Medical and psychological needs for injectable long-acting cabotegravir as pre-exposure prophylaxis

Objectives: Long-acting injectable cabotegravir (LACAB) has proven to be superior to oral pre-exposure prophylaxis (PrEP); however, it represents an issue for PrEP management, given the relevant burden on clinic workload. This study aimed to describe (1) the proportion of users requiring LACAB for medical issues, (2) the proportion of users who wish to switch to LACAB and (3) the factors associated with prioritising LACAB based on a combination of medical and psychological needs. Methods: Toxicity, adherence and efficacy issues were evaluated in PrEP users attending a community-based service. The same population underwent an online survey to measure their desire for and reasons for switching to LACAB. An adjusted model was developed to identify variables associated with both medical needs and interest in LACAB. Results: A total of 1056 individuals were assessed for LACAB medical needs, and 27.8% were eligible, primarily due to adherence issues. Of the 419 survey respondents, 74.9% expressed interest in LACAB. Age older than 25 years, use of any other concomitant medication and reporting sexual encounters without PrEP or condom use were associated with both the medical need for LACAB and interest in this new preventive strategy. Conclusions: The need for and desire to use LACAB are significant. The health system needs to be implemented to address the issues posed by this novel approach.