Making It Stick: Considerations and Case Studies for Implementation of Long-Acting Antiretroviral Therapy (Web)

A. 19yo cisgender pregnant female currently on dolutegravir and emtricitabine/tenofovir with undetectable HIV viral load and BMI 26 kg/m2 with no known ART resistanceB. 31yo transgender female with gluteal implants currently on bictegravir/emtricitabine/tenofovir with HIV viral load of 35 copies/mL and BMI 35 kg/m2 with no known ART resistanceC. 45yo cisgender male currently on darunavir/cobicistat/emtricitabine/tenofovir with undetectable HIV viral load and BMI 42 kg/m2 with RT Mutations: K103N, Y181CD. 56yo cisgender male currently on emtricitabine/rilpivirine/tenofovir with HIV viral load 100 copies/mL and BMI 32 kg/m2 with no known ART resistance

Congratulations. The best choice is D. Answer A is not correct because LAI CAB/RPV is not currently recommended for use in pregnant individuals. Answer B is not correct because LAI CAB/RPV is not recommended in individuals with gluteal implants. Answer C is not correct because LAI CAB/RPV is not recommended in individuals with known resistance to the rilpivirine component.

References: https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/guidelines-adult-adolescent-arv.pdf

Sorry, the correct answer is D. Answer A is not correct because LAI CAB/RPV is not currently recommended for use in pregnant individuals. Answer B is not correct because LAI CAB/RPV is not recommended in individuals with gluteal implants. Answer C is not correct because LAI CAB/RPV is not recommended in individuals with known resistance to the rilpivirine component.

References: https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/guidelines-adult-adolescent-arv.pdf

A. Maintain virologic suppressionB. Presence of uncontrolled depressive disorderC. Presence of NNRTI mutationsD. High body mass index

Congratulations. The best answer is C. According to the reference, A is incorrect because 47% of individuals switching to this regimen had viremia at baseline (Viral suppression doubled to 94% with the use of CAB + LEN). While depressive disorders in choice B is described as a Warning and Precaution in the package labeling for Cabenuva, it is more specifically associated with the rilpivirine component. This reason is not listed as any justification for using this LAI combination of CAB + LEN. D is incorrect because only 1 patient in the reference was switched to this CAB/LEN due to high BMI.

Reference: Gandhi M, et al. OFID, 2024

https://academic.oup.com/ofid/article/11/4/ofae125/7646382 doi: 10.1093/ofid/ofae125

Sorry, the best answer is C. According to the reference, A is incorrect because 47% of individuals switching to this regimen had viremia at baseline (Viral suppression doubled to 94% with the use of CAB + LEN). While depressive disorders in choice B is described as a Warning and Precaution in the package labeling for Cabenuva, it is more specifically associated with the rilpivirine component. This reason is not listed as any justification for using this LAI combination of CAB + LEN. D is incorrect because only 1 patient in the reference was switched to this CAB/LEN due to high BMI.

Reference: Gandhi M, et al. OFID, 2024

https://academic.oup.com/ofid/article/11/4/ofae125/7646382 doi: 10.1093/ofid/ofae125

A. Develop a collaborative implementation protocol with clearly defined professional roles and responsibilities for each discipline involved.B. Expand clinic hours to evenings and weekends to increase clinic availability for persons with HIV to get injections.C. Recruit and hire additional staff to coordinate and administer LAI ART in the practice.D. Expand existing clinic practice to include a mobile service that includes LAI ART administration as well as STI testing.

Congratulations. The best answer is A. Based on article by T McCrimmon, this suggestion was included as a qualitative potential implementation strategy to address organizational barriers to the widespread access and uptake of LAI. Answers B, C, D are less correct in that they require interventions or strategies that may be beyond the control of the person implementing LAI based on info provided in the case.

Reference: McCrimmon T et al. AIDS Patient Care and STDs. 2024
https://pubmed.ncbi.nlm.nih.gov/38381949/

Sorry, the best answer is A. Based on article by T McCrimmon, this suggestion was included as a qualitative potential implementation strategy to address organizational barriers to the widespread access and uptake of LAI. Answers B, C, D are less correct in that they require interventions or strategies that may be beyond the control of the person implementing LAI based on info provided in the case.

Reference: McCrimmon T et al. AIDS Patient Care and STDs. 2024
https://pubmed.ncbi.nlm.nih.gov/38381949/

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The content covered was useful and relevant to my current or future scope of practice.
The activity was fair, balanced, and free of bias.
The activity improved my knowledge of this clinical issue.
The learning objectives for this activity were achieved.
I am better able to: Communicate/collaborate with other members of the care team on this issue.
I am better able to: Improve access to care and treatment for underrepresented patient groups or geographies because of what I learned.
The information learned during this activity will help improve my skills or judgment within the next six months.
The content was presented clearly.
The educational activity was well planned and presented.

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I intend to: Modify/change my practice or the practice of my team based on this educational activity.
I intend to: Work with my team to create/revise protocols, policies, and/or procedures with my care team.
I intended to: Share what I learned with other members of my care team.
I intend to: Make changes in how I communicate with/educate my patients.
I intend to: Seek additional information on topics discussed during the activity.
On average, I utilized the patient treatment strategies described in this educational activity prior to my participation.

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My office and practice systems can accommodate the above changes.
My patients can accommodate the above changes.
Patient access to the treatments provided will be a barrier to implementing the above changes.

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Making It Stick: Considerations and Case Studies for Implementation of Long-Acting Antiretroviral Therapy (Web)

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