By Michael Gwarisa
Nearly seven in ten Zimbabweans who previously used daily oral HIV prevention pills abandoned treatment because of the burden of taking medication every day, a new survey has revealed, adding fresh evidence that long-acting injectable HIV prevention could transform the country’s fight against new HIV infections.
The findings come just months after Zimbabwe rolled out Lenacapavir (LEN), the world’s first twice-yearly injectable HIV prevention medicine, with health experts saying the country’s early experience with injectable HIV prevention is already demonstrating higher continuation rates than traditional daily oral pre-exposure prophylaxis (PrEP).
A survey conducted by the Zimbabwe Civil Liberties and Drug Network (ZCLDN) among 87 people who use and inject drugs (PWUIDs) in Harare found that 71% of respondents who had previously used oral PrEP had either stopped treatment or skipped doses because taking a pill every day proved difficult. At the same time, 76% said they would be willing to start Lenacapavir, while 68% preferred a twice-yearly injection over a daily pill.
The findings provide one of the clearest indications yet that Zimbabwe’s shift towards long-acting HIV prevention technologies could help overcome one of the biggest weaknesses of oral PrEP, poor adherence.
The survey also found that 58% of respondents had previously used oral PrEP, suggesting awareness of HIV prevention is relatively high among this key population, but remaining on daily medication continues to be a significant challenge.
Zimbabwe officially introduced Lenacapavir into its HIV prevention programme in February 2026, becoming one of the first few countries in Africa to roll out the breakthrough injectable medicine.
The programme has since expanded rapidly.
Speaking during a Ministry of Health and Child Care Lenacapavir media training workshop facilitated by OPHID and the Health Communicators Forum Zimbabwe (HCF), Gertrude Ncube said Zimbabwe had secured additional funding from the United States Department of State through PEPFAR, enabling the country to dramatically increase the number of people who will receive the drug this year.
“The Department of State, through PEPFAR, requested us to budget for another 43,000 clients. So in total, we will have about 46,500 clients receiving Lenacapavir this year,” said Ncube.
According to Ministry of Health data, 1,478 people had already been initiated on Lenacapavir since the rollout began in February. Women accounted for 67% of recipients, while 42% of those initiated had transitioned from either oral PrEP or long-acting injectable cabotegravir (CAB-LA), highlighting growing confidence in newer HIV prevention technologies.
The Ministry’s data further show that demand for Lenacapavir is highest among adults aged 25 to 39 years, with the 30 to 34-year age group accounting for 20% of all initiations, followed closely by those aged 35 to 39 years, who represented 19%. Uptake among adolescents aged 15 to 19 years remains comparatively low at just 2%.
The latest survey suggests the growing interest in Lenacapavir is driven largely by frustration with daily pill-taking.
Researchers found that respondents viewed the six-monthly injection as a practical alternative to oral PrEP, particularly for people whose lifestyles make daily medication difficult.
“The data make a compelling case: the daily adherence challenge is real and documented. LEN’s biannual injection schedule directly addresses the primary reason oral PrEP failed this population,” the report says.
However, the survey also found that demand alone will not guarantee successful uptake.
Nearly 63% of respondents expressed concerns about possible side effects, while 41% cited stigma and confidentiality, 34% questioned the drug’s effectiveness, 29% worried about cost, and 27% identified irregular access to healthcare facilities as a barrier.
Researchers also found significant distrust of conventional healthcare settings.
Only 11% of respondents preferred receiving Lenacapavir at government health facilities, while the majority favoured key population friendly clinics, community organisations and mobile outreach teams. Long waiting times, fear of discrimination by health workers, lack of services tailored to people who use drugs and fear of law enforcement around health facilities were all cited as barriers to accessing HIV prevention services.
The findings reinforce Zimbabwe’s earlier experience with another long-acting injectable HIV prevention option, Cabotegravir Long-Acting (CAB-LA), which is administered every two months.
Speaking during an HIV Prevention Strategic Meeting in Harare in 2024, Population Solutions for Health (PSH) Technical Specialist for Voluntary Medical Male Circumcision, Dr Leslie Bidi, said uptake of CAB-LA had exceeded expectations.
“We are above the target. In terms of recipients of care who are coming for the second injection, so far it has been relatively good with an average of 91% in all three sites. Only 15 clients did not come back for their second injection,” said Dr Bidi.
He said continuation rates for CAB-LA after one month were considerably higher than those recorded for daily oral PrEP at the same sites, suggesting that long-acting injectable HIV prevention could help solve adherence challenges that have limited the effectiveness of oral PrEP programmes.
Programme data presented by Dr Bidi showed that 70% of CAB-LA users had previously been on oral PrEP, while 28% were completely new to PrEP, demonstrating strong willingness among both existing and first-time users to adopt injectable prevention.
He also reported encouraging safety outcomes.
“Regarding adverse events and seroconversions, we did not have any seroconversions yet and the adverse events we have recorded were around pain post-injection, which the three recipients indicated as their reason for returning to Oral PrEP,” he said.
Unlike CAB-LA, which requires an injection every two months, Lenacapavir is administered only twice a year, making it the longest-acting HIV prevention medicine currently available.
The ZCLDN survey suggests that such long dosing intervals could prove particularly valuable among people who use and inject drugs, a population that often experiences unstable housing, stigma and difficulties accessing routine healthcare.
The survey also highlighted the central role of community-based service delivery in ensuring the success of Zimbabwe’s Lenacapavir programme.
More than half of respondents identified peer outreach workers as their most trusted source of information, while 44% said they first learned about Lenacapavir through peer educators. Nearly two-thirds said they would need ongoing peer support and follow-up to remain on the injectable medicine.
The report concludes that while Zimbabwe’s key populations are ready to embrace long-acting HIV prevention, the success of Lenacapavir will depend on how the medicine is delivered.
“The PWUID community in Zimbabwe is ready for LEN but readiness alone does not guarantee uptake. The conditions for sustained engagement must be deliberately constructed,” the report states, recommending expanded community-based delivery, stronger investment in peer outreach, and targeted education to address concerns about side effects.
As Zimbabwe scales up Lenacapavir to reach 46,500 people this year, the convergence of real-world programme data and community evidence paints a clear picture. For many people at substantial risk of HIV, the challenge is no longer a lack of willingness to use prevention. Instead, it is ensuring that prevention is convenient, trusted and delivered in ways that people can realistically sustain over time.
