CAB-LA injectable PrEP:
the injection that protects you every two months.
No daily pill. No daily reminder. No daily dose to remember after a night out. Cabotegravir long-acting (CAB-LA) is an injection given every two months that provides the same greater-than-99% HIV protection as daily oral PrEP.
💉 Interested in injectable PrEP? Our team of pharmacists, nurses, and doctors is available to walk you through whether CAB-LA is right for you. Chat With Us →
Daily oral PrEP works. For many people, it works very well. But daily adherence is genuinely difficult for some, people whose routines are irregular, who travel frequently, who drink socially, who share living spaces that make privacy difficult, or who simply find that the daily pill habit does not stick no matter how many alarms they set.
For these people, CAB-LA, injectable cabotegravir long-acting, changes the picture entirely. It is a single injection administered into the muscle of the buttock every two months, providing continuous, highly effective HIV protection with no daily task attached to it. It represents a genuine leap forward in HIV prevention, and it is available through Zivoko in Nigeria today.
The science behind the injection.
Cabotegravir is an antiretroviral drug in the integrase inhibitor class, the same class used in many modern HIV treatment regimens. The long-acting (LA) formulation is an injectable suspension that is absorbed slowly from the muscle tissue into the bloodstream over weeks, maintaining protective drug concentrations continuously without any daily dosing.
Unlike oral PrEP, which relies on the patient remembering a pill every day at roughly the same time, CAB-LA functions as a depot: a single injection establishes a sustained drug level that gradually releases into the circulation over approximately two months. When the next injection is given on schedule, the cycle repeats, maintaining uninterrupted protection.
The effectiveness data is compelling. The HPTN 083 trial (for men who have sex with men and transgender women) and the HPTN 084 trial (for cisgender women) both found CAB-LA to be superior to daily oral TDF/FTC PrEP in their respective populations, not because the drug is inherently more potent, but because real-world adherence to an injection given every two months is higher than real-world adherence to a daily pill. Effectiveness in both trials exceeded 99%.
How the injection schedule works in practice.
Baseline assessment
First injection
Second injection
Maintenance injections
How they compare, and how to choose.
- ✓No injection required
- ✓Lower cost per month
- ✓Safe in pregnancy (strong data)
- ✓Also treats hepatitis B if present
- ✗Daily habit required
- ✗Missed doses reduce protection
- ✗Kidney/bone monitoring needed
- ✗GI side effects in first weeks
- ✓No daily pill
- ✓Highest real-world adherence
- ✓No kidney or bone concerns
- ✓Completely private, nothing to carry
- ✗Injection required at clinic
- ✗Higher cost than oral PrEP
- ✗Tail period risk if stopping (see below)
- ✗Pregnancy data still accumulating
CAB-LA is particularly well suited to people who struggle with daily pill adherence, those who value complete privacy (nothing to carry or store), people who travel frequently, and anyone for whom a twice-monthly visit to a clinic is easier to maintain than a daily habit. Your Zivoko pharmacist will help you assess which formulation genuinely fits your life.
What to expect from the injection.
The most common side effect of CAB-LA is injection site reactions, localised pain, swelling, or tenderness at the injection site in the buttock muscle. These are typically mild to moderate and resolve within one to two weeks of each injection. They tend to improve with subsequent injections as the body adjusts.
Systemic side effects (affecting the whole body) are generally less common and less severe with CAB-LA than with oral PrEP. There are no meaningful gastrointestinal side effects since the drug bypasses the digestive system. Headache has been reported in a small proportion of people. There are no significant kidney or bone density concerns associated with cabotegravir.
If injection site reactions are severe or worsen with subsequent doses, a nurse or doctor should evaluate the injection technique and site rotation. Your Zivoko pharmacist will follow up after each injection to check how you are tolerating the treatment.
Why stopping CAB-LA requires careful planning.
After your final CAB-LA injection, the drug continues releasing slowly from the muscle tissue for weeks to months. During this period, known as the “tail period”, drug concentrations are present but gradually declining. The concern is that if HIV exposure occurs during the tail period while concentrations are sub-therapeutic, the drug may partially suppress HIV rather than block it, potentially creating a pattern of delayed or altered seroconversion that is harder to detect on standard HIV tests.
For this reason, stopping CAB-LA is not simply a matter of missing your next injection. The standard recommendation when discontinuing CAB-LA is to transition to daily oral PrEP (TDF/FTC) for approximately 12 months after the final injection to provide cover during the tail period. Your Zivoko pharmacist will manage this transition and provide the oral PrEP bridge, ensuring no gap in your HIV protection. Read our guide on how to stop PrEP safely for full details.
Questions about CAB-LA in Nigeria.
QDoes the injection hurt?
The injection is given into the gluteal muscle (the upper outer quadrant of the buttock) by a nurse using a standard intramuscular technique. Most people describe it as a brief pinch followed by a dull ache at the injection site that can persist for a few days, similar to how a tetanus or hepatitis B vaccine injection might feel. The injection site is typically sore to touch for one to two weeks. This tends to improve after the first one or two injections.
Applying a warm compress to the injection site after the appointment and avoiding prolonged sitting immediately after can reduce discomfort.
QWhat if I miss my scheduled injection date?
CAB-LA can be given up to 7 days before or after the scheduled date and remain within the recommended dosing window. If you are going to miss this window, contact your Zivoko pharmacist immediately. They will assess your situation and advise whether oral PrEP should be started to bridge the gap until the next injection can be given, so that no protection gap occurs.
Do not simply skip an injection and resume at the next scheduled date without speaking to your pharmacist, this could create a period of inadequate drug concentration.
QCan I switch from oral PrEP to CAB-LA?
Yes. Switching from daily oral PrEP to CAB-LA is straightforward and involves no gap in HIV protection when managed correctly. You continue your last oral PrEP tablets until the day of your first CAB-LA injection, which can be given at any point during a cycle of oral PrEP. Your Zivoko pharmacist coordinates the transition and confirms the timing. Contact us on WhatsApp to discuss switching.
QIs CAB-LA more expensive than oral PrEP?
At present, yes. Injectable PrEP formulations carry a higher cost than daily oral PrEP, reflecting the manufacturing complexity and delivery mechanism. However, for people who struggle significantly with daily adherence to oral PrEP, resulting in missed doses and reduced real-world protection, the cost difference may represent genuine value. Contact your Zivoko pharmacist for current pricing on both formulations so you can make an informed comparison.
Interested in switching to injectable PrEP?
Our pharmacists will assess whether CAB-LA is the right fit for your situation, coordinate your baseline tests, arrange the injection clinic, and manage your two-monthly schedule, all via WhatsApp. No hospital visit needed to get started.
Explore CAB-LA PrEP →HIV prevention should not require perfection every single day.
One injection every two months. That is all CAB-LA asks of you.
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