LONG-ACTING ART: Edited by Marta BoffitoClinical implementation of long-acting antiretroviral treatment in high-income countries: challenges and advantagesWaters, Lauraa,b; Sparrowhawk, Alexc,d Author Information aBritish HIV Association bMortimer Market Centre, Central & North West London NHS Trust cUK Community Advisory Board dTerrence Higgins Trust, London, UK Correspondence to Laura Waters, Consultant Physician HIV & Sexual Health, Mortimer Market Centre, London WC1E 6JB, UK. Tel: +4420 3317 5241; e-mail: [email protected] Current Opinion in HIV and AIDS: May 2022 - Volume 17 - Issue 3 - p 121-126 doi: 10.1097/COH.0000000000000730 Buy Metrics Abstract Purpose of review Long-acting antiretroviral therapy (LA-ART) brings a paradigm shift to HIV care with injectable cabotegravir/rilpivirine (IM-CAB/RPV) in current or imminent use in several countries. This brings the usual opportunities and challenges of a new therapy, plus requirements to adapt services to reliably deliver injections and ensure patients understand advantages and limitations. We summarise key considerations for implementation in high-income countries. Recent findings Monthly IM-CAB/RPV is noninferior to oral ART and monthly IM-CAB/RPV to 1-monthly in carefully selected virally suppressed people. The numerically higher virological failure rate on two-monthly IM-CAB/RPV warrants close attention and careful monitoring. Implementation projects report positive experiences for patients and staff, but also barriers. Data is needed in younger people, pregnancy/breastfeeding, and in those with detectable viraemia secondary to suboptimal adherence. Summary We highlight a paucity of real-world data and key unanswered questions. Existing data on injection techniques may have implications for training; monitoring of outcomes is crucial to ensure clinical trial results are replicated in real-life. Better understanding of treatment failure, and individualised therapy, is crucial, and it is important to repeat patient preference surveys as new data emerges to ensure decisions are based on the most recent evidence of benefit vs risk. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.