To achieve a higher level of PrEP use in at-risk people, new long-acting PrEP products are being investigated. The first of these to be proven effective in clinical trials is long-acting injectable Cabotegravir (CAB-LA) which involves an intramuscular injection every 8 weeks. In August 2022, the Australian Therapeutic Goods Administration approved CAB-LA as PrEP. It is critical that Australia is ready for the introduction of injectable PrEP and research is required to understand how CAB-LA should be implemented and evaluated in Australian settings.
To prepare for the introduction of CAB-LA in Australia, this project will investigate how CAB-LA should be implemented and evaluated in Australian settings. Researchers from the Kirby Institute at UNSW Sydney and Alfred Health in Melbourne will conduct a range of activities to determine research priorities and potential implementation issues, consult with stakeholders in the Australian HIV sector, and develop a protocol and funding application for an implementation science trial.
Our formative research activities include:
- A scoping literature review of all published literature on CAB-LA specifically and long-acting PrEP modalities generally;
- Qualitative interviews with stakeholder and service providers;
- Co-design workshops with PrEP end-users and potential end-users, and separately with service providers; and
- A survey on values and preferences about PrEP held by gay, bisexual and other men who have sex with men (GBM).
These formative research activities found high interest in and preference for long-acting PrEP generally and CAB-LA specifically among gay bisexual men in Australia. Service providers and stakeholders showed support for the idea of introducing CAB-LA into Australia as an additional PrEP choice. However, there was some hesitancy and ambivalence from some stakeholders, service providers and PrEP end-users about the specifics of introducing CAB-LA into practice, given the additional burden on clinics that may come with six visits a year. Our participants were able to articulate populations that may be most suitable for CAB-LA. They described many complex implementation issues that would need to be addressed, as well as suggestions to support implementation.
The availability of CAB-LA as PrEP (along with future long-acting modalities as they are proven efficacious) in Australia will offer more choice to those at-risk of HIV and could increase the number of people on PrEP, thereby bringing Australia closer to the national goal of virtually eliminating HIV transmission. Our research exploring potential implementation challenges and strategies will contribute to ensuring the successful introduction of CAB-LA in Australia.
This study is supported by research grants from the Australian Government Department of Health, the Kirby Institute, the New South Wales Ministry of Health, ViiV Healthcare, and the World Health Organization.