The Efficacy of a New Long-Acting Injectable PrEP

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The news today about the efficacy of a new long-acting injectable PrEP, the second such breakthrough announcement in recent months, is nothing short of groundbreaking. These latest results found that twice-yearly Lenacapavir for HIV prevention reduced HIV infections by 96% among cisgender men and gender diverse people. The previous trial results found 100% efficacy among adolescent girls and young women. 

But taken together, these results raise the stakes on the importance of getting this new tool to all those who would benefit from it, in the United States and around the world, once approved. The track record thus far, has not been a good one. Even though highly effective oral PrEP has been available for years, most people who could benefit from it in the U.S. and elsewhere still don’t have access and disparities persist. In addition, although there is a currently available injectable, it has been slow to roll out, faced implementation barriers, and requires more frequent injections.

In the United States, nearly two-thirds of those who could benefit from PrEP have not yet been prescribed it, with people of color and women lagging behind.  In addition, even though PrEP is now covered for free by most insurance plans, as required by the Affordable Care Act (removing what had been a significant barrier to access), this benefit was challenged in federal court by some employers who objected to having to pay for insurance coverage of PrEP on religious and technical grounds, and legal challenges are ongoing.

Globally, while PrEP access has recently begun to rise, still only 17% of the more than 21 million who need PrEP have received it. PEPFAR and the Global Fund are supporting much of the PrEP roll-out, but current global financing for HIV has been flat, at best, posing challenges for scaling up new tools.