The New Era of HIV Prevention: What the Twice-Yearly Injection Means for UK Prescribers

• 23rd October 2025

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A twice-yearly HIV prevention injection has been approved across global markets, marking a breakthrough in HIV PrEP (pre-exposure prophylaxis).

The medication – lenacapavir, a long-acting injection – reduces the need for daily tablets and offers up to 99 per cent protection against HIV when used correctly.

Key Take-Aways

• Twice-yearly protection: Lenacapavir offers protection with just two injections per year.
• New mechanism: First capsid inhibitor for HIV prevention.
• High efficacy: ≈99% effective when administered correctly.
• Reduced adherence burden: Ideal for patients struggling with daily HIV PrEP.
• Prescribing readiness: Clinicians should update protocols and educate patients on HIV prevention options UK-wide.

This article outlines:

• What the new long-acting HIV prevention injection is and how it works
• Why it matters for UK prescribers and NHS rollout plans
• Key HIV prescribing guidance and patient-eligibility considerations
• Practical next steps for Primary Care Networks (PCNs) and Integrated Care Boards (ICBs)

Why This Matters to Core Prescribing Solutions

Core Prescribing Solutions supports healthcare organisations in implementing innovative medicines management models.

As new options like injectable HIV PrEP enter NHS pathways, prescribers need practical support to manage eligibility, adherence, and monitoring safely.

This article demonstrates our commitment to helping clinical teams navigate change and improve patient outcomes.

Understanding the Breakthrough

Lenacapavir is the first approved capsid inhibitor for HIV prevention – a class of drug that targets the virus’s protective shell and interrupts multiple stages of its replication cycle.

Unlike daily oral PrEP, lenacapavir is delivered as a subcutaneous injection every 26 weeks.

Trials (PURPOSE 1 & 2) reported near-complete protection, with adherence and safety both superior to oral alternatives. This makes lenacapavir PrEP one of the most effective and promising long-acting options currently available.

This innovation removes a major barrier to effective PrEP delivery: daily pill adherence. Twice-yearly dosing means fewer clinic visits, reduced stigma, and sustained protection for high-risk patients.

Learn more in the lenacapavir PrEP data from Gilead Sciences.

The NHS Context: Expanding HIV PrEP Access in the UK

The UK’s goal to end new HIV transmissions by 2030 depends on expanding access to proven prevention options.

The NHS has already integrated oral HIV PrEP into routine sexual-health services, but uptake remains uneven – particularly among people who find daily medication difficult or face stigma.

In 2025, NHS England confirmed plans to roll out injectable PrEP UK programmes for eligible patients who cannot take or tolerate oral PrEP, beginning with phased regional pilots.

Availability and Prescribing Outlook

Although the introduction of lenacapavir marks a major step forward, it’s not yet widely available on the NHS.

Early rollout is limited to selected regional and specialist services, with GP practices unlikely to prescribe it in the short term.

Broader NHS access will depend on national guidance, funding, and local commissioning decisions over the next 12-24 months.

For now, the key priority for prescribers is awareness – understanding how this fits within the broader HIV preventionlandscape and preparing governance frameworks for future adoption.

This is a pivotal moment in public-health and primary-care prescribing.

Read more about the NHS England injectable PrEP rollout.

Key Differences: Oral PrEP vs Long-Acting HIV Prevention Injection

Feature	Oral PrEP (Tablet)	Long-Acting Injectable PrEP (Lenacapavir)
Administration	Daily tablet	Injection every 6 months
Adherence requirement	Daily routine	2 visits per year
Mechanism	Reverse transcriptase inhibitor	Capsid inhibitor
Common users	Most patients	Those with adherence challenges
Availability (UK)	Established NHS service	Rolling out 2025-26

Comparison of oral PrEP and long-acting HIV prevention injection (UK 2025)

Prescriber Checklist

Step	Key Action
1 – Confirm HIV-negative status	HIV test before every injection to avoid resistance risk.
2 – Assess suitability	Consider patients with poor adherence, intolerance to oral PrEP, or social barriers.
3 – Administer correctly	Subcutaneous injection every 26 weeks; record and schedule follow-ups.
4 – Monitor for side-effects	Mostly mild injection-site reactions; report and review adverse events.
5 – Provide ongoing support	Reinforce safe-sex advice and STI screening at each visit.

Learn more about our clinical pharmacist support service.

What This Means for Your Practice

• Operational planning: Identify capacity for bi-annual injections and follow-up.
• Data capture: Record uptake and outcomes to inform ICB commissioning decisions.
• Training: Ensure clinicians understand administration, contraindications, and patient education.
• Communication: Prepare clear patient messaging on how the injection works and why testing before each dose is essential.
• Collaboration: Liaise with local sexual-health services to streamline referrals and monitoring.

Find out how our Primary Care Network management support can help your practice.

Patient FAQs (for Clinical Use)

For further information, see the WHO HIV prevention guidance.

Strategic Perspective: Innovation in HIV Prevention

The arrival of long-acting injectable PrEP represents a major advancement in HIV prevention options across the UK.

Adeem Azhar, CEO of Core Prescribing Solutions, said:

“While this new long-acting injection represents real progress in HIV prevention, it’s important to remember that it’s not yet widely available on the NHS and GP practices won’t be prescribing it in the immediate future.

Our focus at Core Prescribing Solutions is to help healthcare organisations prepare for innovations like this – ensuring safe, evidence-based adoption when they do become available through NHS channels. It’s about being ready, informed, and clinically confident.”

It aligns with broader NHS goals to create smarter, patient-centred care models and reduce preventable disease burden.

For prescribers, it signals a need to stay current with evolving PrEP prescribing guidance and HIV prescribing guidance, data reporting, and collaborative care pathways – areas where Core Prescribing Solutions can offer direct support.

Explore our full range of services and support for prescribers.

How Core Prescribing Solutions Can Help

We partner with PCNs and ICBs to deliver safe, scalable prescribing models that adapt to new therapies like injectable PrEP UK.

👉 Contact Core Prescribing Solutions to discuss how we can support your organisation.

Disclaimer

This content is for informational purposes only and is not a substitute for clinical judgment or official NHS guidance. Always refer to local prescribing protocols and governance requirements before initiating treatment.