BACKGROUND: We describe the integration of long-acting injectable cabotegravir (LAI CAB) PrEP, administered by community health workers, or non-medically licensed staff, in a primary health clinic.

DESCRIPTION: Whitman-Walker Health (WWH) is a primary care center in Washington, D.C. In 2018, WWH launched the “PrEP Clinic,” a clinic where center-qualified peer health staff (or PrEP Specialists), who are trained in PrEP care follow up discussions, navigation, rapid HIV testing, and phlebotomy, conduct follow-up visits after individuals have been initiated on oral daily PrEP by their licensed physician. The clinic has 900 oral PrEP clients and the clinic sought to administer LAI CAB by Specialists.
LESSONS LEARNED: For LAI CAB implementation, we formed a workgroup to devise a clinical protocol, Specialist procedure checklist, missed appointment follow up plan, unique LAI CAB pharmacy communication system, specialized EMR changes and dashboard, client billing communication, marketing plan, and structural examination room changes. An education program was formulated to train Specialists in conversations regarding LAI CAB care, administering the ventrogluteal intramuscular injection, medical documentation, and appointment scheduling. The injection room resembles a spa resort room overlooking the beach to generate a more relaxing environment for clients who may fear injections; appointments are 30 minutes in length. From February - May 2023, 87 LAI CAB PrEP clients have received care, 153 injections have been administered, 5 people discontinued injections, 106 appointments were scheduled, 5 people missed appointments with oral PrEP bridging, one person required re-loading injections, none seroconverted, and 1 had a false positive HIV Ag/Ab test. PrEP clients were 31% AA/Black, 18% Hispanic/Latino, 7% transwomen, 77% MSM, 5% cisgender women, and aged 24-51 years. Those who discontinued injections included one cisgender woman, 4 MSM, and 4 non-whites; 2 occurred after the first injection due to site pain, 2 due to inconvenience, and 4 transitioned to oral PrEP. One hundred percent of clients reported no dissatisfaction with LAI administered by Specialists during their post-injection survey.
CONCLUSIONS: LAI CAB PrEP delivered by community health workers or non-medically licensed, trained health staff is feasible and well received by PrEP users. Program methods and lessons learnt can aid other organizations to adopt similar programs.

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