Long-Acting Injectable Preexposure Prophylaxis for HIV Prevention in South Africa: Is There a Will and a Way?

Human immunodeficiency virus (HIV) antiretroviral therapy (ART) use results in substantial improvements in HIV-related morbidity and mortality [1, 2] and leads to dramatic reductions in sexual transmission of HIV among heterosexual serodiscordant couples when ART suppresses HIV viremia in the infected partner [3]. Yet 6000 new HIV infections continue to occur daily across the globe. Use of oral antiretrovirals as chemoprophylaxis has substantial potency for HIV prevention among diverse populations [4–8]. However, effectiveness is highly dependent on consistent daily or near-daily product use. For women, even more-rigorous adherence may be necessary to realize optimal protection [9], a finding borne out by complete abrogation of effectiveness when either oral or topical vaginal preparations are used infrequently [10, 11].