1024. Real-world Adherence and Persistence with Long-Acting Cabotegravir Plus Rilpivirine (CAB+RPV LA) Compared to Oral Antiretroviral Therapy (ART) Among People with HIV (PWH) in the US: The ABOVE Study
Authors: Garris Cindy , Desai Raj , Chang Rose , Clear Louise , Chen Zhuo , Liu Daisy , DerSarkissian Maral , Teichner Paula , Overton Edgar T 
Published: November 2023

Abstract

Background
CAB+RPV LA is the only complete long-acting regimen for treatment of virologically suppressed PWH. Administered monthly or every 2 months by a healthcare provider, CAB+RPV LA may alleviate adherence challenges with daily oral therapy. The ABOVE study evaluated real-world adherence and persistence to CAB+RPV LA versus remaining on oral ART regimens.

Methods
ABOVE was a retrospective US cohort study using Symphony Health Solutions Integrated Dataverse administrative claims database from 01/01/2020 to 12/31/2022. PWH ≥12 years of age on stable guideline-recommended oral ART were categorized into those initiating CAB+RPV LA and those remaining on oral ART. Index date was defined as first injection between 01/01/2021 and 6/30/2022 (CAB+RPV LA cohort) or imputed for the oral ART cohort. PWH were required to have ≥6 months of follow-up after index. Standardized mortality ratio (SMR) weights were generated based on propensity scores to balance baseline characteristics between cohorts. Adherence (proportion of days covered (PDC) ≥0.9 over 6-months following index) and persistence to the index regimen (days from index to the earliest of treatment discontinuation or end of follow-up) were compared. Logistic regression model was used to estimate the odds ratio (OR) and 95% confidence interval (CI) for adherence.

Results
393,484 PWH were identified during the study period. After applying eligibility criteria, 130,362 in the oral ART cohort (N=950 after weighting) and 947 in the CAB+RPV LA cohort comprised the analysis sample. Key baseline characteristics were balanced post SMR weighting (Table 1). Majority of CAB+RPV LA dosing was every two months only (50%) or switched from monthly to every two months (33%). A higher proportion of PWH in the CAB+RPV LA cohort were adherent (72% vs 43%, p&lt; 0.001) and had higher persistence (274 vs 256 days, p&lt; 0.001) compared with the oral ART cohort (Table 2). PWH in the CAB+RPV LA cohort had significantly higher adjusted odds of being adherent compared to the oral ART cohort (OR: 4.43, 95% CI: 2.38, 8.24, p&lt; 0.001).

Conclusion
These data demonstrate that, among US PWH on stable oral ART, switching to long-acting ART resulted in significantly higher adherence and persistence, a critical aspect of long-term success of HIV treatment, compared with remaining on oral ART.

Disclosures
Cindy Garris, MS, GSK: Stocks/Bonds|ViiV Healthcare: Employee Raj Desai, PhD, Analysis Group, Inc: Employment|ViiV Healthcare: Grant/Research Support Rose Chang, ScD, Analysis Group, Inc.: Employee|ViiV Healthcare: Grant/Research Support Louise Clear, MPH, Analysis Group, Inc.: Employment|ViiV Healthcare: Grant/Research Support Zhuo Chen, MPH, Analysis Group, Inc.: Employment|ViiV Healthcare: Grant/Research Support Daisy Liu, MS, Analysis Group, Inc.: Employment|ViiV Healthcare: Grant/Research Support Maral DerSarkissian, PhD, Analysis Group, Inc: Employment|ViiV Healthcare: Grant/Research Support Paula Teichner, PharmD, GlaxoSmithKline: Stocks/Bonds|ViiV Healthcare: Employment Edgar T. Overton, MD, ViiV Healthcare: Employment|ViiV Healthcare: Stocks/Bonds