Background: Long-acting injectable cabotegravir (CAB-LA) as pre-exposure prophylaxis (PrEP), given once every eight weeks, has been found to have superior efficacy over oral PrEP among men who have sex with men (MSM). We compared the epidemiological impact of expanding CAB-LA to current oral PrEP users with different levels of adherence, and non-PrEP users among MSM in the Netherlands. Methods: An MSM HIV transmission model was calibrated to the Dutch MSM HIV epidemic. The real-world effectiveness of daily oral-PrEP was assumed to decrease by users’ adherence levels: High (defined as >75% of the days covered, 93% effectiveness), medium (50–74% covered, 69%), and low (<50% covered, 18%), respectively. CAB-LA effectiveness was assumed as 91%. CAB-LA was targeted to current oral-PrEP users by their use adherence and non-PrEP-using MSM in 2025. The epidemiological impact of CAB-LA targeting strategies was evaluated over five, 15, and 25 years. Results: Assuming 100% coverage, providing CAB-LA to MSM with low oral PrEP adherence would avert 862 (19.7%) new HIV infections among all MSM over 25 years. Expanding CAB-LA to MSM with medium/high oral PrEP adherence and non-PrEP users did not show a substantial epidemiological impact. Moreover, our model suggested that the epidemiological impact would decrease with a lower real-world CAB-LA effectiveness. Conclusions: Our model showed that CAB-LA can be an important addition to ending the HIV epidemic by 2030. To optimise the full potential of CAB-LA at the beginning stage of CAB-LA introduction, we suggest prioritising the transition of current oral PrEP users with low adherence to CAB-LA to reduce HIV transmissions more efficiently.
Wang et al. (Mon,) studied this question.
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