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Long-Acting Injectable Cabotegravir Use and Persistence Over 2 Years
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JAMA Netw Open
Published Online: June 26, 2026
Download the PDF here
Download the PDF here
Discussion
In this cohort study, LAI-CAB users accounted for 3% of all US PrEP users from 2022 to 2024. The growth of LAI-CAB use was modest, with an average biannual increase of 3170 users. Overall, in their first year of LAI-CAB care, one-half of users were LAI-CAB persistent, and after accounting for modality switch, more than one-half were PrEP persistent (57%). Over a 2-year period, fewer than one-quarter (23%) were LAI-CAB persistent and fewer than one-third were PrEP persistent (30%).
LAI-CAB uptake was low compared with oral PrEP. A higher proportion of LAI-CAB users (26%) were covered by Medicaid than were oral PrEP users (14%), possibly indicating lower access barriers for Medicaid recipients compared with users with other insurance types. Conversely, a lower proportion of LAI-CAB users (2%) than of oral PrEP users (15%) were enrolled in assistance programs, suggesting potential challenges in accessing LAI-CAB through this channel.
To our knowledge, this study is the first to document 2-year persistence for LAI-CAB users nationally. Persistence in oral PrEP care has proven to be challenging.27,28 In modeling studies, low levels of persistence led to limited progress toward ending the HIV epidemic.29,30 In our analysis, first-year LAI-CAB persistence (50%) was lower than previous national analyses of oral PrEP persistence (56%),31 and over a 2-year period, LAI-CAB persistence (23%) was substantially lower than oral PrEP persistence (41%).31 After accounting for modality switch, PrEP persistence (57%) was comparable to oral PrEP persistence at year 1 but lower at year 2 (30%). These findings suggest that there could be additional persistence barriers unique to LAI-CAB.
The implementation of more effective new PrEP modalities alone is unlikely to substantially increase PrEP use in the US, and future research should examine structural supports and behavioral interventions to facilitate scale-up of new, highly efficacious modalities.
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