PrEP works. Investment in more options must continue. Faster, smarter rollout must be a top priority.
Antiretroviral drugs (ARVs) were originally developed to treat people living with HIV. But research has proven that ARVs can also prevent HIV acquisition among individuals who are HIV-negative. This is called pre-exposure prophylaxis, or PrEP, and it’s a vital tool in HIV prevention.
The first daily PrEP pill was approved by the FDA in 2012, but rollout was slow, uncoordinated and poorly planned. Uptake is nowhere near where it should be to address the HIV epidemic. While PrEP won’t be right for everyone at risk, the next generation of products—some entering the market now—must act on the lessons from oral PrEP rollout, by improving coordination and speeding access.
The rollout of injectable lenacapavir (LEN for PrEP), injectable cabotegravir (CAB for PrEP) and the dapivirine vaginal ring (DVR), the latest prevention tools to be proven effective, represents an opportunity to get rollout right.
The pipeline of ARV-based prevention has significant momentum in long-acting innovations, with scientific advances across both injectable and oral delivery platforms.
Further along in development are a monthly oral pill (MK-8527), a 3-monthly ring, a multi-purpose technology that combines PrEP with a contraceptive that prevents pregnancy (the Dual Prevention Pill), and a four-monthly and annual injectables. To learn more about these products go to prepwatch.org/products. Meanwhile, Early-stage studies of multipurpose prevention technologies (MPTs), implants, and on-demand regimens are stalling due to funding cuts, threatening the future diversity of the HIV prevention pipeline.
Sustained investment, strategic prioritization, and early access planning are essential to ensure that basic science and innovation in early phase R&D ultimately expands, not narrows, real prevention choice for women, adolescent girls, and all people affected by HIV.
The emergence of multiple options simultaneously raises opportunities, while presenting critical policy and programmatic questions about how governments will prioritize and allocate resources while safeguarding user preferences and choice. AVAC supports a range of programs to advance this advocacy. We track the status of rollout and uptake of PrEP and R&D of upstream research. We call for continued investment in R&D for new options; support engagement between researchers, donors, community leaders, government, and civil society in the design of trials investigating new PrEP options and the design of programs to deliver PrEP effectively to everyone who needs it; and participate in collaborations to hold decision-makers accountable to commitments on funding, policy, and implementation.
Find out more about PrEP access and rollout across the globe at AVAC’s PrEPWatch.
Our People’s Research Agenda offers a state of the field update on ARV-based prevention, which has seen significant momentum in long-acting innovations, with scientific advances across both injectable and oral delivery platforms.
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The People’s Research Agenda sets out a people-centered framework for equitable and accelerated R&D and product introduction. It tracks the science, shows where investments align—or fail to align—with community-defined priorities, and spotlights critical gaps in the pipeline of prevention options needed to meet the diverse realities of all populations.
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The HIV prevention market is headed toward a period of significant opportunity—and possible congestion—as a slate of new products are on track for continued development and potential introduction to the market in 2027 and 2028. Markets and policies must be built to support the products in the market already, so that new options can be rapidly deployed and deliver impact. Otherwise, the field will squander time and money, with epidemic control slipping further out of reach.
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The pipeline of non-vaccine HIV prevention products includes oral pills, vaginal rings, vaginal and rectal gels, vaginal films, long-acting injectable antiretrovirals and more. Also pictured are the range of MPTs in development that aim to reduce the risk of HIV and STIs and/or provide effective contraception for women.
In the first year since efficacy results were reported, LEN for PrEP has achieved critical milestones in record time compared to oral PrEP, the dapivirine vaginal ring, and injectable cabotegravir. Speed, scale, and equity are still needed to deliver impact.
The database allows users to view clinical trials around the world, gaining an understanding of the many developments currently being made in the field of HIV prevention research.
Comparing the annual price of oral TDF/FTC vs. the dapivirine vaginal ring and injectable cabotegravir.
The pipeline of non-vaccine HIV prevention products includes oral pills, vaginal rings, vaginal and rectal gels, vaginal films, long-acting injectable antiretrovirals and more. Also pictured are the range of MPTs in development that aim to reduce the risk of HIV and STIs and/or provide effective contraception for women.
This timeline shows the potential time points when the next-generation of HIV prevention options might find their way into new programs.