New guidance identifies Nigeria among 24 countries expected to introduce lenacapavir for HIV prevention by the end of 2026, urging governments to prioritise affordability, community involvement and health system readiness to ensure equitable access.
By Bunmi Yekini
The Joint United Nations Programme on HIV/AIDS (UNAIDS) has called on countries preparing to introduce long-acting injectable lenacapavir for HIV prevention to strengthen health systems, secure sustainable financing and involve affected communities in planning and implementation.
The call is contained in a new 2026 implementation guide, Introducing Long-acting Injectable Lenacapavir as HIV Pre-exposure Prophylaxis: Implementation Considerations, which provides a roadmap for countries seeking to expand access to the twice-yearly HIV prevention injection.
Nigeria is among 24 countries expected to begin programme-based delivery of the drug by the end of 2026, with support from the Global Fund and/or the United States President’s Emergency Plan for AIDS Relief (PEPFAR).
Eswatini and Zambia began programme-based delivery in December 2025, according to the report.
Lenacapavir, commonly referred to as LEN, is a long-acting injectable pre-exposure prophylaxis (PrEP) option administered twice a year, following a mandatory oral loading dose. The World Health Organization recommended it for HIV prevention in 2025.
The drug offers an additional prevention option for people who may find it difficult to take daily oral medication, potentially expanding choices in HIV prevention and contributing to reductions in new infections.
However, UNAIDS cautioned that introducing the drug requires more than securing supplies, stressing that countries must consider their HIV burden, healthcare infrastructure, financing capacity, regulatory environment and community priorities before beginning implementation.
The guidance comes against the backdrop of persistent inequalities in access to HIV prevention and declining international funding for the global HIV response.
It noted that the UNAIDS 2026–2031 Global AIDS Strategy has set a target of ensuring that 90 per cent of people in need use HIV prevention options by 2030.
Yet, fewer than four million people used PrEP in 2024, compared with an estimated annual need of 20 million person-years of use, highlighting the gap between existing prevention coverage and global demand.
To address the implementation challenges, the report proposes a five-phase approach covering preparation, planning and design, pre-implementation readiness, early implementation and national scale-up.
Under the framework, countries are expected to begin with stakeholder consultations and a rapid assessment of their HIV epidemiology, healthcare capacity, regulatory requirements, financing arrangements and community perspectives.
The assessment would help governments identify priority populations and geographical areas for initial introduction, rather than adopt a uniform approach that may not reflect local HIV transmission patterns or healthcare needs.
UNAIDS also recommends that countries build on existing PrEP programmes and healthcare delivery platforms instead of establishing parallel systems that could further fragment HIV prevention services.
The guide places particular emphasis on meaningful community participation, recommending that community-led organisations, key population networks and people living with HIV be involved in decisions about service delivery, communication, monitoring and programme expansion.
It further calls for healthcare workers to receive appropriate training, facilities to be assessed for readiness, and supply chains and monitoring systems to be strengthened before the first clients receive the injection.
During early implementation, countries are encouraged to introduce the drug at selected sites for between six and 12 months, allowing programme managers to monitor uptake, continuation rates, timely reinjections, adverse events and possible HIV infections among users.
The findings would inform adjustments to service delivery and determine whether programmes are sufficiently prepared for nationwide expansion.
On affordability, the report identifies generic availability from 2027 as an important opportunity to improve access in low- and middle-income countries.
It estimates that at least 120 eligible countries could access generic lenacapavir at approximately $40 per person annually for the injections, with an additional $15–$17 for the oral loading component at initiation.
However, UNAIDS warned that countries must look beyond the price of the drug itself when developing financing plans.
Costs associated with HIV testing, clinical consultations, healthcare worker training, supervision, community mobilisation, monitoring and supply chain management must also be included in programme budgets.
The report urges governments to develop multiyear financing strategies that combine domestic resources with external funding while preparing for a gradual transition towards sustainable national financing.
It also warns against allowing the introduction of lenacapavir to divert resources from existing HIV prevention interventions, including oral PrEP and other effective prevention options.
As countries move towards nationwide implementation, UNAIDS says efforts must also address structural barriers such as stigma, criminalisation and geographical, economic, gender-based and age-related inequalities that could prevent some populations from accessing the drug.
The guidance concludes that the success of lenacapavir will depend not only on its scientific effectiveness but also on countries’ ability to deliver it equitably, sustain financing and integrate it into existing HIV prevention programmes.
Source: UNAIDS, 2026, Introducing Long-acting Injectable Lenacapavir as HIV Pre-exposure Prophylaxis: Implementation Considerations.