Research Summary

US Claims Study Finds Modest Uptake of Injectable Cabotegravir PrEP

Edited by:
Ashton L. Stahl

Key Highlights

  • Long-acting injectable cabotegravir accounted for 3% of US pre-exposure prophylaxis users from 2022 through 2024.
  • Cabotegravir persistence was 50% among users with at least 1 year of follow-up and 23% among those with at least 2 years of follow-up.
  • When transitions to oral PrEP were included, PrEP persistence was 57% among users with 1 year of follow-up and 30% among those with 2 years of follow-up.

Long-acting injectable cabotegravir represented a small proportion of pre-exposure prophylaxis (PrEP) use in the United States, and persistence declined substantially over 2 years, according to a cohort study published in JAMA Network Open. From 2022 through 2024, 24,194 individuals used long-acting injectable cabotegravir, accounting for 3% of 781,040 PrEP users.

The retrospective cohort study used deidentified pharmacy and medical claims from the Symphony Health PatientSource database between January 1, 2022, and December 31, 2024. Participants had at least 1 claim for an approved oral or injectable PrEP medication.

Investigators defined cabotegravir persistence as having at least 2 long-acting injectable cabotegravir claims during each 6-month period. Persistence with any PrEP included at least 2 claims for injectable or oral PrEP during each 6-month period, allowing for treatment switches. Multivariable logistic regression was used to explore characteristics associated with cabotegravir use compared with oral PrEP.

Study Findings

Cabotegravir use increased from 704 individuals in the first half of 2022 to 16,557 in the second half of 2024, representing 4% of 390,816 PrEP users. The average increase was 3,170 users per 6-month period.

Among 12,118 cabotegravir users with at least 1 year of follow-up, 6,020 (50%) remained persistent with the injectable medication. When transitions to oral PrEP were included, 6,879 users (57%) met the study’s definition of PrEP persistence.

Of 3,381 users with 2 years of follow-up, 785 (23%) remained persistent with cabotegravir throughout all four 6-month periods, while 1,019 (30%) remained persistent with any PrEP. Two-year cabotegravir persistence was lower among users recorded as female at birth than among those recorded as male (13% vs 25%) and higher among users older than 50 years than among those aged 18 years or younger (35% vs 9%).

Clinical Implications

According to the study authors, implementing more effective PrEP modalities alone is unlikely to substantially increase national PrEP use. They stated that structural supports and behavioral interventions are needed to facilitate access to and sustained use of highly effective long-acting PrEP options.

The authors noted that 48% of race and ethnicity data were missing, but addressed this using hot-deck imputation. The claims database also lacked information about gender identity and sexual risk behaviors, limiting analyses involving these characteristics.

Expert Commentary

“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,” the researchers concluded.

Reference

Koh SHE, Huang W, Hall EW, et al. Long-acting injectable cabotegravir use and persistence over 2 years. JAMA Netw Open. 2026;9(6):e2620699. doi:10.1001/jamanetworkopen.2026.20699