Hi Alex,
yes I think you are good to follow the target date approach- at my practice this is what we do as well. It is much simpler for clinicians and patients! Usually we tell patients "you are due for your injection on the 5th (+/- 7 days) of even months" (as an example) and then they are able to remember when they are due.
For the example you gave, I would not want to extend this dosing interval to 77 days just to make sure the levels of cabotegravir don't drop. I personally would just use the 11th of odd months as the TTD moving forward since their last dose was on 3/11/25.
Hope that helps!
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Carly Floyd (she/ella), PharmD, PhC, AAHIVP
Albuquerque, NM
CaCloud@salud.unm.edu------------------------------
Original Message:
Sent: 04-30-2025 10:37
From: Alex Gonzalez
Subject: Apretude PrEP "Target Date" dilemma
Hi all - I have some Apretude PrEP patients whom I started without the oral lead in, whom I've already initiated, and who are now on continuation injections q8 weeks. My organization is trying to integrate injectable PrEP into our primary care framework across several sites (which is super exciting given that we care for several hundred thousand patients in Eastern Massachusetts), and it would be MUCH easier for our primary care nurses to adopt an Apretude PrEP protocol if it followed the injection schedule recommended on the Viiv site (which recommends picking an injection date between the 1st and 28th of the month and sticking with that number date as the +/- 7 days target, eg "your target date is the 13th day of every other month and you should get your Apretude shot within 7 days before or after that date") instead of the injection schedule that was used in the clinical trials and that I have been using (which involves making the continuation injection target date the same day of the week, but always 8 weeks apart from the previous injection date, +/- 7 days eg "your first injection was on 2/27/24 and your first continuation injection target date is 28 + 56 days after that ie 5/21/24, and every subsequent continuation injection target date will be 56 days from that continuation injection target date, and you have 7 days before and after that target date to get your shot" which is admittedly quite a mouthful). Seeing how much easier and learnable the Viiv website approach is, we are going to follow it going forward for all subsequent Apretude starts. My questions to the hive are:
- is it safe for me to "convert" all of these q8 weeks folks to the Viiv website target date approach now? Specific example using the above dates: my 2/27/24 start got his second initiation shot on 3/28/24 (30 days), his first continuation shot on 5/29/24 (62 days), his second continuation shot on 7/22/24 (54 days), his third continuation shot on 9/17/24 (57 days), his fourth continuation shot on 11/18/24 (62 days), his fifth continuation shot on 1/14/25 (57 days), and his sixth continuation shot on 3/11/25 (56 days). If I "convert" him to the Viiv website approach and honor that initial target date of 27, his next continuation shot will be 5/27/25 (77 days) instead of 5/6/25 plus or minus 7 days (4/29/25-5/13/25). We've spoken to Viiv folks and they think it's safe to convert the patient and use the target date of 27 moving forward. What do you think?
- for those of you doing a lot of this Apretude work... are you using the Viiv website target date approach? Or are you sticking with the q8 week continuation dosing protocol used in the trials, even if this makes for a lot more math (which could lead to more mistakes)?
Congrats if you are still reading this far!
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Alex Gonzalez
Natick MA
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