Injectable PrEP Overall Acceptable, Preferred for HIV Prevention

Across several studies, researchers identified an overall preference for injectable pre-exposure prophylaxis (PrEP) for preventing human immunodeficiency virus (HIV). The systematic review was published in the Journal of the International AIDS Society.

While oral PrEP does not need to be taken continuously, adherence during periods of risk is crucial to ensure PrEP is effective at preventing infection, said Lara MJ Lorenzetti, PhD, affiliated with FHI 360, and coauthors. A once-daily oral pill may present challenges related to adherence and persistence, researchers said.

“Newer PrEP products, especially long-acting modalities, could increase PrEP uptake and use,” Dr Lorenzetti and coauthors said. “Understanding acceptability, interest in and views about injectable PrEP from potential end-users is key to informing global guidelines to facilitate uptake, thereby increasing coverage of HIV prevention among populations at substantial risk.”

The team searched PubMed, Global Health, Cochrane Register of Controlled Trials, Embase and the Cumulative Index to Nursing and Allied Health Literature, as well as conference websites, for peer-reviewed articles and grey literature published from January 2010 to September 2021. There were no restrictions on location, but articles were excluded if they did not include primary data, had duplicative data, or reported interim results if final results were available.

Sixty-two articles were included in the review. Most were observational, cross-sectional, qualitative studies involving men who have sex with men (MSM).  

“Most studies (57/62) examined injectable PrEP, including hypothetical injectables (55/57) or placebo products (2/57),” authors reported. They found 6 studies that specifically involved the long-acting injectable cabotegravir.

Injectable PrEP was often but inconsistently preferred in the United States. Participants in the ECLAIR study, which involved long-acting cabotegravir, reported higher satisfaction with the injectable than the daily oral pill as well as higher interest in future injectable use, compared to other articles. In other studies, MSM were willing to receive and preferred injectable PrEP over oral PrEP, on-demand PrEP, and gels or suppositories.

“Many stakeholders indicated that injectable PrEP could help address adherence challenges associated with daily or on-demand dosing for oral PrEP and may be a better lifestyle fit for individuals seeking privacy, discretion and infrequent dosing,” researchers said.

Younger MSM preferred condoms or yearly implants over injectables or quarterly implants. Younger Black and Latino MSM more often preferred daily oral pills, followed by implants and then injectables. 

Global preferences varied, researchers said.

Regarding injectable PrEP, people reported concerns related to fear of needles, injection site reactions and body location, logistical challenges, and efficacy. 

“Despite an overall preference for injectable PrEP, heterogeneity across groups and regions highlights the importance of enabling end-users to choose a PrEP modality that supports effective use,” Dr Lorenzetti and coauthors concluded. “Future research should focus on equitable implementation, including real-time decision-making and how trained health care providers can support choice.”

Reference:
Lorenzetti L, Dinh N, van der Straten A, et al. Systematic review of the values and preferences regarding the use of injectable pre-exposure prophylaxis to prevent HIV acquisition. J Int AIDS Soc. 2023;26 Suppl 2:e26107. doi:10.1002/jia2.26107