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Updated: Sep 15, 2026

Rapid Screening of HIV Reverse Transcriptase and Integrase Inhibitors
Published on: April 9, 2014
Long-acting HIV pre-exposure prophylaxis adherence and discontinuation: a global systematic review and meta-analysis
Xinyue Feng1,2, Xinsheng Wu1,2, Thomas S Fitzpatrick3
1Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China.
Background:
Long-acting HIV pre-exposure prophylaxis (PrEP) may overcome adherence and discontinuation challenges facing oral PrEP, which remain unsystematically reviewed. This study aimed to synthesize the evidence on long-acting PrEP adherence and discontinuation.
Methods:
We conducted a systematic review and meta-analysis of studies published from database inception to July 1, 2026 in PubMed, Web of Science, EMBASE, and Cochrane Library. Eligible studies reported adherence (on-time doses receipt at time points, e.g., at 2 months) or discontinuation (stopping doses or loss to follow-up within a time period, e.g., within 6 months) of long-acting PrEP, including long-acting injectable (LAI) and intravaginal ring (IVR) PrEP. Non-longitudinal designs and non-English publications were excluded. We used random-effects meta-analyses to pool estimates. Subgroup analyses were conducted by population, region, and study design.
Findings:
We identified 46 eligible studies (28 LAI and 18 IVR) including 22,945 individuals (14,190 and 8755). Adherence to six-monthly and two-monthly LAI-PrEP at 12 months was 93.0% (95% CI: 91.6-94.3) and 88.1% (84.7-90.8%); discontinuation for the six-monthly and two-monthly regimens within 12 months was 8.2% (4.9-13.4) and 16.0% (10.8-23.1). Discontinuation for two-monthly LAI-PrEP was higher in implementation studies than in clinical trials (14.6% vs. 1.8% within 6 months; 32.0% vs. 10.3% within 12 months, P < 0.0001). IVR-PrEP adherence was 66.1% (42.2-83.9%) at 6 months and discontinuation was 21.4% (12.6-33.8%) within 12 months. Compared with clinical trials, implementation studies showed lower adherence (32.0% vs. 73.8%) and higher discontinuation (41.1% vs. 7.7%) at 6 months (P < 0.0001).
Interpretation:
Adherence to LAI-PrEP remained high through 12 months, with the best adherence being observed in clinical trials, which serve as upper-bound benchmarks. Compared to LAI-PrEP, IVR-PrEP had lower adherence and higher discontinuation. Efforts facilitating longer-term adherence warrant research.
Funding:
This study was supported by the National Key R&D Program of China.
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