CAB-LA PrEP Prescriptions and Abandonment in the United States, January 2022-June 2025.

BACKGROUND: Injectable long-acting cabotegravir (CAB-LA) for HIV preexposure prophylaxis (PrEP) was approved by the US Food and Drug Administration in 2021. A national assessment of CAB-LA PrEP abandonment, defined as not filling any prescription, could inform national PrEP implementation efforts. METHODS: We conducted a national observational cohort study using IQVIA Longitudinal Prescription data to characterize persons prescribed CAB-LA or daily oral PrEP (DO-PrEP) in the United States during January 2022-June 2025. We compared 6-month abandonment risk among individuals with an index CAB-LA or DO-PrEP prescription during 2022-2024. Associations were estimated using multivariable modified Poisson regression models and reported as adjusted risk ratios (aRRs) with 95% confidence intervals (CIs). RESULTS: The number of individuals prescribed CAB-LA PrEP increased from 4,645 in 2022 to 23,378 in 2024 and 25,018 during January-June 2025. The proportion of individuals receiving CAB-LA increased from 0.1% in quarter 1 of 2022 to 5.4% in quarter 2 of 2025. While women had a higher 6-month PrEP abandonment risk than men, regardless of PrEP regimen, they were less likely to abandon CAB-LA (11.9%) than DO-PrEP (18.1%, aRR=0.68, 95% CI: 0.62-0.74). The opposite was observed for men, with men more likely to abandon CAB-LA PrEP (10.2%) than DO-PrEP (8.1%, aRR=1.25, 95% CI: 1.20-1.31). CONCLUSIONS: CAB-LA PrEP prescribing increased steadily during the first 3.5 years after approval; abandonment risk differed by PrEP regimen and sex. Addressing barriers to injectable and daily oral PrEP uptake, and strengthening sex-specific PrEP implementation strategies, may further reduce abandonment risk.