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Capstone Intervention Plan: Long-Acting Injectable Cabenuva for HIV Management
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Capstone Intervention Plan: Long-Acting Injectable Cabenuva for HIV Management
This Capstone intervention plan evaluates monthly long-acting injectable Cabenuva versus daily oral antiretroviral therapy for virally suppressed adults with HIV, focusing on improving medication adherence and viral suppression over six months at an urban outpatient clinic. By integrating evidence-based nursing frameworks and advanced technologies, the plan addresses cultural, ethical, and policy barriers to deliver equitable, patient-centered care. Strategic leadership and stakeholder collaboration drive the initiative to enhance health outcomes for a vulnerable population.
Intervention Plan Components
Core Components
The intervention introduces long-acting injectable Cabenuva (cabotegravir and rilpivirine) for virally suppressed adults with HIV at the AIDS Healthcare Foundation (AHF) clinic. It tackles adherence challenges of daily oral antiretroviral therapy (ART) by offering monthly injections. Key components include patient selection, education, medication administration, monitoring, and resource coordination. Eligible adults are identified through electronic health records, followed by nurse-led education on Cabenuva’s benefits, administration process, and potential side effects, such as injection site reactions. Trained nurses administer intramuscular injections using sterile techniques. Monthly follow-ups track adherence via appointment attendance and viral suppression through viral load tests, supported by counseling and mobile reminders. The clinic secures Cabenuva through the Ryan White HIV/AIDS Program (RWHAP) and manages refrigerated storage requirements.
Cultural Considerations
The target population, often including racial minorities and low-income individuals, faces stigma and socioeconomic barriers. Education materials are tailored to diverse literacy levels and provided in multiple languages to enhance accessibility. Flexible scheduling and transportation assistance accommodate unstable living situations, ensuring equitable access (U.S. Department of Health and Human Services, 2024). Private injection settings mitigate stigma, fostering patient trust and engagement in care.
Theoretical Foundations
Theoretical Frameworks
The intervention aligns with Orem’s Self-Care Deficit Theory, which emphasizes nursing support when self-care demands exceed capabilities (Hartweg & Metcalfe, 2022). Cabenuva reduces the burden of daily pill-taking, while nurse-led education addresses knowledge deficits. Motivational interviewing, a psychological approach, enhances adherence by exploring barriers like stigma and motivations for treatment (Reinauer et al., 2021). Technologies, including electronic health record alerts and mobile apps, ensure operational efficiency.
Evidence-Based Justification
According to the National Institutes of Health (2023), long-acting injectable ART (LAI-ART) maintains viral suppression and improves adherence, particularly for patients with adherence challenges. Nurse-led counseling is an established strategy for ART adherence, as demonstrated in HIV prevention programs (Centers for Disease Control and Prevention, 2025). These findings validate the intervention’s focus on injectable therapy supported by nursing and technological strategies.
Stakeholders, Policy, and Regulations
Stakeholder Needs and Impact
Stakeholders significantly influence the intervention’s success, including patients, nurses, clinic administrators, and payers like Medicaid and RWHAP. Patients require convenient, stigma-free care, necessitating private injection settings and flexible scheduling within the intervention plan. Nurses need training to administer injections safely, requiring professional development programs that impact the education component (Chang et al., 2024). Administrators must address procurement and storage challenges, such as refrigerated storage for Cabenuva, affecting resource coordination. Payers determine coverage, influencing patient access to the medication, which shapes the intervention’s scalability. These needs ensure the intervention aligns with stakeholder priorities, enhancing implementation feasibility (U.S. Department of Health and Human Services, 2024).
Regulatory Implications and Potential Support
Regulatory frameworks and governing bodies, including the Centers for Medicare & Medicaid Services (CMS) and the Health Resources and Services Administration (HRSA), impact the intervention. CMS oversees billing compliance, requiring accurate electronic health record documentation for reimbursement, which affects the monitoring component. HRSA’s guidance through RWHAP supports equitable LAI-ART distribution, providing potential funding for medication procurement (U.S. Department of Health and Human Services, 2025). However, state-level variations in Medicaid and AIDS Drug Assistance Program (ADAP) coverage, often requiring prior authorization, pose regulatory barriers that could delay implementation. Potential support includes RWHAP grants and HRSA technical assistance, which can streamline procurement and training, enhancing intervention success.
Policy Considerations
Existing RWHAP policies partially support Cabenuva access but are inconsistent across states, limiting equitable distribution (U.S. Department of Health and Human Services, 2024). The intervention proposes new policy considerations to address these gaps. At the state level, policies should mandate Cabenuva inclusion in all Medicaid and ADAP formularies without prior authorization to reduce access barriers. Federally, increasing RWHAP funding would bolster medication availability and clinic resources. Advocacy engaging HRSA and state health departments would support the intervention’s implementation by ensuring consistent access and financial sustainability.
Ethical and Legal Implications
Ethical Considerations
Equitable access to Cabenuva is critical, as cost and coverage barriers may disproportionately affect low-income or minority patients, exacerbating disparities. Informed consent requires clear communication about benefits and risks, including injection site reactions. Stigma necessitates discreet injection administration to protect patient privacy.
Legal Considerations
Nurses must comply with state regulations for injection administration and maintain accurate electronic health record documentation for Centers for Medicare & Medicaid Services (CMS) billing. Non-coverage by payers could raise legal concerns about discriminatory care practices, particularly for underserved groups.
Mitigation Strategies
Sliding-scale payment options and advocacy for expanded coverage address access issues. Secure electronic health record systems and private injection settings safeguard confidentiality, aligning with Health Insurance Portability and Accountability Act (HIPAA) standards.
Management and Leadership
Leadership Strategies
Transformational leadership fosters interprofessional collaboration. Nurse leaders train staff on Cabenuva administration, coordinate with pharmacists for procurement, and engage social workers for patient support. Monthly team meetings address challenges, promoting innovation and alignment with project goals.
Change Management
Transitioning to Cabenuva requires workflow adjustments, such as scheduling injections and updating electronic health records, potentially increasing initial nurse workload. Improved adherence and viral suppression enhance care quality and reduce long-term costs, like hospitalizations. Cost control leverages RWHAP funding and optimizes clinic resources (U.S. Department of Health and Human Services, 2024).
Delivery and Technology
Delivery Methods
The intervention involves in-clinic injections by trained nurses, supported by telehealth for follow-up counseling to accommodate patient schedules. Community outreach, including flyers and support groups, promotes enrollment and awareness, ensuring broad reach.
Technological Integration
Electronic health records track appointments and viral loads, while mobile apps send adherence reminders. Emerging technologies, such as automated text-based nudges, could enhance engagement. Telehealth facilitates remote monitoring, reducing clinic visits for stable patients (National Institutes of Health, 2023), aligning with care efficiency goals.
Timeline
Implementation Schedule
The six-month plan includes:
· Month 1: Identify patients, train staff, provide education, and conduct baseline viral load testing.
· Months 2–5: Administer monthly injections, provide counseling, monitor adherence and side effects, and perform viral load tests.
· Month 6: Evaluate outcomes (adherence and viral suppression rates vs. oral ART), analyze data, and disseminate findings.
Influencing Factors
Timing depends on staff training, medication procurement, and enrollment. Delays from payer approvals or supply chain issues are mitigated by early advocacy and RWHAP support.
Conclusion
This intervention plan harnesses Cabenuva’s potential to improve adherence and viral suppression for adults with HIV. By addressing cultural, ethical, and policy barriers with evidence-based nursing and technological strategies, it enhances care quality and equity. Stakeholder collaboration, policy advocacy, and robust leadership ensure sustainable, patient-centered outcomes.
References
Centers for Disease Control and Prevention. (2025). HIV prevention: Pre-exposure prophylaxis (PrEP). https://www.cdc.gov/hiv/prevention/prep.html#:~:text=PrEP%20is%20for%20adults%20and,during%20pregnancy%2C%20or%20while%20breastfeeding.
Chang, Y. Y., Chao, L. F., Chang, W., Lin, C. M., Lee, Y. H., Latimer, A., & Chung, M. L. (2024). Impact of an immersive virtual reality simulator education program on nursing students’ intravenous injection administration: A mixed methods study. Nurse Education Today, 132, 106002. https://doi.org/10.1016/j.nedt.2023.106002
Hartweg, D. L., & Metcalfe, S. A. (2022). Orem’s self-care deficit nursing theory: relevance and need for refinement. Nursing science quarterly, 35(1), 70-76. https://doi.org/10.1177/08943184211051369
National Institutes of Health. (2023). Long-acting injectable antiretroviral therapy for HIV. https://doi.org/10.1186/s12879-023-08071-9
Reinauer, C., Platzbecker, A. L., Viermann, R., Domhardt, M., Baumeister, H., Foertsch, K., … & Meissner, T. (2021). Efficacy of motivational interviewing to improve utilization of mental health services among youths with chronic medical conditions: a cluster randomized clinical trial. JAMA network open, 4(10), e2127622-e2127622. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2784614
U.S. Department of Health and Human Services. (2024). Ryan White HIV/AIDS Program services report. https://ryanwhite.hrsa.gov/about/recipient-resources
U.S. Department of Health and Human Services. (2025). Health Resources and Services Administration: HIV/AIDS Bureau. https://hab.hrsa.gov/
U.S. Department of Health and Human Services. (2025). State Medicaid and AIDS Drug Assistance Program formularies. https://ryanwhite.hrsa.gov/about/parts-and-initiatives/part-b-adap
Above was the work from last time
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APA FORMAT REQUIRED FOR ALL ASSIGNMENTS
· Written communication is free of errors that detract from the overall message.
· Font and font size: Times New Roman, 12 point.
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(Minimum of 2 to 3 pages)
· Define the outcomes that are the goal of an intervention plan
· Create an evaluation plan to determine the impact of an intervention for a health promotion, quality improvement, prevention, education, or management need