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1w
Long-acting injectable PrEP: bridging the gap between clinical efficacy and real-world HIV prevention for at-risk patients.

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?

  • 1w
    I discuss long-acting injectable options for Prep with all patients eligible for Prep, and more and more patients are switching over. The majority of my patients on oral Prep have not actually confessed to issues with compliance; we have never had a Prep patient seroconvert. One of my Apretude patients always experienced injection-site pain, so he has switched to Yeztugo. One of my Yeztugo patients did not like the cosmetic appearance of the injection-site nodules, so he has switched back to oral Prep. Regardless of Prep modality, I see my patients every three months for continued STI testing. The biggest barrier to prescribing injectable Prep is not with patient compliance nor tolerability, but administrative: determining patient benefits (I double-check any benefit investigations provided by the manufacturers), obtaining prior authorization, coordinating deliveries with specialty pharmacies, including making sure I call the pharmacy far enough in advance to make sure the delivery will happen on time. This coordination has to be timed because if you call the pharmacy to process it too early, you will get a refill-too-soon rejection, but then if you call too late, you risk not having it delivered in time for the patient's appointment! It actually has been unbelievable how much administrative time these medications take; my spreadsheet is ever-expanding. That won't ever deter me from making sure my patients who want it get it, but I wish that aspect of it could also be discussed during manufacturer-sponsored roundtables, etc, so our expectations as providers are clear. From the patients' point of view, injectable Prep is very convenient, everything is done for them ahead of time, and the manufacturer copay savings takes care of all out-of-pocket costs.
  • 1w
    I have used Apretude for some patients, prior authorization for this medication is simple and straightforward even for Medicaid patients. Yeztugo is harder to get authorized, Patient often express distress over the tender nodules that deveop after the first injection and need constant reassurance and education to deal with this side effect.
  • 3w
    I have not added them in yet as they are too difficult to get approved and into the patients hands. Cost and access are too large of a barrier. Haven't found a solution yet.
  • 3w
    My biggest barrier is the prior auth. process by far.
  • 3w
    The difficulty is always in getting insurance to see the preventive benefit and being willing to cover. it seems they would prefer to cover consequences of disease rather than prevention, which ultimately would be life and cost saving...
  • 4w
    I agree that insurance coverage is the biggest barrier. Most patients are accepting of an injection and that is not the biggest issue. It helps to have dedicated staff to assist with prior authorizations and staff that are familiar with the patient assistance programs and copay that is not always feasible if your clinic does not have a large population of eligible patients. Onsite pharmacy is helpful.
  • 1mo
    Insurance coverage becomes an issue for patients and this needs to be discussed with them as a potential barrier when discussing treatment. Having dedicated staff to help with prior authorizations are helpful.
  • 1mo
    long acting PREP is a great ideal, if the patient would buy in and insurances would cover the cost. the other thing is provider will need to be educated on administration and side effects.
  • 1mo
    Integrating long-acting injectable PrEP is most successful when utilizing shared decision-making to address pill fatigue, though providers face significant hurdles with prior authorization and navigating the "bridge period" for medication access. Effective,, practice-level strategies to overcome these barriers include employing dedicated patient navigators for paperwork, collaborating with specialty pharmacies for procurement, and utilizing EHR registries for scheduling
  • 1mo
    Insurance is the biggest hurdle but once done to remind and bring patients per schedule is also a hurdle-requires good coordination and communication with patients
  • 1mo
    Discuss issues related to insurance. Also releated to the length of time.
    Obviously oral is the one that is most acceptable
  • 1mo
    I discuss oral vs injectable and insurance barriers and possible out of pocket costs along with periodic office visits and lab monitoring. Most patients prefer oral formulations. I provide names of medications and recommend they read about it and call their insurance to help determine cost and coverage.
  • 1mo
    most of my patients on PrEP are on Descthe vy but are interested in a long acting injectable options. Some of them have stated Apretude but complain of constant local injection site reactions including myalgia. I found the prior authorization process for Apretude quite seamless. We schedule the next injection before the patient leaves the office. Yeztugo is an entirely different authorization is much more challenging and I have not used buy and bill process yet. I order it via specialty pharmacy
  • 1mo
    Usually insurance is the biggest hurdle when it comes to Prep and injectables. Also the hassle of referring to a infusion center and authorization to get it done. These are all barriers I see within my practice versus oral prep is generic and can be taken as 1 tab PO QD without any of these hurdles. But for the ones who do request it I will try to get it covered.

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