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New Study Shows Support for Long-Acting, Injectable PrEP

New options for HIV prevention are on the horizon. Clinical trials being conducted in the U.S., Brazil, and Africa show that long-acting injectable pre-exposure prophylaxis (PrEP) could eliminate the need to take a daily pill to prevent HIV infection. As these studies continue to produce impressive results, many people who now take oral PrEP are reporting interest in switching to injectable PrEP once it becomes available.

A recent survey by researchers at Hunter College suggests that more gay and bisexual men currently taking oral PrEP would rather take long-acting injectable PrEP. This finding highlights the need for PrEP dosing methods that better suit user preference.

Only 1% of the five million gay and bisexual men in the U.S. who meet the recommendations for PrEP by the Centers for Disease Control and Prevention (CDC) are currently using it. Improving the user experience of PrEP will be crucial to increasing its uptake among the broader population of potential users.

Oral pills for HIV prevention have become a common public health practice over the past few years, particularly among gay and bisexual men. Although PrEP in pill form is remarkably effective when taken every day, many men struggle to gain the optimal benefit due to adherence issues. By contrast, one injection with long-acting PrEP has the potential to protect against HIV infection for as long as three months.

Among the 104 gay and bisexual men who took the survey, those men who preferred oral PrEP expressed concerns that injectable PrEP would not be effective and would wear off over time. Future research on the effectiveness of injectable PrEP will help address these concerns.

Steven A. John, a research scientist at Hunter College and lead author of the paper, compared the trajectory of PrEP drug development to that of birth control. Indeed, many women throughout the world have switched from the pill to injections of long-acting birth control hormones such as Depo-Provera. Like birth control pills, taking oral PrEP carries a stigma that could be avoided by more intermittent injections.

“Similar to the history of birth control options for women, methods of PrEP dosing are currently under clinical study that would expand delivery options beyond a once-daily pill,” said Dr. John. “A long-acting injectable form of PrEP might be a good alternative for some — assuming it is shown to be effective and approved by the U.S. Food and Drug Administration — because daily pill adherence can be a challenge and burdensome.”

Due to the long duration of clinical trials, it may take several more years before long-acting injectable PrEP is available to consumers. Dr. John pointed out several unanswered questions that scientists must address before users can make truly informed decisions about whether to switch to injectable PrEP.

“It is important to note that we do not yet know how effective long-acting injectable PrEP is, how long the protection lasts, what the final recommended injection schedule will be, how much it will cost, and whether insurance will pay for it, all of which will have important implications for whether gay and bisexual men would prefer to switch from a daily-oral pill to a long-acting injectable,” said Dr. John.

For those individuals who have decided against using PrEP in the past due to pill burden, it is important to keep in mind that future forms of PrEP may be more acceptable. As with birth control, there is no one-size-fits-all approach to HIV prevention. The finding that many gay and bisexual men would prefer using a long-acting injectable PrEP could embolden scientists and drug makers to continue their search for new and potentially more effective dosing methods of PrEP.