Long-acting PrEP uptake is rising—but persistence lags

Clinical takeaway: When offering long-acting injectable cabotegravir for HIV PrEP, plan early for persistence: schedule follow-up injections before patients leave the clinic, address insurance or access barriers proactively, and discuss oral PrEP as a fallback option if injections become difficult to maintain.

Long-acting injectable cabotegravir can reduce barriers tied to daily oral PrEP, but its population-level impact depends on whether patients can start and stay on treatment.

In a national claims-based cohort study of 781,040 US PrEP users from 2022 to 2024, long-acting injectable cabotegravir (LAI-CAB) remained a niche option despite steady growth. Overall, 24,194 people used LAI-CAB at least once, accounting for 3% of all PrEP users. By the second half of 2024, LAI-CAB represented 4% of PrEP use.

LAI-CAB users were mostly male (85%) and commercially insured (68%); 19% were Black, 19% Hispanic, and 58% White. Compared with oral PrEP users, LAI-CAB users were more often female (15% vs 11%) and more likely to have Medicaid coverage (26% vs 14%).

Persistence was the major challenge. Among 12,118 users with at least 1 year of follow-up, 50% remained persistent on LAI-CAB, while 57% remained persistent on any PrEP after accounting for switches to oral medication. Among 3,381 users with 2 years of follow-up, LAI-CAB persistence fell to 23%, and overall PrEP persistence was 30%.

Sex-based differences stood out: 2-year LAI-CAB persistence was 25% among male users versus 13% among female users. Persistence was broadly similar across racial and ethnic groups.

The authors cautioned that “the implementation of more effective new PrEP modalities alone is unlikely to substantially increase PrEP use in the US,” calling for structural supports and behavioral interventions to improve scale-up and retention.

Source: Koh SHE, et al. (2026 June 26) JAMA Netw Open. Long-Acting Injectable Cabotegravir Use and Persistence Over 2 Years