Xinyue Feng, Xinsheng Wu, Thomas S Fitzpatrick, Jason J Ong, Benjamin R Bavinton, Chien-Yu Cheng, Yingqing Chen, Nittaya Phanuphak, Hongbo Jiang, Xiaojie Huang, Linghua Li, Haiyan Min, Shu Liang, Rugang Wang, Xun Zhuang, Jun Zou, Lianguo Ruan, Sitong Luo, Xiaojun Meng, Hongxia Wei, Jin Zhao, Guochun Chen, Meiyin Zou, Jin Zhang, Zhen Ning, Feng Qian, Song Fan, Xiyu Liu, Maohe Yu, Jun Han, Yaokai Chen, Jianhua Yu, Yuxia Song, Yanhua Fu, Chengliang Chai, Hui Xue, Ping Ma, Yinzhong Shen, Bin Su, Huachun Zou
Adherence to LAI-PrEP remained high through 12 months, with the best adherence being observed in clinical trials, which serve as upper-bound benchmarks. Compared to LAI-PrEP, IVR-PrEP had lower adherence and higher discontinuation. Efforts facilitating longer-term adherence warrant research.
BACKGROUND: Long-acting HIV pre-exposure prophylaxis (PrEP) may overcome adherence and discontinuation challenges facing oral PrEP, which remain unsystematically reviewed. This study aimed to synthesize the evidence on long-acting PrEP adherence and discontinuation.
METHODS: We conducted a systematic review and meta-analysis of studies published from database inception to July 1, 2026 in PubMed, Web of Science, EMBASE, and Cochrane Library. Eligible studies reported adherence (on-time doses receipt at time points, e.g., at 2 months) or discontinuation (stopping doses or loss to follow-up within a time period, e.g., within 6 months) of long-acting PrEP, including long-acting injectable (LAI) and intravaginal ring (IVR) PrEP. Non-longitudinal designs and non-English publications were excluded. We used random-effects meta-analyses to pool estimates. Subgroup analyses were conducted by population, region, and study design.
FINDINGS: We identified 46 eligible studies (28 LAI and 18 IVR) including 22,945 individuals (14,190 and 8755). Adherence to six-monthly and two-monthly LAI-PrEP at 12 months was 93.0% (95% CI: 91.6-94.3) and 88.1% (84.7-90.8%); discontinuation for the six-monthly and two-monthly regimens within 12 months was 8.2% (4.9-13.4) and 16.0% (10.8-23.1). Discontinuation for two-monthly LAI-PrEP was higher in implementation studies than in clinical trials (14.6% vs. 1.8% within 6 months; 32.0% vs. 10.3% within 12 months, P < 0.0001). IVR-PrEP adherence was 66.1% (42.2-83.9%) at 6 months and discontinuation was 21.4% (12.6-33.8%) within 12 months. Compared with clinical trials, implementation studies showed lower adherence (32.0% vs. 73.8%) and higher discontinuation (41.1% vs. 7.7%) at 6 months (P < 0.0001).
INTERPRETATION: Adherence to LAI-PrEP remained high through 12 months, with the best adherence being observed in clinical trials, which serve as upper-bound benchmarks. Compared to LAI-PrEP, IVR-PrEP had lower adherence and higher discontinuation. Efforts facilitating longer-term adherence warrant research.
FUNDING: This study was supported by the National Key R&D Program of China.