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Long-Acting Injectable Antiretrovirals in Incarcerated Populations

Despite access to antiretroviral therapy (ART) in the U.S. criminal justice system, about three-quarters of people with HIV do not have suppressed viral loads after incarceration, according to the authors of a Perspective article. Greater use of long-acting ART can help address this problem.

“To test strategies that involve starting patients on cabotegravir-based regimens, it may be better to begin with long-acting injectable [preexposure prophylaxis (PrEP)] than with injectable ART, since there are fewer concerns about existing and induced drug resistance with this approach,” the group writes. “Introducing long-acting injectable PrEP in carceral settings might also provide insights into the feasibility and acceptability of implementing long-acting injectable ART. Lessons learned from experience providing doses of injectable medications for opioid use disorder when people are released from incarceration might also be applied.”

Another important aspect of care in jails is “bridging” care after discharge, which typically occurs within a median of 1 week and a mean of 1 month. “For the initial period of incarceration, continuing ART regimens prescribed in the community may be reasonable, but for people with longer jail stays or prison sentences, costs will quickly become problematic, since the price of long-acting injectables far exceeds that of oral regimens,” the authors explain. “During the Covid-19 pandemic, investigators found that oral integrase inhibitors could prevent treatment interruptions when a scheduled dose of long-acting injectable ART was delayed. With good communication between jails and community health systems, jails could adopt a similar bridging strategy of switching to conventional ART regimens when cost prohibits use of long-acting injectables.”

Source: New England Journal of Medicine