Positive Talk

Guest Article

Long-Acting HIV Treatment Is Coming. Our Health Care System Needs to Prepare
Kenyon Farrow

New conversations are starting in HIV care as phase III trials have shown that monthly injections of cabotegravir and rilpivirine (Edurant) are non-inferior to a three-drug pill regimen. In 2018, TheBody asked a range of people living with HIV about their willingness to switch to an injectible, and most had mixed feelings. But even if there’s widespread interest in this new way of taking antiretroviral therapy (and most likely also prevention, not too far away), it’s important to consider not just the willingness of people to move to this new form of treatment, but whether health care systems and providers in the U.S. are ready to support this innovation.

 

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August Question of the Month

How do you feel about injecting your HIV medication once a month versus taking a daily pill(s)? What recommendations would you make for educating communities - that are already harder to reach about HIV prevention and adherence to medication - about injections?
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I am personally very excited about being able to do an injection once a month as opposed to taking a pill every day. Since being diagnosed with HIV 25 years…

I am personally very excited about being able to do an injection once a month as opposed to taking a pill every day. Since being diagnosed with HIV 25 years ago, I have seen many different medications come and go. Some have had great success with helping people maintain the HIV virus, but there have also been many who have not had great experiences with their medications because of side effects. In the past most worried about side effects from their medications. For example it is 19 years today that my mother passed because of complications from HIV, but a lot of that came from her making a conscious decision to stop taking HIV medications because of the side effects. It did not take long for the HIV virus to run rampant throughout her body and eventually she died. Today things are so different. We have progressed to where I am able to take one pill a day and go about my business. The fact that we may be able to take an injection once a month for me would be amazing. I live a very busy life with work, family, and advocacy. so sometimes I forget to take my pill.  It does not happen very often but it has happened. With the injection, whether I am able to do it myself or come in to the doctor’s office once a month is genius!! With that being said, it is very important that we continue to educate society as a whole, and most importantly communities that are the hardest to reach. We must educate about how this is just another progression in HIV health care, and it shows how far we have come from the AZT days. Also letting society know that HIV is no longer a death sentence, but a manageable disease, saying that although we are HIV positive, it will not stop us from living long, fulfilling, enriching lives just as long as we take our medications and do all we need to do to take care of our health. Like other advancements with health issues like Cancer, being able to have an injection once a month is just that, it is an advancement in HIV health care.

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I feel that the one time monthly injection is wonderful!!! I am looking forward to seeing if I can start that myself. I have occasionally forgot to take my one-a-day…

I feel that the one time monthly injection is wonderful!!! I am looking forward to seeing if I can start that myself. I have occasionally forgot to take my one-a-day pill so not having to worry about it will be such a relief. Anyone that has an issue adhering to their daily medication should seriously consider this option; I know I have!!!

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Because I am a person living with HIV/AIDS (PLWHA) and a Community Leader/Educator, I have to definitely answer this question in two parts. First, as a PLWHA I am so…

Because I am a person living with HIV/AIDS (PLWHA) and a Community Leader/Educator, I have to definitely answer this question in two parts. First, as a PLWHA I am so very grateful that the medications that are presently available offer such a vast assortment of choices. I find my regimen easy to take and it has been effective in helping me to achieve an undetectable viral load and a CD4 count of 865 (a normal CD4 is 500-1500). I have been on my present regimen for about seven years and thankfully have not experienced any problems with it, there may come a time when it has to be changed and if the injections are available, I would be open to utilizing them as an option. As an Educator, I have to stay current on the latest developments in the HIV world, so I will share the information that I research and allow people to make an informed decision about the injections as I do with anything else that I talk to community members about. Because HIV prevalence and incidence rates remain significantly higher for brown and black folks, it is so important that the information I impart is accurate and delivered in a manner that empowers them and ignites a desire to deal with the realities of risky behavior, HIV prevention, and adherence if they contract or have contracted the virus.

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I have been reading about the once a month injection HIV medication for quite a while now and the studies have shown that these long-acting medications can prevent replication as…

I have been reading about the once a month injection HIV medication for quite a while now and the studies have shown that these long-acting medications can prevent replication as well as the pills do. My first thoughts were that if I have multiple resistances, will this work for me, but I do not have enough information about that yet. I have been taking HIV pills daily for 30 years now and I have never had a problem with adherence. So, I guess my answer to the first part of this question would be that for myself it does not matter so long as what I am taking is working and keeping my viral load undetectable with minimal side effects. I do however believe that a once a month HIV injection regimen could be the ideal solution for people who have been failing with daily adherence or who may have pill fatigue. I think that emphasizing the ease and convenience of taking their meds this way may appeal to many and help them stay more adherent, but they must remember to get the injection every month! When it comes to HIV prevention, I think educating people about this once a month injection regimen could ease their fears about getting tested, because people living with HIV will now have more options for managing the virus.  The once a month injection can also help prevent skipped doses which can put people with HIV and their sexual partners at risk. This could play a big role in reducing HIV transmission in the years to come and that is a great thing.

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I believe this is a great option and one of the many practices we can use to help with adherence to treatment. However I do recognize the risks of using…

I believe this is a great option and one of the many practices we can use to help with adherence to treatment. However I do recognize the risks of using needles especially for former drug users who may be exposed to a traumatic memory, which could lead to a relapse. I highly believe this should be rolled out first in the doctor’s offices and clinics to monitor the progress closely.

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I think a once a month injection of medications would be far easier. It is less complicated so people with adherence issues would not have to worry. Also if doctors…

I think a once a month injection of medications would be far easier. It is less complicated so people with adherence issues would not have to worry. Also if doctors or nurses could go to patients houses to give them their meds they would not have to worry about transportation issues. I know that some people with severe mental health issues have doctors or nurses come to their house, so why couldn’t we do the same for people with adherence and transportation issues? As for me, I get side effects from my meds a couple times a week. They make me extremely nauseous and usually I have to lie down after taking them, which means I usually take them before bed. If it was on an injection I would only have to worry about side effects for a couple of days after the injection. It would make my life far easier. I would recommend communities interested in injectable medications do the research. Look up other drugs that are injected once a month and see what the side effects from the injections are, and what issues the medical community often sees with such meds. As always talk to your doctor, ask questions and make sure you are fully informed before making a switch to once a month meds. All in all, I think that once a month injections would be a positive addition to treatments. Even implanted devices that slowly medicate people throughout the month, similar to birth control, would be a great addition to fighting HIV.

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I think injecting once a month would be a great option to have. I would explain how much easier it may make things depending on those who may struggle with…

I think injecting once a month would be a great option to have. I would explain how much easier it may make things depending on those who may struggle with taking a pill. Though needles may make people squeamish. I would just pose it as another option available. Pointing out how far HIV care has come and the options for treatments are now more diverse.

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I say “Yes, please!” As a long term survivor, I remember the pill burden, which has now been alleviated by newer medications and now a once a day pill. I…

I say “Yes, please!” As a long term survivor, I remember the pill burden, which has now been alleviated by newer medications and now a once a day pill. I think about how this can improve prevention efforts because taking medication once a month versus trying to remember everyday can only increase the number of people with undetectable viral loads, which means no sexual transmission!! It is amazing that I lived long enough to see this progress. I look forward to educating communities, that are hard to reach, about adherence to medication because this makes it so much easier. A once a month reminder on your phone which can be set for an entire year or more! I am looking forward to learning more so I can educate my community. I also look forward to working with, and providing support, to the substance using community around injecting HIV medications.

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A monthly injection of HIV medication is not for me. I would rather stick with my one pill a day regimen because it is easier for me to manage, it…

A monthly injection of HIV medication is not for me. I would rather stick with my one pill a day regimen because it is easier for me to manage, it gives me more ownership over my health, and I do not care for needles. I take “one for the team” when I get my bloodwork done every six months. Never knowing how many tubes they need is enough for me. The injection can be an option for those that are in and out of care, not in care at all, or without housing. It really is an individual decision. I am very grateful that this is now available for those who would prefer this method over taking daily medication.

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I need to see more scientific data on it in order for me to be sold on it. I do think that this would be a viable option for those…

I need to see more scientific data on it in order for me to be sold on it. I do think that this would be a viable option for those who seldom fall out of care. I do believe that everyone should be presented all the options along with the risks and side effects.

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