Long-acting injectable pre-exposure prophylaxis (PrEP) has demonstrated substantial efficacy advantages over daily oral formulations across major clinical trials, yet real-world implementation shows that fewer than 53% of individuals prescribed PrEP initiate with their first injection. Slow PrEP uptake and persistent racial and gender disparities mean that populations facing the greatest barriers to adherence are often the least served by oral-first approaches.

The gap between clinical promise and practice-level uptake stems from structural challenges: the required HIV-negative status confirmation interval between prescription and first injection, workflow demands, insurance and reimbursement barriers, and patient unfamiliarity with injectable prevention modalities. While this approach offers a meaningful persistence advantage, therapy-level considerations, including the required bridge period before first injection and the need for ongoing clinic-based administration, add complexity to implementation. A long-acting injectable approach, dosed on a less frequent schedule than daily oral options, may better serve patients for whom daily adherence is not feasible.

Identifying appropriate candidates, counseling patients on modality preferences, and supporting follow-up injection scheduling are emerging as central competencies for clinicians integrating these options. Strategies such as pharmacy coordination, interdisciplinary care teams, and patient navigation programs are proving key to improving access and long-term retention in prevention care.

Please provide a minimum of a 3-sentence response.
How are you integrating long-acting injectable PrEP into your prevention conversations, and what barriers are you encountering in practice? What practice-level strategies have you found most effective in overcoming access, reimbursement, or workflow barriers to long-acting injectable PrEP?