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ImPrEP CAB at CROI
Optimizing LA ART for Sexual and Gender Minorities in Latin America: Insights From CROI 2025

Released: April 04, 2025

Expiration: April 03, 2026

Emilia M. Jalil
Emilia M. Jalil, MD, PhD
Activity Information

Activity

Progress
1
Course Completed
Key Takeaways
  • Initial results of ImPrEP CAB Brasil showed the potential role of long-acting PrEP in addressing challenges with daily oral PrEP, particularly among youth from sexual and gender minorities.

The 2025 Conference on Retroviruses and Opportunistic Infections (CROI) featured important results from ImPrEP CAB Brasil, an implementation study of long-acting (LA) injectable cabotegravir (CAB) for HIV prevention among men who have sex with men and nonbinary or transgender people in Brazil.

Given that Latin America continues to experience rising HIV incidence, especially among young individuals from sexual and gender minorities, these findings are highly relevant to local public health efforts and clinical practice in the region.

Choice
The ImPrEP CAB Brasil study aims to provide critical insights into LA CAB implementation for HIV prevention in Brazil, particularly in terms of pre-exposure prophylaxis (PrEP) choice, adherence, coverage, efficacy, and loss to follow-up. I think this study is important because most participants were non-White (60%), most were cisgender men who have sex with men (91%), and many were aged 18-24 years (42%).

Initial findings presented by Beatriz Grinsztejn reported that among 1447 participants, 83% opted for LA CAB over oral PrEP. Young participants (aged 18-20 years) and those with higher decision conflict were more likely to opt for oral PrEP, while those exposed to a self-applied mHealth intervention (containing information about HIV prevention and PrEP alternatives) and those reporting condomless anal sex more commonly chose LA CAB.

The most common reason for choosing oral PrEP was fear of injections, whereas the most common reason for choosing LA CAB was difficulty with daily medication.

Coverage
Only 6% of participants receiving LA CAB were lost to follow-up, with a higher proportion of loss to follow-up among those with lower educational levels and those who are trans or gender diverse.

Adherence to timely injections was remarkably high, with 94% of doses administered on schedule. PrEP coverage, defined as the proportion of days covered by PrEP during follow-up, was 95% among individuals on LA CAB, compared to about 50% for those on oral PrEP. There were also no HIV seroconversions among those on LA CAB, in contrast to 10 seroconversions among individuals on oral PrEP.

Interpretation
These are crucial findings, as they show the potential role for LA injectable PrEP to address challenges with PrEP, particularly among populations disproportionately affected by HIV. Implementing LA PrEP in public health services could improve uptake and coverage, as well as address retention challenges in HIV prevention, especially for those struggling with daily oral regimens. The evidence generated by these studies will be instrumental in advocating for policy changes and securing funding to scale up the availability of injectable PrEP, ultimately reducing HIV incidence in Latin America.

Nevertheless, strengthening HIV prevention requires more than providing access to LA PrEP; it also involves continuous community engagement, adequate funding and tailored public policies, and addressing structural barriers.

Your Thoughts
How do the results from the ImPrEP CAB Brasil study affect your views on LA PrEP? What are some barriers or facilitators of LA PrEP implementation in your practice? Leave a comment to join the discussion!