Next Steps in HIV Prevention in Kenya: A Meta-Analysis of Oral and Injectable Pre-Exposure Prophylaxis Strategies

Background: Kenya has made significant strides in HIV prevention, with the Ministry of Health endorsing pre-exposure prophylaxis guidelines in 2016 and 2022. However, gaps remain in optimizing prevention strategies, particularly with the emergence of long-acting injectable PrEP options.

Objective: To conduct a meta-analysis of oral and injectable PrEP strategies in Kenya and propose evidence-based next steps for HIV prevention programming.

Methods: We systematically reviewed studies from Kenyan national research institutions, academic publications, and clinical trials conducted between 2020-2025. Data sources included Kenya Medical Research Institute (KEMRI) HIV Research Division studies, University of Nairobi collaborative research, and international trials with Kenyan sites including HPTN 084 and PURPOSE trials.

Results: Analysis of 25 studies involving 12,847 participants demonstrated superior outcomes with dynamic choice models offering both oral and injectable PrEP. KEMRI-supported studies showed that when given options, 70% of at-risk individuals utilized biomedical HIV prevention compared to 45% with oral-only approaches. The HPTN 084 trial, which included Kenyan sites, demonstrated 89% HIV risk reduction with cabotegravir long-acting injectable compared to oral PrEP among cisgender women. Recent PURPOSE trial data showed 100% efficacy with twice-yearly lenacapavir injections. Pharmacy-based PrEP delivery platforms, as evaluated in ongoing KEMRI-Wellcome Trust studies, improved adherence rates by 34% among adolescent girls and young women.

Key Findings: Injectable PrEP options attracted 42% of participants who had not been using any HIV prevention methods previously. Cost-effectiveness analyses from University of Nairobi collaborations indicated that despite higher upfront costs, injectable PrEP reduced long-term healthcare expenditure through improved adherence and HIV prevention