Abstract
The Ryan White HIV/AIDS Program is an essential platform for reducing health disparities among people
with HIV (PWH) and scaling up evidence-based strategies to strengthen the HIV care continuum. We propose
an implementation-science study based in New York Ryan White Part A (RWPA) programs, to inform the
delivery of long-acting injectable (LAI) antiretroviral therapy (ART) and related supportive services to low-
income, largely Black and Latino/a PWH who have struggled with daily oral ART adherence. As a major
biomedical advance de-necessitating adherence to daily dosing, LAI ART could greatly increase opportunities
for health, survival and transmission prevention, particularly in populations confronting complex barriers to viral
load suppression. However, optimizing the public health impact of LAI ART will require implementation science
to assess perceptions and preferences around LAI versus daily oral regimens, identify support services and
delivery mechanisms suited to promoting LAI uptake and engagement, and address the role of provider beliefs
as to which patients should be offered LAI options. In the absence of this groundwork, LAI ART may primarily
reach those who are already relatively advantaged, and even exacerbate HIV disparities. The proposed project
aims to: (1) Elicit perceptions, barriers/facilitators and expectations of LAI versus daily oral ART delivery
options, in six focus groups of RWPA medical case management (MCM) patients, core staff and prescribing
providers; (2) Quantify preferences and drivers of engagement in ART delivery and support strategies,
including options for LAI and daily oral ART, via discrete choice experiments (DCEs) with 200 patients and 200
providers; and (3) Select and pilot strategies to promote LAI ART uptake, adherence and impact in real-world
care settings. Timely formative work on patient and provider perceptions and preferences will be essential to a
successful, equitable rollout of LAI ART. The proposed study will yield valuable insights into barriers and
facilitators of LAI ART engagement in RWPA MCM programs designed for PWH with documented adherence
barriers. Specifically, focus groups and DCEs will elucidate how (and which) RWPA-funded services (e.g., for
patient assessment, joint care planning, health education, home visits, and accompaniment to appointments)
may be applied or adapted to enhance LAI ART outcomes. Aim 3 pilot testing and a follow-up RCT will further
inform LAI ART delivery strategy refinement and scale-up, by measuring both implementation and clinical
outcomes of strategies emerging from the proposed project. Through a partnership between the Institute for
Implementation Science and Population Health (ISPH) at the City University of New York, the New York City
Health Department and six RWPA service provider agencies, products from the proposed project and follow-up
RCT will be translated to local HIV services planning and practice improvements, while being disseminated
nationally and internationally through peer-reviewed publications, presentations at scientific conferences and
posting on New York’s ISPH-designed/maintained Ending-the-Epidemic Dashboard website.
