Injectable PrEP and HIV Treatments

Injectable Long-Acting PrEP (PrEP With No Pills)

In May 2024 ViiV Healthcare announced that APRETUDE (an injectable form of PrEP using a drug called cabotegravir) as the first long-acting injectable PrEP approved in Canada. This PrEP medication is injected into the muscle tissue to act as protection against HIV for two months. Like oral PrEP it is not a cure for HIV, and it does not protect you from other STIs. You should consider condoms and Doxy-PEP to prevent STIs.

In 2026, we will see injectable PrEP be made available that will be easier to inject and protects people from HIV for six months. (Of note: A PrEP injection that will last one year is in research stages as well.)

For more on Doxy PEP: https://www.actoronto.org/health-information/doxy-pep-and-doxy-prep/

For more on condoms & lube: https://www.actoronto.org/health-information/campaign-1-condoms-lube/

Who Finds Injectable PrEP Useful?

People who travel a lot find injectable PrEP very helpful in terms of not needing to bring medications through customs or having to take a daily dose of a medication in different time zones.
People who do not want to have PrEP pills at home find injectable PrEP a great way to ensure this privacy.
People who find it hard to take a pill every day, but will come to an appointment every two months. (Note: taking a pill form of PrEP will also require appointments every three months.)

What Are Some Of The Issues?

Some people don’t like needles and prefer pills.
Because this is long-lasting, it means that if you have side effects, they can last two months – pharmacies have a way to screen for this by switching you to a period of taking pills first before going to injections. (Some people don’t want to do this, prefer jump into injections right away and take this risk.)
Soreness at the injection site can last a day or possibly a couple of days – this can bother some people to the point that they do not want to do it anymore. (This is an intramuscular injection that is usually given in the butt and can make sitting uncomfortable.)
This intramuscular injection can’t be administered by yourself and must be done by a qualified medical professional. (This is not like a flu vaccine injection.)

Good To Know: The new PrEP (offering protection for six months)will not be an intramuscular injection; it will be subcutaneous, and you can do it yourself (if you have the fine motor skills) with much less possible injection site pain! Some people have decided to wait for the new PrEP to be available before switching to PrEP injections.

Cost & Coverage

In Ontario, APRETUDE would cost a little less than $2000 per injection (ie every two months). Cost may vary since starting APRETUDE will require some procedural differences: either an injection once a month or pills. Note: this is a long-lasting drug; it is important to consider the possibility of side effects by using the medication in a limited way before beginning injectable PrEP that lasts two months.

Most private/employer insurance plans now cover APRETUDE.

In terms of public plans: As of March 2025, APRETUDE was covered by the federal government’s NHIB Program and Ontario’s ODB.

About Canada’s Non-Insured Health Benefits (NIHB) Program:

A First Nations person registered under the Indian Act, or an Inuk recognized by an Inuit land claim organization who is a Canadian resident, are covered under the NIHB. Veterans are also included and can get APRETUDE under the NIHB.

About Ontario’s Ontario Drug Benefit Formulary (ODB):

The ODB lists the medications covered by all of Ontario’s benefit programs which include drug coverage. (ie ODSP, Ontario Works, OHIP+, Senior’s Plan and the Ontario Trillium Drug Program.)

Getting PrEP

-Find out how to get PrEP on the Getting PrEP Page: https://hivnow.ca/getting-prep/

-Find out about financial coverage for PrEP on our “Paying for PrEP” page: https://hivnow.ca/paying-for-prep/

Starting & Stopping Injectable Long-Acting PrEP

There is a specific process for starting injectable PrEP that requires:

a look at any potential side effects before you take a long-lasting dose of this medication; and
ensuring you are not already HIV positive. (Giving someone who is already HIV positive APRETUDE could create a drug resistant form of HIV to Integrase Inhibitors, which are an important class of HIV treatment drugs.)

There are also specific strategies for when you choose to stop injectable PrEP – just as there are for oral PrEP. Stopping any sort of PrEP should be planned with a medical professional so that:

you are fully aware of any risks for HIV if you continue to have sex while stopping PrEP; and
you do not develop a drug resistant form pf HIV. (ie an Integrase Inhibitor resistant form of HIV in the case of APRETUDE.)

The Current (Two-Month) Injectable PrEP Is Not Like Getting A Vaccine

It is not a one-time injection for the season. It is one dose every two months with checks for STIs and any potential side effects.
It is not an injection to the arm. It is given in the butt (gluteal intramuscular injection), which pharmacists cannot do without some specific training, often a trained person to do this is made available during a specific time for you to get your injection. Missing your appointment at the pharmacy to get your injection means rescheduling a qualified medical professional. (You have seven days after your injection due date to get that injection before your PrEP may become less effective. Also good to know: you can get an injection as early as seven days before the injection due date.)

Research

Community members can participate in a current research project looking at gaps in PrEP access. “The Future of PrEP is Now” is one such project that is focused on ensuring that the needs of men who are not currently taking PrEP are prioritized for injectable PrEP. See here for more information. https://www.cbrc.net/thefutureofprep