Beyond the injection: Delivering on the next frontier of HIV prevention

by Dr Robert Newman

Executive Director, Amp Health

A new kind of HIV prevention is here. Instead of taking a pill every day, people can now protect themselves with just a few injections a year. Known as long-acting PrEP (pre-exposure prophylaxis), these injectable options offer a new way to prevent HIV – one that could be simpler, more private, and easier to access for many people.

And as we mark World AIDS Day 2025, there may be no better time to ask: are our systems ready to deliver it?

Dr Linda-Gail Bekker, CEO of the Desmond Tutu Health Foundation, has called long-acting PrEP a “gamechanger”, explaining: “We have never had something this discreet, long-lasting and user-friendly. It meets people where they are.”

The early results have been remarkable. Recent findings from large clinical trials in Africa and globally show that the injectable version offers near-total protection. In one trial among women in Uganda and South Africa, none of the participants who received long-acting PrEP acquired HIV – a 100% efficacy result. In a separate trial of men, transgender, and non-binary people, twice-yearly injections reduced the risk of HIV by about 96% compared to what would be expected with no treatment, with 99.9% of participants remaining HIV-negative.

For people in sub-Saharan Africa – where new HIV infections remain high, and health systems are often stretched – a more flexible, highly effective prevention option could make a big difference. But even the most promising innovation cannot reach its potential if the systems that deliver it are not ready.

A leadership test, not just a technical task

Across the continent, governments are weighing whether and how to integrate long-acting PrEP into their national HIV prevention programmes. Regulatory pathways need to be finalised. National guidelines must be updated. Providers will require training on new protocols. Communities must be engaged to build trust and demand. Delivery platforms, many of which are already overstretched, need to be adapted or rebuilt. And financing plans must be developed to cover not just the product, but the systems that will deliver it.

This is not just a technical checklist. It is a leadership challenge.

Introducing a new product into a public health system is never about the product alone. It’s about whether systems, teams, and institutions are prepared to put that innovation into practice and sustain it. Most HIV programme teams were not designed for this level of rapid adaptation. Without the time, support, and skills to lead that change, even the most promising tools risk being underused.

Innovation meets austerity: can systems rise to the challenge?

The UNAIDS 2025 Global Update warns of a “historic funding crisis” threatening to unravel decades of progress. That warning is no longer hypothetical: the crisis is already here. In 2024, 80% of HIV prevention funding in sub-Saharan Africa came from external sources, and cuts introduced in early 2025 are straining prevention budgets across the region.

Yet, the need for bold investment in prevention has never been greater. Sub-Saharan Africa is still home to half of all people living with HIV, and nearly half of all new infections. Long-acting PrEP could help change that, but not if governments are forced to choose between sustaining essential services and introducing new ones.

In many global health conversations, innovation is still seen as a silver bullet. But innovation without systems is just theatre. The real test is not how many doses are approved or procured. It is whether the delivery systems behind them can build trust, train providers, track data, and get these tools to the people who need them.

Systems do not transform themselves

Scientific breakthroughs do not implement themselves. They require leadership, coordination, and systems that can turn potential into progress. For long-acting PrEP to become more than a headline, governments must be supported to lead.

This means giving public sector teams the time and tools to plan for sustainable introduction. It means equipping leaders to navigate trade-offs, align partners, manage costs, and build buy-in. It means treating the successful rollout of long-acting PrEP not as a pharmaceutical milestone but as an institutional one.

At Amp Health, we have seen how this kind of systems readiness is achieved. It is not a one-size-fits-all solution. It is about enabling public sector teams to set clear priorities, coordinate effectively, and adapt delivery models over time.

A moment we cannot afford to miss

This World AIDS Day, as we reflect on progress and look to the future, we must not be lulled by the promise of new tools. Long-acting PrEP is a genuine breakthrough, but, like all breakthroughs, it demands follow-through. It demands systems that work, leaders who can drive change and partners who are willing to invest in people, not just products.

If we fail to deliver on that, we risk turning a pivotal moment into just another missed opportunity.