Havens JP, O’Neill J, Kubat M, et al. Scalability Metrics and Effort Requirements for a Long-Acting Injectable Antiretroviral Treatment Program.  Open Forum Inf Dis.  2026 March 4.  https://doi.org/10.1093/ofid/ofag116.

This study describes staff effort, resource allocation, and scalability based on implementation of a long-acting injectable program at a Ryan White-funded HIV specialty clinic housed within an academic center.  The primary outcome was estimated staff effort required for program support: this was calculated based on direct observation, interviews, and department records (information specific to role and task categories was also collected).  Scalability metrics (i.e., patients/FTE and injections/FTE) were calculated annually to assess changes in program efficiency.  The site utilized the “buy and bill” mechanism for medication procurement.  From May 2022 to December 2024, 113 adults receiving LA-CAB/RPV were included in this analysis.  The number of injections increased from 68 (second half of 2022) to 301 (CY23) and 515 (CY24), representing a 657% increase.  Prior to program launch, the initial start-up period required ~0.24 FTE to manage protocol development, workflows, and medication access/ordering.  After program initiation, total dedicated effort increased from 1.0 FTE to 2.25 FTE and effort distribution across roles evolved as the program gained experience and scaled up.  The program coordinator remained the single largest component (comprising 33-50% of total FTE each year).  Clinician effort decreased over time, from 42% to 4%.  Administrative effort shifted, with the addition of various roles: access coordinator, benefits/billing specialists, and outreach and technology staff.  With these refinements, program efficiency improved: the number of patients managed and injections per dedicated FTE both increased (27 to 50 and 68 to 229, respectively).  No virologic failures were observed and the discontinuation rate was less than 3%.

Information from this “real world” analysis can help guide resource planning and allocation to support long-acting injectable therapy scale up.  Although the clinic had prior experience as a trial site and utilized a “buy and bill” mechanism for CAB/RPV procurement (and therefore its experiences may differ from other clinics and practice models), the program was able to demonstrate successful growth and efficiency gains over a relatively short time.  It achieved this by gradually shifting FTE toward program/administrative personnel, encouraging multidisciplinary collaboration and flexibility, optimizing health information technology use, and investing in a dedicated program champion/coordinator.