Expanding HIV PrEP with long-acting injectables: What can we learn about acceptability from a clinical trial?

An ounce of prevention is worth a pound of cure. Questions remain though in the field of HIV prevention on how best to deliver that ounce. The use of HIV pre-exposure prophylaxis (PrEP) is a way for people to prevent HIV infection. A daily oral PrEP pill is effective at reducing the risk of HIV infection among men who have sex with men and among couples where only one partner is HIV-positive. However, PrEP administered by pill, vaginal gel or ring products among women, many in sub-Saharan Africa, shows no or more modest effectiveness. The difference? It comes down to adherence, meaning it only works if people consistently take PrEP according to the prescribed schedule.

One way to eliminate the need for daily PrEP adherence is to make a drug that stays in the system and works over a longer period. These “long acting” drugs are often delivered through an injection. The safety and acceptability of a long-acting injectable drug was tested in the HPTN 077 phase 2a clinical trial. As part of the trial, my colleagues and I conducted a study to explore if participants would actually find a long-acting injectable PrEP product desirable and acceptable. Our findings are important for researchers and program implementers planning to introduce or design such injectable products, and I describe several key takeaways here.