Exploring provider preferences for HIV treatment support packages integrating long-acting injectable antiretroviral therapy in New York Ryan White Part A medical case management programs

BACKGROUND: Understanding the preferences of core HIV medical case management (MCM) program staff for long-acting injectable antiretroviral therapy (LAI ART)-related support services could help integrate those services into MCM programs, thus facilitating uptake of LAI ART and increasing opportunities for viral suppression among clients who have struggled with daily oral ART adherence. SETTING: New York City (NYC)-area Ryan White Part A MCM programs. METHODS: We conducted a survey among MCM program administrators, clinicians, and non-clinical direct-service providers (hereafter, "providers") concerning LAI ART adherence supports. The survey included a discrete choice experiment (DCE) and implementation-readiness and choice-motivation questions. We defined four DCE attributes with 2-4 levels each: Type of ART Medication (monthly/bimonthly LAI ART), Service Location and Mode, Support for Clients, and Rewards for Clients. We ran latent class analysis (LCA) to explore hypothesis-free preference heterogeneity. RESULTS: From July 2022-January 2023, 177 providers completed surveys. About half (52%) were aged 40-59, 72% were women, and the plurality (41%) were Latino/a. In the two-group LCA solution, both groups preferred Bimonthly over Monthly LAI ART. Group 1 (n=45) preferred conventional approaches (e.g., clinic-based injections) whereas Group 2 (n=132) preferred more client-centered approaches (e.g., home-based injections). Reported motivations focused on client convenience. Implementation measures indicated endorsement of LAI ART supports. CONCLUSIONS: Our implementation science study suggests that NYC-area MCM providers are motivated to facilitate LAI ART access and adherence. More work is needed to understand what LAI ART-related services programs have integrated, track uptake, and ascertain impacts on viral suppression.