Can LAI-CAB Sustain Long-Term PrEP Use?

A national claims analysis found modest uptake and declining persistence over 2 years despite increasing use of injectable HIV pre-exposure prophylaxis.

By
Andrea Surnit
July 17, 2026
4 min

Conexiant

Overview

Long-acting injectable cabotegravir (LAI-CAB) accounted for only 3% of PrEP use in the US, with persistence declining significantly over two years. The study analyzed data from 781,040 patients, revealing that only 23% of LAI-CAB users remained persistent after two years.

Background

HIV continues to be a major public health challenge in the United States, with over 38,000 new diagnoses projected for 2024. Long-acting injectable cabotegravir offers an alternative to daily oral PrEP, but understanding its uptake and persistence is crucial for effective HIV prevention strategies.

Data Highlights

Time Point	LAI-CAB Persistence	Overall PrEP Persistence
1 Year	50%	57%
2 Years	23%	30%

Key Findings

LAI-CAB represented only 3% of all PrEP users in the US.
Persistence with LAI-CAB declined from 50% at 1 year to 23% at 2 years.
57% of LAI-CAB users remained engaged in PrEP overall after 1 year.
A greater proportion of LAI-CAB users were covered by Medicaid compared to oral PrEP users (26% vs 14%).
Female patients had lower long-term persistence on LAI-CAB (13% at 2 years) compared to male patients (25%).
Older patients showed higher persistence rates than younger patients.

Clinical Implications

The findings indicate that while LAI-CAB is gaining traction, its long-term persistence is significantly lower than expected. Addressing structural barriers and enhancing support for patients may be necessary to improve adherence to long-acting PrEP options.

Conclusion

The study underscores the challenges of sustaining long-term use of LAI-CAB for PrEP, suggesting that simply increasing availability may not be sufficient to enhance adherence.