Exploring the Early Implementation of Injectable Antiretroviral Therapy in Ontario using the RE-AIM Framework: A Retrospective Cohort Study and Cross-Sectional Survey
Bibliographic record
Abstract
Background: Injectable cabotegravir/rilpivirine (CAB/RPV-LA) is an HIV regimen and may benefit marginalised populations facing barriers to oral ART access and adherence. Using RE-AIM, I assessed uptake in the first 12 months following its publicly-funded availability in Ontario (Dec2021-Nov2022). Methods: I assessed Reach (evaluated using On-Marg), Effectiveness, and Maintenance retrospectively at three Toronto HIV clinics. Participants were on standard ART regimens, had HIV RNA<200copies/mL, no contraindications/resistance, and had an Ontario postal code. I assessed Adoption and Implementation by surveying Ontario HIV clinic personnel. Results: Of 1506 participants, 5% accessed CAB/RPV-LA. Predictors included younger age, being MSM, and lower marginalization. Small cell sizes limited conclusions on Effectiveness and Maintenance. Surveys showed 16/23 clinics prescribed CAB/RPV-LA, mostly in Toronto/Ottawa, preferring 8-weekly dosing without an oral lead-in. Implementation challenges included administration logistics, but clinicians acknowledged its patient-level benefits. Conclusions: Access to CAB/RPV-LA remains limited for marginalised populations, despite efforts to improve accessibility.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".