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The Long-Acting Cabotegravir Tail as an Implementation Challenge: Planning for Safe Discontinuation


The long-acting feature of cabotegravir, an integrase-inhibitor highly effective in preventing acquisition of HIV in adolescents and adults, is both its greatest strength and a challenge to its implementation. Cab-LA is administered at 8-week intervals (after an initial loading dose) but has a long, variable drug “tail” that may leave users vulnerable to future drug resistance if they contract HIV during this critical period. The potential for cab-LA to meaningfully contribute to ending the HIV Epidemic is hindered by, among other factors, limited resources to guide patients and providers on how to safely discontinue injections. We suggest three key strategies to overcome this specific challenge: (1) Comprehensive patient education and counseling about the drug tail; (2) Training and coaching PrEP care teams, including clinical and non-clinical staff, on communication around the tail; (3) Adherence support strategies, including monitoring of cabotegravir drug levels after discontinuation, for a personalized medicine approach to safe discontinuation.

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This work was supported by the National Institutes of Health [R01MH123262 to KM and SAG; K23AI150378 to JZ; K23-MH124569 to BAK; UM1AI069470 to MES; P30-MH43520 to RHR].

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KM, NN, JZ, MTY were responsible for conceptualization; KM, NN, JZ wrote the original draft; BAK, MTY, and RR reviewed and edited the original draft; SAG, MES, CC, DC reviewed and edited additional drafts. All authors reviewed, edited, and approved the submitted manuscript.

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Correspondence to Kathrine Meyers.

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MES has received grants to her institution from NIH, GSK and ViiV Healthcare to conduct clinical trials of Long-Acting Cabotegravir for treatment and prevention outside of the submitted work. No authors have a conflict of interest.

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Meyers, K., Nguyen, N., Zucker, J.E. et al. The Long-Acting Cabotegravir Tail as an Implementation Challenge: Planning for Safe Discontinuation. AIDS Behav 27, 4–9 (2023).

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