Prescription of Long-Acting Antiretroviral Therapy Among U.S. Adults with HIV

BACKGROUND: Long-acting injectable antiretroviral therapy (LA-ART) has enormous potential benefit for increasing viral suppression among persons with HIV (PWH). SETTING: U.S. HIV care facilities. METHODS: We analyzed data on past 12-month LA-ART prescriptions collected over 3 annual data collection cycles (2021-2023) from probability samples of U.S. adults with HIV (collected 6/1/2021-5/30/2024, N=11,524). We report weighted percentages of PWH prescribed LA-ART and use prevalence ratios (PRs) with predicted marginal means and 95% confidence intervals (CIs) to quantify differences in prescription of LA-ART over time and between groups. RESULTS: The percentage of PWH prescribed LA-ART increased from 0.4% (CI 0.2-0.7) in the 2021 cycle to 3.4% (CI 2.8-3.9) in the 2023 cycle (PR 7.8 [CI 4.5-13.6]). During the 2022-2023 cycles, prescription of LA-ART was higher among those living in Northeastern Medical Monitoring Project (MMP) states versus Southern MMP states (3.4% [CI 2.4-4.3] vs. 1.9% [CI 1.3-2.5], PR 1.8 [1.2-2.8]) and those receiving care at Ryan White HIV/AIDS program (RWHAP)-funded versus non-funded facilities (2.9% [CI 2.4-3.4] vs. 1.8% [CI 1.3-2.4], PR 1.6 [CI 1.1-2.2]). Older age (>50 vs. <40 years) was also associated with lower ART prescription. CONCLUSION: Prescription of LA-ART is increasing among U.S. adults with HIV, though prevalence remains low. LA-ART uptake lagged in the South, where HIV infections and negative health outcomes are disproportionately high. Comprehensive HIV care delivery-such as found in RWHAP-facilities-may facilitate LA-ART adoption.