Study Explores Challenges in Uptake of Long-Acting Injectable PrEP


Challenges for uptake of long-acting injectable pre-exposure prophylaxis in populations at risk for HIV include fear of needles, potential adverse effects, and concerns about diminished efficacy.

Research shows that the use of daily, oral pre-exposure prophylaxis (PrEP) can safely and effectively prevent HIV infection when used as directed. However, difficulties with adherence to daily PrEP have led researchers to develop new PrEP modalities to reach patients for whom taking a daily pill is not feasible.

Most significantly of these is long-acting injectable PrEP, which has been approved by the FDA. In a study presented at IDWeek 2022 titled “A Qualitative Exploration of New and Existing HIV PrEP Modalities Among Men Who Have Sex with Men in Philadelphia,” researchers evaluated perceptions and use of long-term injectable PrEP compared with use of daily PrEP pills among a racially diverse sample of men who have sex with men (MSM).

The study enrolled 28 HIV-negative MSM—8 Black, 10 Hispanic, and 10 White—from January to May 2021. The study population lived in Philadelphia, PA, and had used social media sites, such as Facebook, Twitter, and Instagram, within the past year.

The researchers collected qualitative data for this population using a hybrid virtual approach, with 4 focus groups and 10 semi-structured interviews. The investigators said that the focus groups were kept racially and ethnically homogenous to best identify differences.

MSM participants addressed their willingness to use PrEP and expressed a preference for different HIV prevention modalities. Participants said that not having to take a daily pill was the primary appeal for the use of injectable PrEP. The most frequently reported challenges for use of injectable PrEP included fear of needles, concerns about the potential for adverse effects, and concerns regarding diminished efficacy.

The investigators delineated the PrEP perceptions of Black and Hispanic MSM because these populations have disproportionately higher HIV incidence and lower PrEP uptake, according to the study. Black and Hispanic MSM enrolled in the study said they were significantly more likely to consider intramuscular injectable PrEP if their primary care providers gave detailed information regarding the risks and benefits.

The investigators said that there is a clear need for primary care providers to provide accurate information regarding different PrEP treatment modalities. They added that providers should focus on the ease of dosing, efficacy, and safety of long-acting PrEP in preventing infection as they promote its use to high-risk populations.

Special attention and PrEP guidance should also be provided to those with the greatest risk of HIV infection, according to the study authors.

“Our findings provide important guidance for the development and promotion of future strategies to enhance the uptake of long-acting injectable PrEP to address the HIV epidemic among MSM,” the study authors wrote. “Primary care providers should play a key role in ameliorating concerns related to hesitancy towards injectable PrEP, including emphasizing ease of dosing, effectiveness, and safety of long-acting PrEP to prevent infection.”


Nguyen K Tran, MPH, Omar Martinez, JD, MPH, Neal Goldstein, PhD, MBI, Ayden Scheim, PhD, Seth Welles, PhD, ScD, 847. A Qualitative Exploration of New and Existing HIV PrEP Modalities Among Men Who Have Sex with Men in Philadelphia, Open Forum Infectious Diseases, Volume 8, Issue Supplement_1, November 2021, Pages S513–S514,

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