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Date of Award

Spring 2025

Degree Name

Master of Medical Science (Physician Assistant)

Department

Physician Assistant; College of Health Sciences

First Advisor

Jacinta Hollinger

Abstract

New infections of HIV occur at only 2/3rd the incidence rate observed at the zenith of the epidemic, with a 12% decrease in new infections annually between 2018 (36,200) and 2022 (31,800). This change was driven by a combination of of safe sex and injection practices, as well as pre-exposure prophylaxis (PrEP) medication regimens. However, infections remain relatively prevalent and still represent a significant challenge to people living with HIV – for example, HIV has been shown to increase mean all-cause annual and cumulative medical costs sevenfold. Furthermore, while Black and Hispanic individuals represent 12% and 19% of the population respectively, they each represent 39% and 31% of new HIV infections, showing a lack of equity in HIV reduction . Daily oral regimens of TDF/FTC (Truvada) or TAF/FTC (Descovy) were the only two FDA approved options for PrEP until 2021 when long-acting injectable cabotegravir (CAB-LA) was first approved for use as PrEP. A systematic review comparing CAB-LA to placebo groups of TDF/FTC showed a pooled RR of developing HIV of 0.21with CAB-LA usage (95%:[.07, .61], p=.004). It is imperative for providers to understand CAB-LA and who will benefit the most from this novel preventative therapy. This CME article will outline this so that providers can be better stewards for the LGBTQ+ population and, in turn, promote a more equitable primary care environment for all patients.

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Comparing Long-Acting Injectable Cabotegravir (CAB-LA) to Oral Regimen for HIV Pre-Exposure Prophylaxis

New infections of HIV occur at only 2/3rd the incidence rate observed at the zenith of the epidemic, with a 12% decrease in new infections annually between 2018 (36,200) and 2022 (31,800). This change was driven by a combination of of safe sex and injection practices, as well as pre-exposure prophylaxis (PrEP) medication regimens. However, infections remain relatively prevalent and still represent a significant challenge to people living with HIV – for example, HIV has been shown to increase mean all-cause annual and cumulative medical costs sevenfold. Furthermore, while Black and Hispanic individuals represent 12% and 19% of the population respectively, they each represent 39% and 31% of new HIV infections, showing a lack of equity in HIV reduction . Daily oral regimens of TDF/FTC (Truvada) or TAF/FTC (Descovy) were the only two FDA approved options for PrEP until 2021 when long-acting injectable cabotegravir (CAB-LA) was first approved for use as PrEP. A systematic review comparing CAB-LA to placebo groups of TDF/FTC showed a pooled RR of developing HIV of 0.21with CAB-LA usage (95%:[.07, .61], p=.004). It is imperative for providers to understand CAB-LA and who will benefit the most from this novel preventative therapy. This CME article will outline this so that providers can be better stewards for the LGBTQ+ population and, in turn, promote a more equitable primary care environment for all patients.