Overview: A new chapter in HIV prevention
A potential breakthrough in the fight against HIV is on the cusp of becoming standard care in England and Wales. Cabotegravir, known as CAB-LA, is an injectable pre-exposure prophylaxis (PrEP) option that could be administered every two months to reduce the risk of HIV infection among HIV-negative adults and young people. Unlike the daily oral PrEP tablets that some at risk groups struggle to use consistently, CAB-LA offers a long-acting alternative that may boost adherence and protection.
The development is being advanced through draft guidance from the National Institute for Health and Care Excellence (Nice). If final guidance confirms the recommendation, CAB-LA would be the first injectable PrEP approved for use in the country and the first PrEP medicine Nice has endorsed. The rollout is anticipated roughly three months after Nice publishes its final guidance later this year.
The significance of an injectable PrEP option
PrEP, short for pre-exposure prophylaxis, has been a cornerstone in HIV prevention since daily pills became widely available. However, there are medical or other reasons why the pills aren’t suitable for everyone at risk. CAB-LA addresses these barriers by providing an injectable alternative that requires far less frequent dosing. For people who cannot tolerate or adhere to daily regimens, an injection every two months can offer dependable protection from HIV transmission.
How CAB-LA works
Cabotegravir is an antiretroviral medication that targets the virus at its earliest entry point in the body. When administered as an injection every two months, it maintains drug levels that help prevent HIV infection for those who may be exposed to the virus through sexual activity or other risk factors. This long-acting formulation reduces the day-to-day burden of maintaining protection and could improve uptake among individuals who have previously avoided PrEP due to pill fatigue or contraindications.
Public health impact and practical considerations
England has seen rising engagement with PrEP services. UK Health Security Agency (UKHSA) data show more than 111,000 people accessed PrEP in sexual health clinics in England last year, a 7% increase from the year before. NICE estimates suggest that around the same number of people could benefit from CAB-LA annually in England once it is available. Health Secretary Wes Streeting described the injection as “game-changing,” underscoring its potential to accelerate progress toward national HIV targets.
Officials frame CAB-LA as a complementary tool, not a replacement for existing PrEP approaches. It aligns with England’s broader ambition to end new HIV transmissions by 2030 by expanding access and offering more flexible options to prevent infection. Implementing an injectable regimen will involve coordinating appointments, injections administered by trained clinicians, and monitoring for any adverse effects. As with all PrEP strategies, ongoing education about safe sex practices and regular HIV testing remains essential.
Voices from the health community
Helen Knight, director of medicines evaluation at Nice, emphasized the ongoing public health challenge posed by HIV while highlighting the new tool: “HIV remains a serious public health challenge, but we now have powerful tools to prevent new infections.” She noted that approximately 1,000 people in England cannot take daily oral PrEP due to contraindications or other barriers, making CAB-LA a vital option for expanding protection across vulnerable populations.
Public health experts expect that the injectable option could substantially broaden PrEP reach among groups who have struggled with pill-based regimens, including younger populations and those with complex medical histories. As NICE finalizes its guidance, healthcare providers, clinics, and community organizations are preparing to integrate CAB-LA into existing PrEP services, with a focus on equity and accessibility.
What comes next
With NICE’s draft recommendation in hand, the real-world rollout hinges on the final guidance and system readiness. If approved, CAB-LA is projected to be available about three months after NICE’s final guidance is published. England intends to maintain momentum toward ending HIV transmissions by 2030, aided by expanded PrEP options and continued public health investment.
