Health Science Reviews

By Ntokozo M. Ntuli

In sub-Saharan Africa, thousands of women face the risk of HIV infection, often through no fault of their own. Young women and girls in this region are three times more likely to contract HIV than their male peers. While oral PrEP (pre-exposure prophylaxis) offers protection, it comes with strings attached: a daily pill, social stigma and practical challenges for women who may lack autonomy over their healthcare.

So, what if there was a better way?

Cabotegravir for PrEP (CAB-PrEP) is a long-acting injectable approved by the FDA in December 2021 and endorsed by the World Health Organisation. It is administered every two months by a healthcare provider and delivers discreet, highly effective protection without the daily hassle. Clinical trials have also shown CAB-PrEP to be safe, highly effective and well-accepted for HIV prevention, especially among individuals who find oral PrEP burdensome.

CAB-PrEP is a game-changer for women who want privacy, control and fewer clinic visits. However, this is only if they choose to use it.

A 2024 desk review of peer-reviewed papers relating to CAB-PrEP use by women in SSA set out to understand what encourages or discourages women from using CAB-PrEP. The researchers applied two behavioural models, namely: the Theoretical Domains Framework (TDF) and the Capability, Opportunity, Motivation and Behaviour (COM-B) model.

• The COM-B Model suggests that capability, opportunity and motivation are key factors influencing behaviour. Therefore, understanding these elements can help in developing interventions to encourage positive behaviour change.
• The TDF (Figure 1) expands on the COM-B model by using 14 behavioural domains derived from various psychological theories. It helps identify the underlying barriers and facilitators of behaviour change, thus providing an evidence-informed framework to promote desired behaviours.

By analysing 60 studies across the continent and applying these behavioural models, the researchers identified patterns in what encourages or discourages women from using CAB-PrEP.

Figure 1: Theoretical Domains Framework (TDF) as an extension of the COM-B model

Why Some Women Embrace CAB-PrEP:

• Familiarity with injectable contraception.
• Desire for privacy from partners or family.
• Preference for long-lasting protection.

Why Others Hesitate:

• Needle anxiety.
• Misinformation about side effects, such as infertility myths.
• Low community awareness.

They concluded that to increase uptake, CAB-PrEP must meet women where they are, not just physically, but socially and emotionally. Here’s what can help:

• Integrate CAB-PrEP into family planning clinics and antenatal care services.
• Expand access to pharmacies and mobile clinics to reduce travel and stigma.
• Train healthcare workers in respectful, stigma-free counselling.
• Empower peer educators to share accurate information within their communities.

Ultimately, women want more than just a jab; they want accurate information, safe spaces and the freedom to make informed choices. Therefore, pilot programs are crucial for addressing concerns, navigating logistical challenges and educating communities about CAB-PrEP prior to large-scale implementation.

CAB-PrEP offers a new choice for HIV prevention that may appeal to more individuals and potentially increase adherence and promote long-term use. With the right support, it has the potential to rewrite the story of HIV prevention for women across Africa. However, a strong, sustained commitment from all stakeholders will be required to move CAB-PrEP from an innovative tool to a game-changer in HIV prevention. After all, innovations like CAB-PrEP can only change lives if they reach the people who need them most.

References:

Bishopp, C. et al., 2025. Understanding the Drivers of CAB PrEP Uptake and Use among Women in sub-Saharan Africa to Build Demand for New PrEP Methods. Current HIV/AIDS Reports, 12, 22(1), p. 7.

Liegeon, G. & Ghosn, J., 2023. Long-acting injectable cabotegravir for PrEP: A game-changer in HIV prevention?. HIV Medicine, 6, 24(6), pp. 653-663.