New injectable PrEP set to reshape HIV prevention
England and Wales are nearing a landmark decision that could alter the landscape of HIV prevention. A long-acting injectable drug, cabotegravir (CAB-LA), is recommended for use in adults and young people who are HIV-negative, with the aim of reducing new infections. Unlike the routine daily tablets used in pre-exposure prophylaxis (PrEP), this injection is given every two months, offering a potent alternative for those who face medical or other barriers to daily pill-taking.
The development marks a significant shift in how public health bodies approach HIV prevention. Cabotegravir is the first injectable PrEP option and the first PrEP medicine to receive approval from the UK’s National Institute for Health and Care Excellence (NICE), which published draft guidance on the topic and is expected to issue final recommendations later this year. Once NICE finalises its guidance, CAB-LA could be available in England and Wales roughly three months after the publication of the final document.
Why this could be a game-changer
Health Secretary Wes Streeting described the approval as a “game-changing” development. He argued that the injectable alternative strengthens the country’s HIV prevention toolkit and could accelerate progress toward the long-standing goal of ending HIV transmissions. By offering a reliable option for people who cannot or will not take daily oral PrEP, CAB-LA expands access to effective prevention and could help curb new infections among higher-risk groups.
In practical terms, cabotegravir is administered every two months, a schedule designed to improve adherence and maintain strong protection against HIV acquisition. For individuals who struggle with daily medication regimens due to side effects, stigma, or logistical challenges, the injection provides a more convenient and consistent solution. This is especially relevant for populations that may be less able to access routine healthcare services, a factor that public health officials emphasise as England works toward its 2030 HIV transmission goal.
Impact on patients and clinics
Data from health authorities indicate that PrEP uptake in England continues to rise, with more than 111,000 people accessing PrEP in sexual health clinics last year—an 7% increase from the previous year. NICE projects that around the same number of people could benefit from CAB-LA each year, once the final guidance is in place. This alignment between demand and supply suggests a thoughtful expansion of the prevention landscape rather than a sudden shift.
A chief consideration for clinicians will be identifying suitable candidates for CAB-LA, who should be HIV-negative and able to follow the injection schedule. NICE notes that while oral PrEP remains a valid option for many, some individuals face contraindications or personal barriers that prevent consistent daily dosing. For those people, the jab could offer reliable protection and simplify preventive care within sexual health services.
What comes next
Medical authorities emphasise that CAB-LA is not a substitute for safe sex practices but a complementary tool in HIV prevention. Public health experts expect the injectable PrEP to be integrated into existing PrEP programs, with healthcare providers offering thorough counselling on benefits, potential side effects, and the importance of adherence to the two-month dosing window.
Health policymakers and clinicians are preparing to monitor real-world outcomes closely. If CAB-LA demonstrates strong effectiveness and tolerability in routine practice, it could become a model for other regions looking to broaden access to HIV prevention through innovative approaches. The ultimate aim remains clear: reduce new infections and move toward ending HIV transmissions in the UK by 2030.
A broader view on HIV prevention
Expanding PrEP options reflects a broader commitment to personalized prevention strategies. By tailoring HIV prevention to individuals’ health profiles and daily lives, health systems can improve adherence and, in turn, effectiveness. As England and Wales await the final NICE guidance, the potential approval of cabotegravir underscores the ongoing evolution of PrEP—shifting from a one-size-fits-all model to a more nuanced suite of prevention choices.
