Implementation of a Hospital in the Home model for delivery of long-acting injectable antiretroviral therapy to people living with HIV: development, integration and early experience

BACKGROUND: Long-acting injectable cabotegravir/rilpivirine provides an alternative to daily oral antiretroviral therapy for people living with HIV, but is limited by its clinic-based delivery model. The aim of this study was to describe the implementation and early outcomes of a Hospital in the Home (HITH) program delivering long-acting injectable antiretroviral therapy within an Australian tertiary health service. METHODS: A structured protocol for HITH-based delivery of cabotegravir/rilpivirine was developed at a single tertiary centre in Melbourne, Australia. The program was established through collaboration between infectious diseases clinicians, HITH physicians, nursing leadership and pharmacy. Processes were designed for patient selection, induction dosing, medication storage, cold-chain transport, clinical documentation and escalation of care. HITH staff received targeted training in HIV care, injection technique and stigma-sensitive communication. Following the first dose in clinic, subsequent injections were administered at home every 8 weeks, with pre-visit telephone assessments, post-dose telehealth reviews and routine pathology monitoring. RESULTS: The program was integrated into existing HITH infrastructure without additional resources. One patient has completed five treatment doses, all delivered safely within dosing timeframes. Laboratory monitoring confirmed continued viral suppression. Nursing staff reported high satisfaction, describing the model as patient-centred and professionally rewarding. Operationally, coordination between HITH pharmacy, nursing and infectious diseases teams was efficient and sustainable. CONCLUSION: HITH delivery of cabotegravir/rilpivirine is feasible, safe and well accepted, providing a scalable, decentralised model for HIV treatment in Australia.