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Ask Us Europe Study: Checking in on Treatment Optimization

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Released: August 19, 2026

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Prior studies indicated high levels of interest in long-acting antiretroviral therapy (LA ART), but real-world uptake has been slow. Results of the Ask US Europe study, presented at AIDS 2026, suggested that one reason for this gap may be that healthcare professionals are simply not regularly discussing treatment options with patients. 

Chloe Orkin
Chloe Orkin, MBChB, FRCP, MD
Ask Us Europe

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The complete, injectable HIV treatment with dosing every other month, long-acting (LA) cabotegravir and rilpivirine (CAB + RPV), is already available in many high-resource settings and licensed as an option for people with viral suppression. LA CAB + RPV was approved in the European Union in 2020, but uptake has been slow, despite implementation efforts. 

There are many possible reasons for this, including the need to navigate complex insurance systems and staff and clinic capacity issues. Providing 2-monthly injections is more labor-intensive than prescribing oral pills, and requires clinic space for administration. Some patients also do not want to attend appointments every other month and find oral pills more convenient.

However, I am still surprised by how few people are receiving LA CAB + RPV in Europe, particularly given that studies done before its approval indicated high levels of interest in new therapies, especially injectable antiretroviral therapy (ART). This suggests a gap between what people living with HIV said they wanted and what is happening in real-world clinical practice. 

Ask Us Europe
To understand why so few people are receiving LA CAB + RPV in Europe, my collaborators and I decided to develop the Ask Us Europe study, a community-coproduced, mixed-methods study consisting of a survey and interviews. This study established a study group of people living with HIV from 18 European countries where LA CAB + RPV was available at the time of study initiation. Together, we devised survey questions based on the lived experience of people living with HIV and consultations with their healthcare professionals (HCPs). The aim of the study was to understand whether HCPs are checking in with their patients annually about their treatment regimens to assess whether they are still receiving the best ART for their individual needs.

For people who reported having discussions about treatment satisfaction, we then asked if both oral treatment options and LA CAB + RPV were discussed and offered. Next, we asked questions to determine if people were medically suitable for LA CAB + RPV and about interest in new LA modalities, such as longer-acting 4-6 monthly injections, implants, and weekly or monthly oral options. 

Findings
Results from the Ask Us Europe study were presented in 2 posters at AIDS 2026. Across the 18 study countries, we recruited more than 1900 participants: 18% were cisgender women, 8% were transgender or gender diverse; 77% were white; 39% were 55 years of age or older; and 8% were recent migrants (within 5 years of arrival).

Overall, 80% of participants were clinically eligible for LA CAB + RPV (no baseline resistance to either component, no active hepatitis B infection, no pregnancy, expected to maintain consistent adherence to injection visits). But only 15% had ever received it.

We found that although 81% of participants had ever discussed whether their treatment was right for them, only 41% had this discussion with an HCP within the past year. Participants older than 55 years of age were less likely to have discussed optimizing their treatment in the past year.

Among participants who did have treatment optimization discussions with their HCP and who had never received LA CAB + RPV, 42% indicated that LA CAB + RPV was discussed. Among those who did not discuss LA CAB + RPV, 45% were both eligible and interested.

In terms of future options for LA therapy, interest in injectables dosed 2 or 3 times per year was highest at 77%, whereas 56% of participants were interested in the weekly oral tablet.

Ultimately, most participants did not have treatment optimization discussions annually, and almost 20% did not ever recall having one. Even when treatment optimization discussions occurred, fewer than one half discussed LA CAB + RPV. Almost one half of those who did not discuss LA CAB + RPV were both interested and eligible, highlighting a major treatment gap: Many people who could benefit from injectable LA ART are not even discussing it with their HCP. Older people were even more likely to be left behind in the delivery of personalized HIV care. With more LA agents on the way, to me, this highlights the importance of guidelines stipulating that optimization discussions should take place annually and that patients should be informed of novel modalities.

Your Thoughts
How often do you think HCPs should be checking in about treatment satisfaction for people living with HIV? How often do you do it, personally? Leave a comment to join the discussion!

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