily oral medication, and can reduce stigma. However, introducing LAI ARV to new settings and delivering it to people with HIV (PWH) at scale in a way that advances health equity requires significant investment to overcome logistical, financial, clinical, and psychosocial barriers. Without targeted interventions designed specifically to help clinics implement and sustain LAI ARV programs among priority populations, only the most resourced clinics and the most resourced patients will have access to this important discovery, thereby exacerbating rather than ameliorating health disparities. 

Methods

The project – “Accelerating Implementation of Multilevel-strategies to Advance Long-Acting Injectables for Underserved Populations” (The ALAI UP Project) – will support the implementation and delivery of LAI ARV at 10 demonstration sites in EHE jurisdictions in New York City (NYC) and the Southeast (SE) region of the US providing care to underserved populations and communities of color. 

The ultimate goal of ALAI UP is to increase access to and uptake of LAI ARV in areas most impacted by the HIV epidemic. Expanding access to LAI ARV at these sites will help reduce HIV-related health inequities in achieving and maintaining viral suppression among priority populations. This goal will be achieved through the formation of a multidisciplinary Coordination and Evaluation Provider (CEP) drawn from:

• Aaron Diamond AIDS Research Center (ADARC)
• Division of Infectious Diseases, and Psychiatry at Columbia University Irving Medical Center
• NYC Department of Health and Mental Hygiene’s Bureau of Hepatitis, HIV, and Sexually Transmitted Infections
• Southeast Regional AIDS Education and Training Center housed at Vanderbilt
• Hunter Alliance for Research and Translation at Hunter College of the City University of New York. 

With expertise in clinical, behavioral, and implementation science and extensive training, capacity building, and evaluation experience – and with critical input from the ALAI UP Advisory Board which includes people with diverse lived experiences and local community members – the CEP will support demonstration sites to implement, deliver, and ultimately sustain provision of LAI ARV through:

1. The co-development of protocols and implementation resources
2. The delivery of technical assistance (TA) on how to use these resources
3. Provider capacity building to increase provider and patient demand for LAI ARV
4. A rigorous monitoring and evaluation plan to inform continuous quality improvement

Cumulatively, ALAI UP’s activities will help reduce HIV-related health inequities among priority populations, with a primary goal of ensuring all persons with HIV have access to high-quality treatment and care that is non-stigmatizing, culturally sensitive, and aligns with evidence-based standards of care.