HIV incidence is not declining in most of Canada, despite Health Canada approval of oral pre- exposure prophylaxis (PrEP) in 2017 and embracement of the ‘treatment as prevention’ paradigm. Two- Spirit, gay, bisexual, queer and other men who have sex with men, including trans men (2SGBQM) are disproportionately affected, representing half of incident infections. Meanwhile, the science of HIV prevention is advancing rapidly, with several exciting new drugs in development. A key feature of ‘next generation’ PrEP options is the emergence of long-acting technologies, including injectable, infusion-based and implantable formulations.
Long-acting PrEP may help overcome common barriers to oral PrEP – including the need to adhere to regular dosing, the inconvenience of pill-taking, and privacy challenges related to hiding pills from others. Prior literature has shown a significant appetite for injectable and implantable PrEP options among community members for these reasons. However, our experience as community leaders and engaged clinicians/researchers suggests that much of the problem goes ‘beyond the pill’, and relates to systemic barriers faced by those most in need. While long-acting PrEP may not intrinsically resolve these challenges, their new modes of delivery (eg. injections, implants, etc.) offer unique opportunities to develop, evaluate and implement innovative new models of PrEP delivery that prioritize the needs of underserved groups. Community perspectives are fundamental to product uptake: new forms of PrEP will only be used if they are acceptable to those for whom they are intended.
Aims: Our objectives are to: (1) Characterize preferences of 2SGBQM in Canada regarding future long-acting PrEP options; (2) Assess the feasibility of various models of delivering long-acting PrEP from the perspectives of diverse, community-engaged health system stakeholders; (3) Design a national demonstration project of long-acting cabotegravir as HIV PrEP that directly responds to the access needs and priorities of individuals experiencing barriers to oral PrEP.
Approach: We will 1) combine qualitative and quantitative methods to understand community needs and preferences regarding long-acting PrEP and ways to deliver them to 2SGBQM under-reached by oral PrEP. This work will include focus groups and a cross-sectional survey containing a discrete choice experiment, and will be the foundation of our project. We will next 2) explore the feasibility, anticipated barriers and facilitators of delivering long-acting PrEP from the perspectives of community-engaged health system stakeholders (eg. pharmacists, nurses, community groups). This work will include an evaluation of early experience with CAB/RPV-LA as HIV treatment, and stakeholder focus groups. Ultimately, the rollout of long-acting PrEP in Canada should be informed by rigorous implementation research. Hence our final step will be to (3) synthesize the perspectives of community members and community-engaged health system stakeholders in the design of a national demonstration project on implementing injectable CAB-LA as PrEP.
Impact: A robust knowledge translation strategy, including integrated knowledge translation and exchange activities, professional education events, and conferences will allow for broad access to our results and outputs. Our work will target four main audiences: GBT2Q+ communities/leaders, healthcare/service providers, researchers, and policy-makers. The demonstration project design may inform key policies on reimbursement and the organization of the health system to optimize the use of prevention technologies.
Partners: CATIE, CBRC, CTN, CHABAC, FEAST, CANAC, CHAP
Methods:
Qualitative and Quantitative
Funder: Canadian Institutes of Health Research
Current Status: Currently in planning phase.