This hybrid type-2 implementation-effectiveness cohort study (ImPrEP CAB Brasil) evaluated the feasibility and effectiveness of integrating same-day long-acting injectable cabotegravir (CAB-LA) delivery into Brazil's public health system (SUS) compared to oral PrEP (tenofovir/emtricitabine) in 3,096 HIV-negative individuals aged 18–30 years across 14 sites in six Brazilian cities, with enrollment from October 2023 to September 2024 and follow-up through October 2025.
HIV incidence was markedly lower in the CAB-LA cohort (0.20 per 100 person-years; 3 infections) versus the oral PrEP choice cohort (0.87; 2 infections) and the oral PrEP SUS cohort (1.48; 18 infections); PrEP coverage was also far higher with CAB-LA (90.8% of follow-up days) compared to oral PrEP choice (47.3%) and oral PrEP SUS (35.5%; p<0.0001), with 92% on-time injection adherence.
This is a non-randomized cohort with self-selected PrEP modality choice, so cohort differences in baseline risk and motivation may confound incidence comparisons; 8.8% of CAB-LA participants were lost to follow-up, disproportionately affecting non-White, less-educated, and those with depressive symptoms, raising equity concerns; follow-up duration was approximately one year, limiting long-term safety and effectiveness conclusions.
Same-day CAB-LA delivery within a public health system is feasible, achieves high adherence (92% on-time injections), and dramatically improves PrEP coverage days compared to daily oral PrEP — clinicians and health systems should consider offering CAB-LA as a routine option, while targeting retention efforts at non-White, lower-education, and mentally unwell patients who are at highest risk of loss to follow-up.
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