Prescription of Long-Acting Antiretroviral Therapy Among U.S. Adults with HIV

Background: Long-acting injectable antiretroviral therapy (LA-ART) has enormous potential benefit for increasing viral suppression among persons with HIV (PWH). Setting: U.S. HIV care facilities. Methods: We analyzed data on past 12-month LA-ART prescriptions collected over 3 annual data collection cycles (2021–2023) from probability samples of U.S. adults with HIV (collected 6/1/2021–5/30/2024, N=11,524). We report weighted percentages of PWH prescribed LA-ART and use prevalence ratios (PRs) with predicted marginal means and 95% confidence intervals (CIs) to quantify differences in prescription of LA-ART over time and between groups. Results: The percentage of PWH prescribed LA-ART increased from 0.4% (CI 0.2–0.7) in the 2021 cycle to 3.4% (CI 2.8–3.9) in the 2023 cycle (PR 7.8 [CI 4.5–13.6]). During the 2022-2023 cycles, prescription of LA-ART was higher among those living in Northeastern Medical Monitoring Project (MMP) states versus Southern MMP states (3.4% [CI 2.4–4.3] vs. 1.9% [CI 1.3–2.5], PR 1.8 [1.2–2.8]) and those receiving care at Ryan White HIV/AIDS program (RWHAP)-funded versus non-funded facilities (2.9% [CI 2.4–3.4] vs. 1.8% [CI 1.3–2.4], PR 1.6 [CI 1.1–2.2]). Older age (>50 vs. <40 years) was also associated with lower ART prescription. Conclusion: Prescription of LA-ART is increasing among U.S. adults with HIV, though prevalence remains low. LA-ART uptake lagged in the South, where HIV infections and negative health outcomes are disproportionately high. Comprehensive HIV care delivery—such as found in RWHAP-facilities—may facilitate LA-ART adoption.