Injectable PrEP and HIV Treatments

Injectable Long-Acting PrEP

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.

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/

Cost & Coverage

In Ontario, APRETUDE would cost approximately 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, so it is important to first be clear on any side effects with a shorter-lived doses being given first when beginning injectable PrEP.

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.)

Injectable PrEP is an injection, but it 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.)

Who finds Injectable PrEP Particularly 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.)

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

Injectable HIV Treatments

In January 2021, Health Canada approved the use of Cabenuva as a stand-alone injectable treatment for HIV. Its two medications, cabotegravir and rilpivirine, are administered as a once-a-month injection in a clinic. (The injection should be a deep intramuscular injection requiring a medical professional to administer it.)

Cabenuva can give people living with HIV more treatment options if they especially do not like taking pills or find they don’t take their meds on time; however, recent US studies have shown the biggest obstacles to taking Cabenuva is a history of missing clinic/lab appointments and the clinic not being able to contact the person who is supposed to get their injection.

Be aware that in Canada most people living with HIV who have already achieved an undetectable viral load are considered eligible for this option.

Some people with HIV may have a strain of the virus that is resistant to Cabenua, and your doctor can determine if the injection can work for you.

If you do qualify for Cabenuva you do not start injections right away; you start with an oral regimen of the pills that contain the same medications as the injected version and then eventually switched over to the injections.

Foot notes:

[1]  CATIE. (March 30, 2023). Clinic finds almost half of people who want long-acting HIV treatment don’t initiate it. Retrieved Sept 5, 2023 from:  https://www.catie.ca/catie-news/clinic-finds-almost-half-of-people-who-want-long-acting-hiv-treatment-dont-initiate-it .

[1] CATIE. (2021).  Cabenuva (injectable cabotegravir + rilpivirine). Retrieved Sept 5, 2023 from: https://www.catie.ca/cabenuva-injectable-cabotegravir-rilpivirine .