Improving Compliance to Injectable Cabotegravir: Real-World Insights for Prescribers
As long-acting injectable antiretrovirals (LAI-ARVs) become more widely adopted, understanding how patients adhere to these therapies in real-world settings is critical.
Missed doses can compromise viral suppression and prevention efficacy, making adherence a top priority for prescribers.
Accredo® Specialty Pharmacy, in collaboration with Evernorth Research Institute, conducted a retrospective analysis of insured patients initiating injectable cabotegravir for either HIV treatment or pre-exposure prophylaxis (PrEP).
The study examined compliance patterns across demographics, clinical characteristics, and geographic regions using claims data from the Komodo Healthcare Map.
What We Learned
Despite the convenience of long-acting injectable antiretrovirals, compliance challenges remain—especially for PrEP patients. Nearly 1 in 3 PrEP patients (29%) were non-compliant, compared to 17% of HIV treatment patients (p < 0.001). This gap highlights that less frequent dosing does not guarantee better compliance and reinforces the need for proactive clinical support.
Geographic differences were also notable: patients in the South and Midwest had significantly lower odds of compliance—54% and 45% lower, respectively—than those in the Northeast. These regional trends suggest that location-specific engagement strategies may be critical.
Interestingly, no significant associations with compliance were found for age, race, sex, insurance type, comorbidities, or social determinants of health, indicating that compliance barriers may be more behavioral and structural than demographic.
Source: Accredo Specialty Pharmacy & Evernorth Research Institute, ID Week Poster, 2025
Strategies for Supporting Compliance
Improving compliance with long-acting injectable therapies requires more than convenience. Prescribers can make a measurable impact by implementing these evidence-based strategies:
- Provide targeted education and support: Help patients understand the importance of compliance to their treatment or PrEP doses.
- Adapt outreach based on geographic trends: Compliance rates are lower in the South and Midwest. Consider region-specific engagement tactics to help close these gaps.
- Address social determinants of health (SDOH):Barriers like transportation and finances can undermine compliance. Leverage programs such as Accredo Care Equity to connect patients with local resources and support.
- Tailor educational approaches to diverse patient needs: Recognize that convenience alone does not ensure consistent use.
Conclusion
Prescribers play a critical role in helping patients benefit from the promise of long-acting injectable therapies. While convenience is a key advantage, real-world data shows that compliance still requires intentional support—especially for PrEP patients and those in regions with lower compliance rates.
By combining targeted education, awareness of regional trends, and programs like Accredo Care Equity, which offers social workers to help patients find local resources, prescribers can help close the gap between convenience and consistent use. These proactive steps ensure patients stay on track and achieve optimal outcomes.
