The U.S. has approved long-acting injectable PrEP options such as cabotegravir (Apretude) and lenacapavir (Yzugo), yet major challenges remain around equitable access, demand generation, and health-system readiness. This project explores what the United States can learn from low- and middle-income countries (LMICs) that successfully expanded injectable contraceptives, an intervention with striking parallels to injectable PrEP.

Using a systematic review of 124 LMIC studies across eight databases, we identified multilevel factors influencing adoption, adherence, and service delivery. Findings reveal consistent drivers across contexts: individual preferences for discreet, infrequent dosing; partner and family influences; community-level stigma and privacy concerns; and system factors such as provider training, delivery modality, and cost-effectiveness of task-shifting approaches.

By translating lessons from global family-planning programs, this research highlights practical strategies to strengthen U.S. PrEP implementation particularly around decentralization, counseling quality, and community-based delivery. As lenacapavir rollout approaches, these insights offer a forward-looking roadmap for equitable, sustainable HIV prevention.