HIV long-acting injectables are promising — but clinics are struggling to scale them up

Long-acting injectable (LAI) regimens for HIV — which allow patients to receive bimonthly injections instead of daily pills — have transformed both HIV prevention and treatment since their FDA approval in 2021. But a new cross-sectional survey presented at IDWeek reveals that many U.S. clinics are still struggling to implement them at scale, largely due to administrative and financial roadblocks.

Researchers surveyed 96 healthcare sites across the U.S. and found that the most common barriers were navigating insurance coverage determinations and lacking the staff to manage them. The complexity stems from inconsistent payer requirements — some mandate pharmacy benefits, others medical benefits, and some allow either — making the process difficult to standardize, especially for under-resourced clinics.

Key Takeaways:

• Larger medical centers report higher LAI utilization for both HIV prevention and treatment
• Three core themes emerged: administrative complexity, need for dedicated coordination, and economic/access bottlenecks
• A dedicated LAI program coordinator was identified as the single most important factor for success
• Experts recommend starting with a small pilot of 5–10 patients rather than rushing to scale

Why it matters: With LAIs offering a powerful tool to improve HIV treatment adherence and prevention, the inability to implement them broadly means patients — particularly those on Medicare and Medicaid — may be missing out. Addressing structural and financial barriers is essential to making these therapies accessible at scale.