Real-World Evidence on Uptake and Persistent Use of CAB-LA in Female Sex Work Hotspots, Malawi

Real-World Evidence on Uptake and Persistent Use of CAB-LA in Female Sex Work Hotspots, Malawi

by Epicentre - MSF

Life & Natural Systems Medicine & Health MJCJInfectious and contagious diseasesMJCJ2Medicine: HIV
🎙 Epicentre - MSF 👥 737 📅 June 28, 2026 ⏱ 10 min 👁 16 📄 original study 🧭 2026-08-16
Available in: English (current) Français

Keywords

CAB-LAPrEPHIVfemale sex workersMalawi

Summary

This presentation from Epicentre - MSF reports preliminary findings from an 18-month observational mixed-method study evaluating the uptake, persistence, and factors influencing the use of long-acting injectable cabotegravir (CAB-LA) as HIV pre-exposure prophylaxis (PrEP) among female sex workers in Malawi. The study is conducted in community-based outreach clinics in Dedza and Neno districts, offering sexual and reproductive health services at 21 hotspots. Quantitative data from routine records and qualitative interviews with clients and stakeholders are analyzed. As of March 2026, 1,393 clients were offered PrEP, with 742 initiations: 41% started on oral PrEP and 59% on CAB-LA, despite 70% preferring CAB-LA, due to supply constraints. Follow-up showed that CAB-LA use persisted more than oral PrEP, with a 10-fold higher probability of staying active at 12 months. However, disengagement was substantial, with about half of users lost to follow-up by 12 months, mainly after the second or third visit. Qualitative findings highlight that CAB-LA’s discretion facilitated use, while injection site pain, stigma, and limited access sites were barriers. No HIV seroconversions were recorded among those returning for PrEP. The study suggests that CAB-LA has potential to improve PrEP uptake and persistence, but strategies to address disengagement and expand access are needed.

200 words

Critical Evaluation

Value of the Information & Strength of the Argument

The presentation provides valuable real-world evidence on CAB-LA use in a key population, addressing a gap in the literature. The argumentation is solid, based on a well-designed mixed-method study with clear objectives and a multi-state model for quantitative analysis. The findings are presented with appropriate nuance, acknowledging limitations such as supply constraints and high loss to follow-up. The qualitative data enrich the quantitative results, offering insights into user perspectives and barriers. The conclusions are supported by the data and suggest practical strategies for improving PrEP delivery.

Scientific Rigor, Source Quality, Title Accuracy

The scientific rigor is high: the study uses a robust observational design, routine data, and qualitative methods. The source is credible (Epicentre - MSF). The title accurately reflects the content. No external sources are cited in the video, but the description mentions the study context. The adequacy between title and content is excellent.

154 words

Title / Content Match

The title accurately reflects the content, which focuses on real-world evidence of CAB-LA uptake and persistent use among female sex workers in Malawi.

Quality & Reliability

8/10

The presentation is based on a rigorous observational mixed-method study with a clear methodology, including quantitative routine data analysis and qualitative interviews. The findings are preliminary but presented with appropriate caution. The source is a reputable organization (MSF Epicentre).

Key Moments

Markers derived by PSI from the transcript: the creator did not define chapters.

Contribution & Novelties

This study provides crucial real-world evidence on the use of long-acting injectable PrEP (CAB-LA) among female sex workers in a low-resource setting, filling a gap in the literature. It highlights the high preference for CAB-LA and its potential to improve persistence compared to oral PrEP, while also revealing significant challenges such as loss to follow-up and injection site pain. The mixed-method approach offers a comprehensive understanding of the factors influencing PrEP use.

Pour aller plus loin :

  • Cabotegravir for PrEP - WHO — Official WHO recommendation on CAB-LA.
  • HIV Prevention - UNAIDS — Overview of HIV prevention strategies.
  • Female Sex Workers and HIV - The Lancet — Key paper on HIV among female sex workers.

115 words

Radar Profile

The radar profile shows high scores across all dimensions, indicating a well-rounded and reliable presentation. The strengths are in information quantity and quality, with a slightly lower technical level, making it accessible to a broader audience while maintaining scientific depth.

Reliability 8/10

💬 No comments were provided for analysis.