Background
Oral pre-exposure prophylaxis (PrEP) with emtricitabine/tenofovir (F/TDF) is highly effective in preventing HIV-1 acquisition, but uptake and adherence remain suboptimal. Long-acting injectable cabotegravir (CAB-LA) has shown high efficacy in trials, though real-world effectiveness data remain limited. We evaluated initial PrEP choices, reasons for selection, and associated factors in ImPrEP CAB Brasil, the first study to evaluate CAB-LA PrEP implementation in Latin America.
Methods
ImPrEP CAB Brasil is an implementation study evaluating PrEP choice, feasibility, acceptability, and effectiveness of CAB-LA in sexual and gender minorities (ages 18-30) in public health PrEP services in 6 Brazilian cities. HIV-negative, PrEP-naive individuals chose between CAB-LA or F/TDF and received either a combination of mHealth education with a decision support tool plus standard of care (SOC) counseling, or SOC counseling alone to assist with PrEP choice. We compared characteristics by initial product choice and applied logistic regression to identify factors influencing CAB-LA choice. Decision-making was assessed using the Decisional Conflict Scale (DCS).
Results
A total of 1,447 participants were enrolled from October 2023-August 2024, with 1,200 (83%) choosing CAB-LA and 247 (17%) oral F/TDF. Most participants were cisgender MSM(91%), 42% aged 18-24, predominantly non-White(60%). Participants receiving the mHealth intervention were more likely to choose CAB-LA. Among those selecting oral PrEP, 46 % cited fear of injections, while 78% preferred CAB-LA due to difficulties with daily medication compliance. Most participants showed strong decision confidence (DCS mean: 1.9, SD: 4.8 ), with 82% believing they would continue their chosen method (Table). Among mHealth users, 65% found the intervention helpful, and 85% reported high satisfaction. Logistic regression indicated that mHealth exposure (OR=2.54; 95%CI:1.89-3.44; p < 0.0001) and CAS report (OR=1.32; 95%CI:0.98-1.77; p= 0.067) were associated with choosing CAB-LA. Younger participants (ages 18-20) and those with higher decision conflict were more likely to opt for oral PrEP (OR=0.94; 95%CI: 0.91-0.97; p< 0.0001).
Conclusions
In this pioneering PrEP choice implementation study in Latin America, the majority of participants chose CAB-LA. Personalized HIV prevention approaches are critical to empower individuals to select a PrEP method aligned with their values and lifestyles, enhancing the likelihood of long-term adherence and effectiveness.