Willingness to switch to injectable cabotegravir among oral PrEP users in Durban, South Africa

Abstract

Background: Adherence to daily oral pre-exposure prophylaxis (PrEP) is challenging. Long-acting injectable cabotegravir (CAB-LA), administered every two months, may improve adherence. Aim: To assess willingness to switch from oral PrEP to CAB-LA among adult PrEP users. Setting: PrEP users were recruited from two public-sector primary health care clinics in Durban, South Africa. Methods: A cross-sectional survey assessed oral PrEP use and related challenges. After providing information on CAB-LA, participants’ willingness to switch was evaluated. Descriptive statistics summarized data, and logistic regression identified factors associated with willingness to switch. Results: Of 126 participants, the median age was 28 years (IQR: 32–33), 88.1% were women, 96.0% identified as black African, and 83.3% were isiZulu speakers. Most were heterosexual (86.5%), 72.2% had tertiary education, and 38.1% were employed. Median oral PrEP duration was 365 days. While 92.1% reported oral PrEP fit their lifestyle, only 51.6% adhered consistently. Awareness of CAB-LA was low (8.7%), but 74.0% were willing to switch to improve adherence. Concerns about CAB-LA included injection site reactions (53.9%), systemic side effects (57.2%), and cost (82.6%). Longer-term oral PrEP users (> 1 year) had lower odds of willingness to switch (aOR: 0.36; 95% CI: 0.15–0.85; p = 0.019). Conclusion: Although oral PrEP was lifestyle-compatible, adherence was inconsistent. Most participants expressed willingness to switch to CAB-LA, but findings should be interpreted cautiously given study limitations. Targeted education may support longer-term oral PrEP users hesitant to switch. Contribution: This study highlights adherence challenges with oral PrEP and supports interest in longer-acting injectable alternatives.