Injectable HIV Treatment Beats Daily Pills in Adolescent Trial

Long-acting injectable (LAI) antiretroviral therapy proved superior to daily oral treatment at maintaining viral suppression in adolescents with HIV, according to results of the LATA trial published in The Lancet. The randomized, open-label, multicenter trial enrolled 476 adolescents aged 12 years and younger than 20 years across 5 clinical research centers in Kenya, South Africa, Uganda, and Zimbabwe, randomly assigning them 1:1 to receive either LAI cabotegravir–rilpivirine or daily oral dolutegravir–lamivudine–tenofovir disoproxil fumarate (TLD).¹

By week 96, 2 participants (0.9%) in the injectable group had confirmed viral rebound, compared with 15 participants (6.4%) in the oral group—an estimated difference of –5.5% (99% CI, –10.3 to –1.5) that met the trial's noninferiority criterion and demonstrated superiority of the injectable regimen (P = .0013).¹

Trial Design and Results

Participants had virological suppression defined as viral load below 50 copies per mL for more than 12 months before enrollment and no history of treatment failure; median age was 16.5 years, 54% were female, and 98% had acquired HIV vertically. Those assigned to the injectable group received cabotegravir 600 mg and rilpivirine 900 mg as intramuscular injections at weeks 4, 8, and 16, then every 8 weeks thereafter, and the control group took the oral fixed-dose combination daily. Median follow-up was 120 weeks.¹

Safety findings were reassuring. Serious adverse events occurred in 14 participants in the injectable group compared with 12 participants in the control group (hazard ratio [HR], 1.16; 95% CI, 0.54-2.51; P = .71), and the only treatment-related serious adverse event was a hypersensitivity reaction.¹

Adverse events of grade 3 or higher were similar between groups (27 participants in the injectable group vs 26 in the control group; HR, 1.07; 95% CI, 0.62-1.83; P = .81), and injection-site reactions—reported in 91% of injectable-group participants—were generally mild and did not lead to treatment discontinuation. Seven participants permanently discontinued the injectable regimen, including 2 for treatment-related adverse events, 1 for incident tuberculosis, 2 for planned pregnancy, and 1 by participant choice. Among those still receiving injections at trial close-out, 94% reported the shots were easier than taking daily medicine.¹

Access Barriers Persist Despite Superior Results

The trial's authors note that adolescents living with HIV have historically had poorer treatment outcomes than adults, including lower adherence and higher rates of disengagement from care—challenges long-acting therapy is intended to address.¹

But the treatment remains largely unavailable where it may be needed most. Sarah Pett, professor and chief investigator of the LATA trial at the UCL Innovative Clinical Trials Unit, said in a news release that "long-acting injectables taken every 2 months can help young people to lead a more normal life," noting that roughly 9 of 10 adolescents with HIV live in Africa, where the regimen remains available in only a small number of clinics even though it is already prescribed to adolescents and adults in the US and Europe.²

Cost and logistics explain much of the gap. The injectable drugs remain on patent and cost more than tablets, rilpivirine requires refrigerated storage and transport, and administering the shots every 8 weeks requires trained clinical staff, unlike tablet regimens that may need clinic visits only every 3 to 6 months. No generic version of the combination currently exists.²

Deborah Ford, corresponding author of the study at the UCL Innovative Clinical Trials Unit, said in a news release that the lack of availability in Africa "risks increasing inequalities in HIV care, leaving most people living with HIV without access to treatments that are available in high-income settings."²

Pharmacists Already Filling Gaps in HIV Prevention

The trial's findings arrive alongside a broader shift already underway in how HIV prevention and treatment services reach patients in the US: through the pharmacy counter. Pharmacists are often the most accessible health care professionals for people in rural areas or neighborhoods with limited access to traditional care, and many now prescribe pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) directly, administer immunizations, and participate in public health partnerships that bring HIV testing into the pharmacy setting. Clinical pharmacists are also embedded in primary care medical homes, working alongside care teams to manage patients living with HIV directly.³

That accessibility carries measurable public health value. About 73% of Americans live within 2 miles of a pharmacy, and pharmacists are broadly trusted, with 70% of Americans in one survey reporting pharmacists act in patients' best interest all or most of the time. Pharmacy-based testing programs have also proven effective at reaching people who have never been tested: in one chain pharmacy HIV testing program, 46% of the 3630 individuals screened had never received an HIV test before.⁴

Pharmacists' authority to act on that access varies widely by state. According to the National Alliance of State and Territorial AIDS Directors, 20 states currently authorize pharmacists to prescribe PrEP or PEP, including Arkansas, Colorado, Louisiana, and Maine, which allow pharmacists to prescribe both medications.⁴

Testing authority is similarly uneven—Nevada and North Dakota permit pharmacists to run HIV-related CLIA-waived tests, while Idaho and Minnesota allow pharmacists to conduct any CLIA-waived test. Only 21 jurisdictions allow pharmacists to independently prescribe and administer hepatitis vaccines, and just 12 allow independent rapid hepatitis C testing.⁴

Reimbursement remains a limiting factor even where authority exists. There are 27 jurisdictions that require state Medicaid programs to reimburse pharmacists for clinical services, and collaborative practice agreements offer states another route to expand pharmacists' scope where direct authority is lacking. The economic case for closing these gaps is substantial—preventing a single HIV infection saves an estimated $554,000 in lifetime medical costs.⁴

REFERENCES

1. Bwakura-Dangarembizi M, Chappell E, Kityo C, et al. Switch to injectable cabotegravir-rilpivirine given every 8 weeks in adolescents living with HIV with virological suppression in sub-Saharan Africa (LATA): a randomised, open-label, multicentre, 96-week non-inferiority trial. Lancet. Published online September 17, 2026. doi:10.1016/S0140-6736(26)01537-0

2. University College London. HIV injections work better than tablets for young people. News release. EurekAlert!. September 17, 2026. Accessed September 21, 2026. https://www.eurekalert.org/news-releases/1144073

3. HIV.gov. Caring for Communities: Pharmacists' Role in HIV Care and Prevention. February 9, 2026. Accessed September 21, 2026. https://www.hiv.gov/blog/caring-for-communities-pharmacists-role-in-hiv-care-and-prevention

4. National Conference of State Legislatures. States Can Empower Pharmacists to Prevent and Treat Infectious Diseases. Updated December 9, 2025. Accessed September 21, 2026. https://www.ncsl.org/health/states-can-empower-pharmacists-to-prevent-and-treat-infectious-diseases