Twice-Yearly Lenacapavir Injection for HIV Prevention in Nigeria: The Real Test Is Access
Uche Kennedy and Sunday Oko (Lead writers)
On 14 July 2025, the World Health Organization (WHO) issued new guidelines recommending twice-yearly injectable lenacapavir as an additional pre-exposure prophylaxis (PrEP) option for HIV prevention. In large trials, twice-yearly lenacapavir delivered near-complete protection against HIV, including zero infections in one major study and very few in another. The guidance brings new momentum to a prevention response that has slowed, but it also raises hard questions about access, equity, and delivery readiness. For Nigeria, these questions are immediate. With an estimated 1.9 million people living with HIV, progress is real, but new infections continue, especially among young people and key populations.
Nigeria’s HIV epidemic shows wide variation and remains a significant public health challenge. National adult prevalence is estimated at around 1–1.4% among adults aged 15–49 years, but risk varies sharply by age, gender, and geography. Young women aged 20–24 are more than three times as likely to be living with HIV as young men of the same age. Across states, prevalence is higher in the South-South and North Central zones and much lower in parts of the North-West, with high-burden states including Akwa Ibom, Benue, and Rivers. Despite progress in expanding treatment access, prevention gaps persist. Nigeria remains among the countries with the highest numbers of new paediatric HIV infections, indicating that prevention for pregnant women, retention in care, and early infant diagnosis are still not reaching enough families.
What makes lenacapavir different?
As Nigeria considers how to sustain momentum in HIV prevention, lenacapavir represents a potential shift in how protection can be delivered to those most at risk. Unlike daily oral PrEP, which can be hard to sustain where stigma, disclosure risks, and pill fatigue are real, lenacapavir is given as a subcutaneous injection every six months. In the PURPOSE 1 clinical trial, there were no infections in the lenacapavir group; in the PURPOSE 2 trial, there were two, far fewer than in the comparison arms. These results place lenacapavir among the most effective HIV prevention tools currently available.
The real test, however, is not whether lenacapavir works; it does. The test is whether it can be delivered at scale, equitably and sustainably, within real-world health systems. For Nigeria, this means whether lenacapavir can be made accessible, priced within available budgets, delivered through trusted, confidential services, and targeted to people at the highest risk without stigma or delay. Lenacapavir offers a practical advantage where twice-yearly dosing can improve adherence, protect privacy, and reduce reliance on daily pill-taking; constraints that have limited the scale-up of oral PrEP.
WHO positions lenacapavir as an additional choice alongside oral PrEP, long-acting cabotegravir, and the dapivirine vaginal ring, within a combination prevention approach. Choice matters, particularly for populations that have not been well served by existing options. Its six-monthly schedule could boost uptake and persistence, but it also introduces new delivery demands. Each visit must include testing, counselling, safe injection delivery, and follow-up. For Nigeria, this presents both an opportunity and a systems test. Impact will depend on policy choices, including political commitment, domestic funding, community trust, and delivery systems that meet the needs of key and priority populations.
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