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James Woolgar (Liverpool Public Health SRH Lead), Dr Martyn Wood, Luke Byrne, Sara Strodtbeck and Kate Rowlandson (Axess Sexual Health Team), share the journey of introducing injectable PrEP into Liverpool’s axess Sexual Health service.
A New Chapter in HIV Prevention
Liverpool has a proud history of leading innovation in sexual health, and the rollout of long-acting injectable PrEP is no exception.
Following NICE approval of cabotegravir (CAB-PrEP), Liverpool moved quickly to make this highly effective HIV prevention option available to local people. Thanks to close collaboration between Liverpool Public Health, axess Sexual Health and partners across the HIV Fast Track Cities programme, Liverpool was among the first areas in England to offer NHS-commissioned injectable PrEP, building on experience gained through earlier compassionate-use access schemes.
Axess anticipated CAB-PrEP becoming available, reviewed national signals early, mapped likely operational requirements, and prepared clinic pathways in advance rather than waiting for formal rollout.
Why Injectable PrEP Matters
For many people, daily oral PrEP works well. For others, taking tablets every day can be challenging.
Injectable PrEP offers an alternative. Given every two months, it removes the need for daily medication and provides another option for those who may struggle with side effects, adherence, or simply prefer not to take tablets.
That choice matters. HIV prevention is not one-size-fits-all, and expanding the range of options available helps more people find an approach that works for them. This has certainly been the case in Liverpool.
Strong Early Uptake
Following formal commissioning of CAB-PrEP in November 2025, Liverpool initiated 17 people by 31 December 2025, 25 by 1 April 2026, 40 by July 2026 and to date nearly 50 people have started injectable PrEP, with numbers continuing to grow.
Early data show that most people choosing CAB-PrEP had previously used oral PrEP, underlining the clear benefit of this option being available.
The most common reasons for switching were gastrointestinal side effects or intolerance (55%), psychological barriers associated with tablet-taking (20%), and difficulty maintaining daily dosing (10%).
Importantly, people are staying on treatment. Discontinuation rates have been very low, delayed injections have been uncommon, and reported side effects have been largely mild, most commonly temporary injection-site discomfort.
These findings suggest that injectable PrEP is already helping people remain protected from HIV when oral PrEP has not been the right fit for them.
This early delivery was made possible by practical operational readiness planning, which allowed the team to understand capacity and cost implications in real time and work constructively with commissioners around future funding and support.
A series of practical steps were taken within axess clinics prior to the formal commissioning of CAB-PrEP, including: ventrogluteal intramuscular injection training for the staff, building staff confidence with two-monthly dosing schedules, strengthening recall and /safety-netting arrangements, and ensuring storage, /supply and pharmacy processes were input, plus clear from the outset. Staff were also supported to have confident, person-centred conversations with counselling for people switching from oral PrEP because of intolerance, adherence challenges or acceptability issues.
This operational readiness was further underpinned by strong governance, including: An already developed injectable IM PrEP SOP, stress-tested patient journey, aligned prescribing, pharmacy and Blueteq processes, and established proportionate MDT routes so that any practitioner across the axess footprint could access timely advice and support. As a result, CAB-PrEP could be introduced quickly, safely and consistently across routine sexual health provision.
Raising Awareness
A key part of Liverpool’s success has been ensuring that people know injectable PrEP is available.
Promotion through services, community networks, neighbourhood programmes and professional education has helped spread awareness of the new option and how it can be accessed. Continuing this work will be essential if injectable PrEP is to reach everyone who could benefit from it.
This awareness work sits within Liverpool’s wider HIV prevention infrastructure, rather than as a standalone clinic offer. CAB-PrEP is being promoted alongside existing routes such as PrEP Express, digital triage, PrEPDirect and outreach-linked pathways, as well as targeted work through Women’s Health Hubs and EJAF-funded activity with underserved communities. This broader approach helps ensure that people are offered the prevention option that best fits their needs, whether that is oral PrEP, digital access, outreach support or long-acting injectable PrEP.
Action to reduce inequalities
Liverpool has seen significant growth in HIV prevention activity over recent years. A recent programme (published here) focused on improving access for women achieved a 114% increase in PrEP uptake among women in just six months. Injectable PrEP could help build on this progress by offering an option that may be more acceptable for some individuals than daily tablets.
While early demand has largely come from existing PrEP users, the next challenge is ensuring that CAB-PrEP reaches people who may never previously have started or sustained oral PrEP. Understanding who is accessing the service, and who is not, will remain central to achieving equitable access.
Much of this work is supported by stakeholders across the HIV Fast Track Cities partnership and has involved extensive co-production with communities to help ensure that we engage effectively and that promotion of offers resonate.
Looking to the Future
The early experience of CAB-PrEP in Liverpool has been extremely positive. Uptake has been strong, tolerability has been good, and the programme is already providing an important new prevention choice for people at risk of HIV.
More importantly, it demonstrates what can be achieved when public health, commissioners, clinicians and communities work together towards a common goal.
This was a genuinely collaborative effort, driven by strong partnership across public health, clinical, pharmacy, operational and community teams. It is also important to recognise the contribution of the wider senior nursing team, including Kate Rowlandson and Sara Strodtbeck, whose leadership helped translate the pathway into safe, practical delivery within clinics. That shared ownership has been central to making CAB-PrEP available quickly, consistently and safely for the people who need it.
This learning will now be strengthened further through the upcoming PrEP-LANA research study, which will examine how long-acting injectable cabotegravir can be implemented in routine NHS care. As one of the study sites already delivering CAB-PrEP, Liverpool will be able to contribute real-world evidence on safe, scalable and equitable delivery models, including how services can reach underserved populations and support people to remain protected from HIV over time.
Liverpool has long been recognised as a leader in HIV prevention. The successful rollout of injectable PrEP is another example of that commitment in action, helping ensure that more people than ever have access to the prevention option that is right for them.