Research Spotlight: How Long-Acting Injectable Treatment Could Transform Care for Postpartum Women With HIV

Sujata Tewari, BA, previously of the Medical Practice Evaluation Center (MPEC) at Massachusetts General Hospital, and Andrea L. Ciaranello, MD, MPH, of the MPEC and Department of Medicine at Massachusetts General Hospital, are the lead and senior authors of a paper published in the Journal of Infectious Diseases, “Long-acting antiretroviral therapy for breastfeeding women with HIV experiencing barriers to adherence in Zimbabwe: Modeling clinical impact and cost-effectiveness.”

Q: How would you summarize your study for a lay audience?

For breastfeeding women who have HIV, consistently taking antiretroviral therapy (ART) is essential for their own health and the health of their infants. New long-acting (LA) injectable ART options, such as LA cabotegravir with rilpivirine (CAB/RPV), can help women suppress the HIV virus within their bodies — keeping them healthy and reducing transmission to their infants. Instead of daily oral pills, the injection is received every two months, making it easier for women to sustain treatment during the postpartum period and keep their medical diagnoses private.

Our study focused on Zimbabwe, a country with high maternal HIV prevalence where LA-CAB/RPV is not yet available outside of research settings. We used microsimulation modeling to evaluate the clinical impact and cost-effectiveness of offering this potentially game-changing therapy to postpartum women.

Q: What questions were you investigating?

There were two main questions we set out to answer:

• If long-acting antiretrovirals were made available to breastfeeding women with HIV in Zimbabwe, what clinical impact would it have compared to the status quo of daily oral therapies?
• What is the cost-effectiveness of LA-CAB/RPV, and does this vary based on the level of difficulty women experienced in adhering to oral ART during pregnancy?

Q: What methods or approach did you use?

We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) model to simulate how HIV is passed on and how it progresses. This framework enabled us to evaluate the long-term clinical outcomes for a hypothetical group of women and their babies undergoing different treatment strategies — in this case, LA-CAB/RPV versus daily oral ART. 

Q: What did you find?

Compared to oral ART, LA-CAB/RPV could prevent up to 160 infant infections per year in Zimbabwe. For women whose HIV has not been fully suppressed by their daily pills at the time of delivery, switching to LA-CAB/RPV could be cost-saving if priced at $156/year or lower. For women whose HIV has already been suppressed at the time of delivery, but who face challenges in adhering to oral ART, switching to LA-CAB/RPV would offer slightly less value, but could be cost-effective if priced at $84/year or lower.

Q: What are the implications?

Long-acting ART formulations hold tremendous promise — especially for people living with HIV who struggle with daily oral regimens, and therefore with viral suppression. We propose that these formulations should be made available globally at an affordable price to ensure they reach the people who may benefit from them most. 

Q: What are the next steps?

Looking ahead, we’ll build on this important work by evaluating the clinical impact and cost-effectiveness of newer long-acting ART formulations, such as long-acting cabotegravir with lenacapavir, among pregnant and breastfeeding women.

Authorship: In addition to Tewari and Ciaranello, Mass General Brigham authors include Shahin Lockman, Clare F. Flanagan, Caitlin M. Dugdale, Anne M. Neilan, and Kenneth A. Freedberg.

Paper cited: Tewari S., et al. “Long-acting antiretroviral therapy for breastfeeding women with HIV experiencing barriers to adherence in Zimbabwe: Modeling clinical impact and cost-effectiveness.” Journal of Infectious Diseases. DOI:

Funding: This work was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R37 HD079214, R01 HD079214-10S1, K08 HD101342, and R01 HD111355), the National Institute of Allergy and Infectious Disease (K24 AI131928, UM1 AI069424, and UM1 AI068636), and the James and Audrey Foster MGH Research Scholar Award. The authors also acknowledge support from the President's Emergency Plan for AIDS Relief through United States AIDS Relief to the Organization for Public Health Interventions and Development’s Target, Accelerate and Sustain Quality Care for HIV Epidemic Control: 72061320CA00005.

Disclosures: Two coauthors from outside of MGB reported disclosures. Risa Hoffman previously received consulting fees for Elsevier Clinical Key for support of educational content (2021-2023). Judith Currier received consulting fees from Merck and Company.