Long-Acting Injectable Antiretroviral Therapy as a Catalyst for Engagement in Opioid Use Disorder Treatment Among People with HIV Who Use Drugs
Elizabeth Whidden, Amanda Perez, M Elle Saine, Jessica MeisnerAbstract
Background
People with substance use disorders living with human immnunodeficiency virus (HIV) experience overlapping structural and clinical barriers to care. Long-acting injectable antiretroviral therapy (LAI-ART) may improve treatment adherence and may strengthen engagement in health services. Whether initiation of LAI-ART is associated with subsequent uptake of medications for opioid use disorder (OUD) is unknown.
Methods
We conducted a retrospective descriptive cohort study of people with HIV and a history of a substance use disorder (SUD) who initiated long acting cabotegravir-rilpivirine (LA-CAB + RPV) at a low-barrier social services and public health organization between February 1, 2022, and June 30, 2025, and received at least six months of follow up. We evaluated whether initiation of this regimen improved HIV and substance use disorder outcomes, including uptake of medications for opioid use disorder (MOUD), sustained treatment engagement, reduced opioid use, and viral suppression.
Results
Forty patients initiated LA-CAB + RPV. . Viral suppression improved from 73% at baseline to 98% at follow up. Adherence was high, with only one missed scheduled dose and no recorded deaths from HIV-related causes. At baseline, 81.1% reported active opioid use and 32.4% were receiving medications for OUD. MOUD utilization increased to 78.4% at six months and 89.2% at end follow up, while opioid use declined to 59.5% and 48.6%. Among those initiating medications for OUD after CAB + RPV, 90.9% remained on treatment, with 40% initiating within two months. Most patients remained engaged in HIV care.
Conclusions
Integrated low barrier care models may improve continuity of care for marginalized populations.