Twice a year, one injection. A new era in HIV prevention and treatment

TWICE A YEAR, ONE INJECTION: A NEW ERA IN HIV PREVENTION AND TREATMENT

By M Check Isho

HIV remains a significant health threat, despite the increasing availability of effective HIV prevention tools such as oral pre-exposure prophylaxis (PrEP). The availability of another option for pre-exposure prophylaxis (PrEP) has the potential to increase uptake and effective use of PrEP and of HIV prevention overall, as it allows people, especially key populations who are always stigmatised, to choose a method that they prefer.

The WHO 2025 updated recommendations on HIV prevention, treatment, and service delivery focus on interventions that can improve health outcomes, increase equity, and strengthen programme efficiency. These recommendations aim to impact Prevention, treatment, and care, as well as to prevent HIV-associated TB, improve service delivery and integration, and enhance adherence.

Summary of the new recommendations to expand access and improve outcomes

The latest WHO recommendations are designed to optimise health outcomes, streamline delivery and address persistent barriers to prevention and care. It focuses mainly on neglected people in service delivery, including adolescents and young people, key populations and people with advanced HIV disease. The guidance emphasises integration, simplification, choice and equity.

HIV prevention and testing: offering six-monthly injectable lenacapavir as an additional PrEP option; use of rapid diagnostic tests to simplify and scale up pre-exposure prophylaxis (PrEP) access for injectable long-acting PrEP delivery.
HIV treatment and care: updated guidance for sequencing ART, including the (re)use of tenofovir or abacavir in subsequent regimens, simplification to two-drug oral or long-acting injectable combinations, revised infant prophylaxis and breastfeeding support, new recommendations for managing advanced HIV disease with CD4 testing and cancer treatment options, and giving priority to short-course tuberculosis (TB) preventive therapy.
Service delivery integration: new recommendations to integrate HIV services with noncommunicable diseases (hypertension and diabetes) and mental health care; updated strategies for antiretroviral therapy (ART) adherence support.
Mpox: A new recommendation for rapid ART initiation among people living with HIV who have mpox and are ART naive or have had prolonged ART interruption.

This is a great development in kicking out HIV in our societies; however, the challenge often faced, especially among the key population, is unequal access.

Resources:

Overview of WHO recommendations on HIV and sexually transmitted infection testing, prevention, treatment, care and service delivery. Geneva: World Health Organization; 2025. https://doi.org/10.2471/B09471.
Guidelines on lenacapavir for HIV prevention and testing strategies for long-acting injectable pre-exposure prophylaxis. https://www.who.int/publications/i/item/9789240111608.