Barriers and Facilitators Related to Providing Long-Acting Injectable HIV Preexposure Prophylaxis in Australian Settings: A Qualitative Study of Clinical and Policy Stakeholders

ABSTRACT: Given injectable HIV preexposure prophylaxis (PrEP) has unique service-delivery requirements, there is a need to investigate the feasibility of its implementation and equitable access for people at risk of HIV. Data were collected from 45 informants (nurses, physicians, general practitioners, policy makers, and community representatives) to identify barriers to and facilitators of implementing long-acting injectable cabotegravir (CAB-LA) in Australian settings. Findings were mapped onto the domains of the updated Consolidated Framework for Implementation Research. Informants welcomed new PrEP options as a way of addressing issues of access equity. However, they questioned the benefits of CAB-LA over oral PrEP, given its dose-scheduling requirements and long pharmacokinetic tail, as well as its cost, complexity, and potential to "remedicalize" PrEP, reversing current trends in PrEP prescribing and consumption. Other concerns included increased resource and capacity implications for clinics resulting from initial assessments and the increased number (and complexity) of subsequent visits.