Whether for treatment or prevention, women's interest in injectable antiretrovirals varied according to their relationship with the injection.
Half of the women surveyed would prefer injectable HIV treatment and prevention. But a significant minority said they were also not interested in more injections. Furthermore, women with a history of injecting drug use were concerned that receiving the injections could lead to a return to unwanted drug use.
These are the results of a qualitative study of 59 women living with HIV and 30 women who might qualify for HIV pre-exposure prophylaxis (PrEP). The findings were published in the journal AIDS Patient Care and STDs .
The study comes as drug manufacturers race to be the first to market long-acting drugs for the treatment and prevention of HIV.
ViiV Healthcare's cabotegravir is being tested as a monthly injectable for prevention in several trials, as well as for treatment in combination with rilpivirine under the brand name Cabenuva . Injectable cabotegravir and rilpivirine were approved for treatment in Europe last month, but the Food and Drug Administration (FDA) has yet to approve Cabenuva, following a false start in 2019.
Meanwhile, Merck is developing its new antiretroviral drug, islatravir, as a weekly pill for HIV treatment and as monthly injections and an implant for prevention.
As cabotegravir injections near FDA approval, researchers have begun to question whether cisgender and transgender women will accept them. Such studies are important after the FDA approved Descovy for HIV prevention, but not for people exposed through vaginal sex, citing a lack of research on the pill in women.
So Morgan Philbin, PhD, of Columbia Mailman School of Public Health, and her colleagues, conducted in-depth interviews with 89 women in New York City, Washington, DC, Atlanta, Chicago, San Francisco, and Chapel Hill, North Carolina, about their past experience with injections and how that might influence their interest in receiving injectable treatment or prevention medications.
The women were generally older (median age 51), African American (76%), mothers (78%), and publicly insured (82%). A significant minority of women, 47%, had incomes below $12,000 per year. The study did not identify whether the women were cisgender or transgender.
Two-thirds of the women had received injections in some form during their lives, ranging from flu shots (72%) to Depo-Provera for contraception (27%) and other medications for diabetes or other conditions (62%). More than half of the women (55%) had used illegal drugs at some point, but only 15% of them had a history of injecting drug use; only one woman reported currently injecting drugs. Nearly one in five of the women (19%) received regular medication injections.
Overall, half of the women living with HIV and 58% of the women who were candidates for PrEP expressed interest in using a long-acting medication. But those findings were broken down by their injection history:
- Women with limited experience with drug injections, such as contraceptives or disease control, had few concerns about long-acting injectable HIV treatment or prevention.
- Women who frequently had to inject themselves to control diabetes or other conditions were not interested in receiving more injections, even for long-acting HIV treatment or prevention.
When it came to women who had ever injected or were currently injecting recreational drugs, the responses were more varied. Some would refuse long-acting antiretrovirals for fear of relapsing into injecting drugs. But others, including the only woman who injected drugs, had few concerns.
“These divergent findings are consistent with recent research that found some people who previously injected drugs viewed long-acting injectables as a potential trigger, while others were less concerned due to their experience with needles,” Philbin and colleagues wrote. “Therefore, providers should consider each patient’s unique history and perceptions when deciding between long-acting injectables and daily pills.”
From: https://www.poz.com/article/women-board-injectable-hiv-meds