Long-acting preexposure prophylaxis: early data on roll-out in the United States

Long-acting preexposure prophylaxis (LA-PrEP), including cabotegravir (CAB-LA) and lenacapavir, could expand biomedical prevention coverage and reduce HIV incidence. This review describes LA-PrEP rollout in the United States, early clinical innovations in delivery, as well as opportunities and challenges for future delivery.

Although CAB-LA is approved in numerous countries, availability is limited outside of implementation studies. Data on CAB-LA rollout in routine care are mainly limited to the U.S at present. Early data indicate that oral PrEP far exceeds CAB-LA use and gaps exist between prescription and receipt of CAB-LA, with barriers including insurance coverage. Successful early clinic models include multidisciplinary staffing for benefits navigation, medication procurement, and injection provision, scheduling, and monitoring. Innovative models are being explored for community health worker delivery, low-barrier care for persons with psychosocial barriers, and telehealth and community-based models. Given persistent disparities in HIV diagnoses and oral PrEP use, there is a critical need for equitable implementation of CAB-LA and forthcoming products, including long-acting lenacapavir.

Gaps exist between the promise of LA-PrEP and actual use in US settings. To achieve population-level impact with LA-PrEP, there is an urgent need for greatly expanded access, clinical systems prepared for delivery, and a focus on LA-PrEP equity.