IAPAC Public Comment to Texas HIV Medication Program

12 April 2024

Mr. Frank Rosas
Chair, Medication Advisory Committee
Texas HIV Medication Program

Dear Mr. Rosas and distinguished Committee members,

The International Association of Providers of AIDS Care (IAPAC), which represents almost 1,000 clinician-members in Texas, urgently requests that long-acting injectable antiretroviral therapy (LAI-ART) be made immediately available to people living with HIV (PLHIV) across Texas who meet income and other eligibility factors through the Texas HIV Medication Program (THMP). As we strive to honor patient choice of effective treatment options that facilitate viral suppression leading to undetectable viral load and U=U (Undetectable=Untransmittable), it is imperative to recognize the significance of LAI-ART in this context.

Numerous studies have shown that LAI-ART has demonstrated remarkable effectiveness in achieving and maintaining viral suppression among PLHIV. Additionally, a study presented at the 2024 Conference on Retroviruses and Opportunistic Infections (CROI) noted that for PLHIV who have consistently shown an inability to adhere to oral antiretroviral therapy (ART) regimens due to challenges with pill-taking, LAI-ART offers a critical alternative. By providing a sustained release of medication over an extended period, LAI-ART eliminates the need for daily pill-taking, thereby addressing a significant barrier to treatment adherence.

Central to the discussion of LAI-ART is the concept of “patient choice.” Autonomy is a fundamental principle in achieving positive HIV and other health outcomes. It is essential that PLHIV have access to a range of treatment options and are empowered to make informed decisions about their care. By offering LAI-ART through the THMP, we uphold the principle of patient choice and provide PLHIV with the opportunity to select the treatment modality that best aligns with their treatment preferences and life circumstances in partnership with their healthcare providers.

Moreover, THMP coverage of LAI-ART is crucial for supporting the goals of the Fast-Track Cities initiative in Texas. The network of four Fast-Track Cities in Texas (Austin, Dallas, Houston, and San Antonio, as well as their respective counties) has made significant progress in closing HIV treatment gaps and reducing HIV incidence. However, to continue this momentum and achieve targets such as a 90% decrease in HIV incidence under the Ending the HIV Epidemic strategy, the Fast-Track Cities initiative’s 95-95-95 targets, and Texas’ goal of a 75% viral suppression rate by 2025, it is essential that Fast-Track Cities in Texas have access to all tools at their disposal, including effective ART options like LAI-ART.

Finally, it is crucial to recognize the role of the national AIDS Drug Assistance Program (ADAP), and state-specific extensions such as THMP, as a safety net for medically indigent PLHIV. THMP plays a vital role in ensuring access to life-saving medications for those who may not have the financial means to afford them otherwise. By including LAI-ART within THMP coverage, we prioritize health equity in the HIV response, ensuring that no person is left behind. Access to innovative treatment options like LAI-ART should not be contingent on socioeconomic status, and by extending coverage to include LAI-ART, we take a significant step towards equitable healthcare access for all individuals living with HIV in Texas.

In conclusion, we urge the THMP Medication Advisory Committee to consider the inclusion of LAI-ART within the ADAP program. Doing so would not only honor patient choice and autonomy but also contribute to the progress towards ending the HIV epidemic and achieving the targets set forth by Fast-Track Cities.

Thank you for your attention to this important matter.

Warmest regards,

Dr. José M. Zuniga


Representing 30,000 members, IAPAC is the largest association of clinicians and allied health professionals working to end the epidemics of HIV and tuberculosis, as well as eliminate HBV and HCV. IAPAC is also a core technical partner to the Fast-Track Cities network and the Secretariat for its Fast-Track Cities Institute. For more information about IAPAC, visit: https://www.iapac.org/