Rollout of Long-Acting Injectable Lenacapavir for HIV Pre-Exposure Prophylaxis in Zambia and Eswatini: Early Implementation Data, December 2025–January 2026
- Presentation Day/Time: Friday, April 24, 3:20 PM
- Presenter: Serena Zhao, PhD, MA, Global Health Center, Division of Global HIV and TB
The Issue
- In late 2025, Eswatini and Zambia became the first sub-Saharan African countries to introduce twice-yearly injectable Lenacapavir (LEN) for HIV pre-exposure prophylaxis (PrEP). Although both countries have generalized HIV epidemics, oral PrEP use is low, partly due to medication adherence burden.
What We Did
- To identify if LEN is reaching populations underserved by PrEP, we analyzed key characteristics of LEN users. Programmatic data on LEN initiation doses given December 2025 through January 2026 were extracted from PrEP registers at all sites which dispensed LEN, comprising two sites in Zambia and 20 sites in Eswatini.
What We Found
- The majority of users initiating LEN were new to PrEP, with 71% in Zambia and 54% in Eswatini. Women, who face disproportionate HIV risk and increased barriers to daily oral PrEP adherence in Sub-Saharan Africa, comprised 60% and 65% of LEN users in Zambia and Eswatini, respectively.
What This Means
- Early data indicate that most LEN initiators had not previously used PrEP, suggesting LEN may reach populations underserved by oral PrEP. The predominance of women among initiators demonstrates that LEN is reaching populations with high prevention needs. With PrEP coverage lagging below global targets, LEN offers an important tool to close coverage gaps and advance progress toward ending the HIV epidemic.
