Early program results of long-acting Cabotegravir Pre-exposure prophylaxis in Livingstone District, Zambia: uptake, safety, and sexually transmitted infection screening findings from routine records

Abstract

Background:
HIV remains a global public health concern, particularly in sub-Saharan Africa, where the rate of HIV acquisition is unacceptably high, despite advances in treatment and prevention strategies. Long-acting injectable Cabotegravir (CAB-LA) is a notable development in pre-exposure prophylaxis (PrEP). This study aimed to assess early CAB-LA PrEP uptake, safety, and STI screening results from routine records in Livingstone District, Zambia.

Methods:
A retrospective cohort study was conducted using secondary data from the medical records of recipients of care aged 16–69 who received at least two CAB-LA injections at Livingstone University Teaching Hospital, Maramba, and Mahatma Gandhi Urban Clinics between July 2024 and January 2025. Data was collected from medical records on demographic characteristics, HIV seroconversion rates, newly detected syphilis cases, side effects, and adverse reactions. Descriptive statistics were employed to analyse the data.

Results:
A total of 224 recipients of care were enrolled in this study, 53.6% were female, with a median age of 32 years (IQR 26–41). Most had secondary education (73.2%), belonged to the general population (79.0%), and were single (50.0%); 45.5% were unemployed. No HIV seroconversions were observed during the follow-up period. Syphilis positivity was low at baseline (1.1%), which increased to 11.2% at visit 2, with the highest rates among Adolescent Girls and Young Women (AGYW) (18.2%), followed by the general population (11.2%) and Female Sex Workers (FSW) (10.5%), before declining to below 10% at later visits. Mild side effects occurred in 4.9% of participants, mainly injection-site reactions, with no adverse drug reactions or discontinuations.

Conclusion:
CAB-LA PrEP shows promising HIV prevention outcomes and a favourable safety profile over six months. The transient rise in syphilis highlights the need to strengthen integrated STIs prevention and pharmacovigilance alongside CAB-LA scale-up