Review Article

Promises and potential pitfalls of long-acting injectable pre-exposure prophylaxis

Carey Pike, Elzette Rousseau, Linda-Gail Bekker
Southern African Journal of HIV Medicine | Vol 24, No 1 | a1497 | DOI: https://doi.org/10.4102/sajhivmed.v24i1.1497 | © 2023 Carey Pike, Elzette Rousseau, Linda-Gail Bekker | This work is licensed under CC Attribution 4.0
Submitted: 29 March 2023 | Published: 27 July 2023

About the author(s)

Carey Pike, Desmond Tutu HIV Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Elzette Rousseau, Desmond Tutu HIV Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Linda-Gail Bekker, Desmond Tutu HIV Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

Abstract

The number of products that can provide pre-exposure prophylaxis (PrEP) for HIV prevention is expanding, with three now approved in South Africa (oral Tenofovir-based PrEP, injectable Cabotegravir, and a Dapivirine-based vaginal ring) and more in the development pipeline. Although highly effective and safe, oral PrEP products have not reduced HIV incidence in South Africa to the extent seen in other countries, primarily due to adherence challenges, rapidly diminishing persistence over time, and insufficient scale-up of PrEP service delivery. The Dapivirine vaginal ring, which provides 1-month-long protection, provides women with a new and discreet choice for PrEP; however, it is Cabotegravir long-acting (CAB LA) that is anticipated to land the largest impact. Administered as an intramuscular injection given every 2 months, CAB LA is safe, highly efficacious, and expected to become available in South Africa in late 2023. Yet, clinical and implementation questions remain, including the need to understand and characterise breakthrough HIV infections amongst CAB LA users, knowledge of how to package each PrEP product in a new context of PrEP choice, and how to avoid the remedicalisation of PrEP access following extensive efforts to make oral PrEP delivery differentiated and community based.


Keywords

HIV prevention; pre-exposure prophylaxis; long-acting PrEP; Cabotegravir long-acting; injectable PrEP

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Crossref Citations

1. Exploring adolescent girls and young women's PrEP‐user profiles: qualitative insights into differentiated PrEP delivery platform selection and engagement in Cape Town, South Africa
Elzette Rousseau, Kathleen J. Sikkema, Robin F. Julies, Katelyn Mazer, Gabrielle O'Malley, Renee Heffron, Jennifer F. Morton, Rachel Johnson, Connie Celum, Jared M. Baeten, Linda‐Gail Bekker
Journal of the International AIDS Society  vol: 27  issue: 5  year: 2024  
doi: 10.1002/jia2.26254