Barriers and Facilitators to Equitable Implementation of Long-Acting Injectable PrEP for Racial, Gender and Sexual Minority Populations in NYC: The EquiPrEP Study.

Long-acting injectable cabotegravir (LAI-CAB) is a novel HIV pre-exposure prophylaxis (PrEP) modality found to significantly lower HIV risk in key populations. EquiPrEP was an observational implementation science study to examine multilevel barriers and facilitators to LAI-CAB implementation among Black and/or Latine MSM, Black and/or Latine cisgender women, and transgender and nonbinary persons. This study took place at the Pride Health Center (PHC) at NYC Health+Hospitals (H+H)/Bellevue in New York City (February 2023-February 2025). Sociodemographic and health related social needs screening data were collected from EquiPrEP participants via a survey. We conducted in-depth interviews with study participants (N=26) and implementers (N=25) guided by The Consolidated Framework for Implementation Research 2.0. Descriptive statistics were used to assess sociodemographics for all EquiPrEP participants versus those recruited for in-depth interviews. Qualitative data was analyzed using thematic content analysis. Comparing all EquiPrEP participants (N=129) with the subgroup (N=26), the subgroup was older, with more Black cisgender MSM, and transgender women, a higher percentage ever on oral PrEP, and referred from an external clinic. Facilitators included open communication among staff, a patient-centered culture of care delivery and the EquiPrEP Navigator. Barriers included distance to clinical services, financial issues and insurance access. EquiPrEP is one of the first LAI-CAB implementation studies for HIV prevention to center equitable access for communities with the highest burden of HIV and elucidate implementation determinants to LAI-CAB. Findings may inform future implementation strategies seeking to incorporate equity as part of LAI-PrEP care.