Advancing Access to HIV Treatment Options: Exploring Patient, Provider, and Clinic-Level Influences on Long-Acting ART Uptake - ABSTRACT Despite advancements in antiretroviral therapy (ART), only 65% of people with HIV (PWH) in the United States (US) achieve viral suppression, with significant differences observed across sociodemographic groups. Long- acting injectable ART (LA ART) has the potential to address challenges associated with daily oral ART, but its adoption has been slow, with only 1.44% of PWH—approximately 15,000 individuals—on LA ART after two years of availability. This low uptake highlights persistent barriers and mirrors challenges seen with pre-exposure prophylaxis (PrEP), including slow adoption and differences in awareness, interest, and use. Further research is needed to understand factors shaping PWH decisions regarding innovative ART therapies. PWH face complex considerations when selecting treatment regimens, including regimen characteristics, psychosocial factors, and logistical barriers. While these factors are well-studied for oral ART, less is known about how PWH weigh these considerations for LA ART. This study will use advanced quantitative methods, including latent class analysis (LCA) and structural equation modeling (SEM), to identify treatment preference typologies and examine how individual, provider, and clinic-level factors shape ART preferences, addressing critical gaps in knowledge. Guided by the Consolidated Framework for Implementation Science 2.0, this project has two aims: 1) Identify HIV treatment regimen consideration patterns (classes) and assess the association between class membership and sociodemographic characteristics among PWH; and 2) Examine how patient (treatment regimen preference patterns), provider (trust, shared decision-making) and clinic-level factors (quality of clinical care) influence ART preferences among PWH. Findings will inform multilevel interventions to improve outcomes. Moreover, the identification of patient treatment typologies will enable providers to align discussions and interventions with the unique preferences of PWH. To achieve these aims, the proposed training plan focuses on developing advanced skills in LCA and SEM, deepening expertise in implementation science frameworks, and applying these findings to design multilevel interventions. Through mentorship, coursework, workshops, and applied research, the applicant will gain the knowledge and experience necessary to become an independent behavioral and implementation scientist, equipped to address access challenges in the evolving landscape of HIV treatment. This NRSA award will provide the necessary mentorship and resources to achieve these goals.
