Real-world adherence, persistence, and health care resource utilization among people with HIV receiving long-acting cabotegravir plus rilpivirine compared with oral antiretroviral therapy in the United States: The ABOVE Study.

backgroundLong-acting cabotegravir + rilpivirine (CAB+RPV LA) is the first US Food and Drug Administration-approved complete long-acting regimen for people with HIV who are virologically suppressed. Long-acting CAB+RPV may alleviate adherence challenges with daily oral therapy.

objectiveTo evaluate and compare real-world adherence, persistence, and health care resource utilization in people with HIV who switched to CAB+RPV LA vs maintained daily oral antiretroviral therapy (ART).

methodsABOVE is a retrospective US cohort study using Symphony Health Solutions Integrated Dataverse administrative claims data from January 1, 2020, to August 31, 2023. The study included people with HIV aged 12 years and older on stable oral ART and with continuous clinical activity for at least 12 months before the index date, categorized into people initiating CAB+RPV LA (LA ART cohort) and people remaining on oral ART (oral ART cohort). The index date was defined as the first injection of CAB+RPV LA or imputed for the oral ART cohort. We used standardized mortality ratio weighting based on propensity scores to balance baseline characteristics. Adherence (proportion of days covered ≥0.9 over 12 months following index) and persistence to the index regimen (days from index to earliest of treatment discontinuation or end of follow-up) were compared. A doubly robust logistic regression model estimated the adjusted odds ratio and 95% CI. Health care resource utilization including preventive care was compared using the doubly robust generalized linear model, with results reported as incidence rate ratios and corresponding 95% CIs.

resultsAfter applying eligibility criteria, the study included 1,245 people in the LA ART cohort (mean age, 47 years; 24.1% female). The oral ART cohort included 58,644 people (mean age, 50 years; 23.3% female). In the standardized mortality ratio-weighted analysis, the LA ART cohort had higher adherence rates (73.7% vs 30.1%) and higher persistence (median [IQR], 424 [201, 537] vs 393 [174, 431] days;

conclusionsPeople who switched to LA ART had significantly higher 12-month adherence and persistence over the follow-up compared with people remaining on oral ART. Higher key preventive measure rates and lower hospitalization rates among people who switched to LA ART highlight increased medical engagement benefits.