My PrEP
What it is
An antiretroviral formulated as a long-acting suspension: injected into muscle, it releases slowly and keeps a protective level for two months.
A long-acting injection
Cabotegravir belongs to the integrase inhibitor family. Injected into the gluteal muscle, it is released slowly and maintains a protective concentration for two months — there is nothing to take between two appointments.
What the medicine does
Like oral PrEP, it blocks HIV before the virus can establish an infection. It is not a vaccine: protection exists only while the drug is present, which is why keeping to the schedule matters as much as the drug itself.
It only protects against HIV
It has no effect on other sexually transmitted infections — chlamydia, gonorrhoea, syphilis, hepatitis, mpox. Screening stays on the programme, at each injection visit.
Who it is for
Adults and adolescents exposed to HIV through sex and weighing at least 35 kg. In practice it answers situations where a daily tablet does not hold.
Injectable PrEP is not better than oral PrEP for everyone — it is better for people whose daily routine makes tablets unreliable, or for whom tablets are not an option at all:
How the protocol runs
A baseline work-up, an optional oral tolerance test, two initiation injections a month apart, then one injection every two months.
- 1Baseline testsHIV test and viral load, hepatitis serologies, STI screening. The test is non-negotiable: receiving cabotegravir with an undetected infection risks drug resistance.
- 2Oral tolerance test — optionalOne 30 mg cabotegravir tablet a day for about a month, to check tolerance before switching to a form that stays active for months. It is not a protection strategy, and many clinics skip it.
- 3First injection600 mg into the gluteal muscle. It can be given in an ordinary practice — no hospital visit required in most countries.
- 4Second injection, one month laterIt is part of initiation: this is the one that establishes a lasting protective concentration.
- 5Then every two monthsSix appointments a year, each with up to seven days of leeway either side of the due date.
Two initiation injections a month apart, then one injection every two months — six a year. Each can be brought forward or pushed back by up to seven days.
Time to protection
Protection is effective seven days after the first injection.
- InjectionDays 1 to 7
- +2 monthsProtected — until the next injection
During the first seven days the protective concentration has not been reached: sex needs another form of protection (condoms or oral PrEP).
During that first week, sex should be protected another way — condoms, or oral PrEP prescribed for the transition. If you are switching from oral PrEP, the first injection is given on the day you stop the tablets, so protection is never interrupted. The same seven-day rule applies whether you start straight with the injection or begin with the oral tolerance test.
What we know about how well it works
In the trials, the injection beat the daily tablet — and the gap comes from adherence.
Those trials compared the injection against a correctly prescribed daily tablet, so the advantage comes essentially from adherence: an injection every two months is harder to miss than a tablet every day. That is the reasoning that led France's health authority to recognise it as a therapeutic advance over tenofovir/emtricitabine.
Side effects
Pain at the injection site for a few days, easing over time; the molecule stays in the body for months after stopping.
Closer monitoring
An HIV test before every injection: that is the trade-off for the convenience.
A viral load test is added to the antibody test because cabotegravir can delay the appearance of antibodies and mask a recent infection. Exactly how often varies by country — France spaces the panel out to every four months after the fifth injection and reserves viral load testing for clinical suspicion, while US and UK practice tests viral load at each visit.
Availability where you live
Cabotegravir is approved across the European Union and in the United States, but who can actually get it — and who pays — differs sharply from one country to the next.
In United Kingdom, NICE recommended cabotegravir in TA1106 and it has been routinely commissioned since 3 February 2026. It is reserved for people who cannot use oral PrEP, and injections are given in specialist sexual health clinics.
In practice, that means it is offered when oral PrEP is medically contraindicated, when tablets are not workable, or when personal circumstances make a daily pill unrealistic.
In Scotland, the Scottish Medicines Consortium accepted cabotegravir in February 2025.
Getting it, and what it costs
PrEP is free in United Kingdom through public sexual health services.
In United States, cabotegravir has been approved since 2021 and health plans that follow the preventive-services rules must cover it without cost sharing.
Getting it, and what it costs
In United States, PrEP is covered through health insurance, and compliant plans must charge nothing for it. Manufacturer and state assistance programmes exist if you are uninsured.
Cabotegravir is approved at regional level, but we could not confirm its availability and reimbursement in Ireland. Ask your doctor or your nearest sexual health clinic — this is exactly the kind of thing they will know.
Getting it, and what it costs
PrEP is free in Ireland through public sexual health services.
Cabotegravir is approved at regional level, but we could not confirm its availability and reimbursement in Canada. Ask your doctor or your nearest sexual health clinic — this is exactly the kind of thing they will know.
Getting it, and what it costs
PrEP is available in Canada, but we could not confirm exactly how it is paid for. A sexual health clinic will be able to tell you.
Cabotegravir is approved at regional level, but we could not confirm its availability and reimbursement in Somewhere else. Ask your doctor or your nearest sexual health clinic — this is exactly the kind of thing they will know.
Getting it, and what it costs
PrEP is available in Somewhere else, but we could not confirm exactly how it is paid for. A sexual health clinic will be able to tell you.
Late injections, stopping, switching
Seven days of leeway around each date; beyond that, oral PrEP bridges the gap.
A late injection
Up to seven days after the due date, nothing changes. Beyond that, contact the team: oral PrEP is prescribed as a bridge until injections resume, and past roughly a month the initiation schedule has to start again.
Stopping cabotegravir
The concentration falls over several months: too low to protect, but high enough to select for resistance if an infection happens. So another form of PrEP is planned — usually oral — starting within two months of the last injection, with regular testing over the following year.
Switching from oral PrEP
The first injection is given on the day you stop the tablets, with no interruption in protection.
Tablet, two-monthly or six-monthly?
All three protect equally well. But the daily pill is the first-line option: the injections are alternatives, for people the daily tablet doesn’t work for.
| — | Oral PrEP | Cabotegravir | Lenacapavir |
|---|---|---|---|
| Who it's for | First line, for everyone | When oral PrEP isn’t suitable | When oral PrEP isn’t suitable |
| Rhythm | 1 tablet a day, or 2+1+1 around sex | 1 injection every 2 months | 1 injection every 6 months |
| Protection starts | 2 hours (2-1-1) to 7 days | 7 days after the 1st injection | Day 2, with the oral loading doses |
| On-demand option | Yes, for anal sex | No — fixed rhythm | No — fixed rhythm |
| Monitoring | HIV test every 3 months | HIV test before every injection | HIV test before every injection |
| Stopping | 2 to 7 days after the last sex | Relay organised over 2 months | Relay organised over ~6 months |
| What you manage | Remembering, every day | Six appointments a year | Two appointments a year |
The daily pill is the first-line option everywhere. The injection is an alternative, kept for people the daily tablet doesn’t work for — poor tolerance, trouble taking a pill every day, a need for discretion. You can move from one to the other, both ways; it is decided with a doctor, not chosen alone in advance.
Common questions
What people ask most often before a first injection.
Does it hurt?
The injection goes into the gluteal muscle, and local pain for a few days is common with the first injections. It lessens afterwards. The volume injected is 3 mL, which explains the feeling of tightness for a day or two.
What if I can't make the appointment?
Seven days either side is built into the schedule. Beyond that, tell the team: they prescribe oral PrEP as a bridge and rebook the injection without leaving you unprotected.
Can I try it and go back to tablets?
Yes. Switching both ways is planned for. Coming off the injection, oral PrEP starts within two months of the last injection to cover the period while the drug fades.
Do I need the oral tolerance test first?
It is optional. Some teams offer it routinely, others go straight to the injection; several major clinics have dropped it entirely. The tablet used for the test does not protect against HIV.
Does cabotegravir replace condoms?
It replaces the daily PrEP tablet, not condoms: other STIs are not covered, which is why screening is scheduled at every visit.