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Brief Report: Long-Acting Injectable PrEP Can Substantially Reduce HIV Incidence in Los Angeles County: A Simulation

Aditya Khanna1, Francis Lee2, Katrina Schrode3

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Journal of Acquired Immune Deficiency Syndromes (1999)
|October 30, 2025
PubMed
Summary

Long-acting injectable pre-exposure prophylaxis (PrEP) significantly reduces HIV incidence among young Black men who have sex with men. High retention rates for injectable PrEP offer comparable or superior HIV prevention compared to daily oral PrEP.

Keywords:
HIVagent-based network modelcomputer simulationlong-acting injectablepre-exposure prophylaxissexual and gender minorities

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Area of Science:

  • Public Health
  • Epidemiology
  • HIV Prevention Research

Background:

  • Oral pre-exposure prophylaxis (PrEP) has reduced HIV incidence but faces adherence challenges due to daily dosing.
  • Young Black men who have sex with men (YBMSM) are disproportionately affected by HIV.
  • Long-acting injectable (LAI) PrEP presents a potential solution to improve adherence.

Purpose of the Study:

  • To simulate the impact of introducing LAI PrEP among YBMSM in Los Angeles County.
  • To evaluate how varying LAI PrEP uptake and retention rates affect HIV transmission.
  • To compare the effectiveness of LAI PrEP against oral PrEP in reducing HIV incidence and prevalence.

Main Methods:

  • Utilized an agent-based network model (ABNM) calibrated with empirical data.
  • Simulated HIV transmission dynamics over 10 years, incorporating dynamic sexual networks and HIV progression.
  • Modeled scenarios with different proportions of PrEP users switching to LAI and varying adherence levels to LAI retention.

Main Results:

  • LAI PrEP substantially reduced HIV incidence and prevalence compared to oral PrEP alone.
  • Retention rates of 60% or higher for LAI PrEP yielded reductions comparable to or exceeding oral PrEP.
  • A 45% decrease in HIV incidence was observed when all PrEP users switched to LAI with 85% retention.

Conclusions:

  • LAI PrEP shows significant potential for advancing HIV prevention among YBMSM by overcoming oral PrEP adherence issues.
  • Integrating LAI PrEP into public health strategies can lead to substantial reductions in HIV incidence.
  • LAI PrEP can contribute to ending the HIV epidemic in high-priority populations like YBMSM.