Long-Acting Cabotegravir Injectable Pre-Exposure Prophylaxis: Efficacy and Implementation in High-Risk Populations 

Wotsomu Evasi

Clinical Pharmacology and Antimicrobial resistance Kampala International University Uganda

Email: evasi.wotsomu@stdwc.kiu.ac.ug

ABSTRACT

Human immunodeficiency virus (HIV) remained a global public health challenge despite advances in antiretroviral therapy. Oral pre-exposure prophylaxis with tenofovir-based regimens has demonstrated efficacy but faces adherence barriers that limit real-world effectiveness. Long-acting cabotegravir, an integrase strand transfer inhibitor formulated for intramuscular injection, represents a paradigm shift in biomedical HIV prevention by eliminating daily adherence requirements. This review critically evaluated the biochemical properties, clinical efficacy, and implementation challenges of long-acting cabotegravir injectable pre-exposure prophylaxis in high-risk populations. A comprehensive literature search identified peer-reviewed clinical trials, pharmacokinetic studies, implementation science research, and policy documents published between 2015 and 2025. Cabotegravir exhibited sustained plasma concentrations following bimonthly intramuscular administration, achieving four-fold higher protective efficacy than oral tenofovir disoproxil fumarate/emtricitabine in clinical trials among men who have sex with men, transgender women, and cisgender women. Phase 3 trials demonstrated 66 to 89 percent relative risk reduction compared to daily oral prophylaxis. However, implementation barriers included injection site reactions in 30 to 40 percent of recipients, prolonged pharmacokinetic tail necessitating oral bridging therapy, healthcare infrastructure requirements for injectable delivery, and substantial cost differentials compared to generic oral formulations. Emerging resistance patterns and inequitable global access remained critical concerns. Long-acting cabotegravir represented a highly efficacious prevention modality that addressed adherence challenges but required comprehensive implementation strategies addressing logistical, economic, and equity considerations to realize population-level impact.

Keywords: Cabotegravir, Pre-exposure prophylaxis, HIV prevention, Integrase inhibitors, Injectable antiretrovirals.

CITE AS: Wotsomu Evasi (2026). Long-Acting Cabotegravir Injectable Pre-Exposure Prophylaxis: Efficacy and Implementation in High-Risk Populations. RESEARCH INVENTION JOURNAL OF RESEARCH IN MEDICAL SCIENCES 5(1):31-37. https://doi.org/10.59298/RIJRMS/2026/513137