P-578. Just “Short of a Cure”: Unique Considerations in Uptake and Use of Long-Acting Injectable Cabotegravir/Rilpivirine Among Long-Term Survivors with HIV

Abstract Background Understanding perspectives of subgroups of people with HIV (PWH) who have accessed long-acting cabotegravir/rilpivirine (CAB/RPV-LA) is crucial for optimizing implementation; especially among long-term survivors (LTS) who have lived through the trauma of the early epidemic to the innovation of today. Methods We analyzed semi-structured interviews collected from 08/2022-05/2023 via a parent study at four Ryan White clinics in Atlanta, Chicago, and San Francisco among early adopters of CAB/RPV-LA (received ≥3 injections or discontinued). Our analysis explored factors impacting CAB/RPV-LA uptake and use in LTS (living with HIV since 2000 or earlier) using a socioecological model of HIV care engagement. Results Among 20 LTS, median age was 56 (Q1-Q3 54-60) years and median time living with HIV was 27 (Q1-Q3 25-34) years. Thirteen (65%) identified as racial/ethnic minorities and seven (35%) as cis or trans women. We identified three primary themes: 1) The majority of LTS eagerly awaited CAB/RPV-LA and seemed unconflicted in their choice to switch from oral antiretroviral therapy (ART). Their confidence stemmed from experience using new iterations of oral ART over decades, with some citing CAB/RPV-LA as being a step closer to a cure. 2) Choosing to start CAB/RPV-LA was sometimes facilitated by input from longstanding, trusted relationships with healthcare providers or other PWH. 3) Reflections on the emotional gravity of witnessing loved ones die from AIDS-related illnesses early in the epidemic, and the mental imprisonment of around-the-clock pill taking required for their own survival, influenced use of CAB/RPV-LA. In fact, many reported transforming HIV-related psychological trauma and tragedy into education, support, and advocacy efforts: using CAB/RPV-LA was a unique mechanism to further benefit their community—indeed, it was an obligation to both PWH who have passed as well as PWH to come, who could learn from their experience. Conclusion The perspectives of LTS who initiated CAB/RPV-LA during early implementation revealed uptake and use was shaped by the emotional, psychosocial, and physical impact of living with HIV for decades. These data serve as a framework to tailor service delivery of current and future long-acting ART options in this population. Disclosures Moira McNulty, MD, Gilead Sciences, Inc.: Advisor/Consultant Katerina Christopoulos, MD, MPH, Janssen: Honoraria