People who received injectable cabotegravir for HIV prevention and engaged with a digital health app showed significantly higher rates of persistence at 3 months compared with those who received oral pre-exposure prophylaxis (PrEP), according to findings from the AURORA study presented at IDWeek 2025.
The pilot study examined rates of persistence among 123 participants who were prescribed either cabotegravir (n=75) or daily oral PrEP (n=48) at West Virginia Health Right in Charleston, West Virginia.
Participants were at least 18 years old and needed to have access to a smartphone to be eligible. Most of the participants were White, followed by Black, Native American/Alaska Native, Asian/Pacific Islander, or other race/ethnicity. More than half of the study population were men (58%) and heterosexual (51%).
Study participants were using PrEP to reduce their risk of contracting HIV from sex and intravenous drug use.
At the conference, W. David D. Hardy, MD, of Keck School of Medicine of the University of Southern California, presented the findings of the 1-year study. Dr. Hardy and colleagues gave participants access to a customized digital health app that reminded them to take PrEP and complete their labs. It also provided PrEP education and surveyed participants about social determinants of health (SDOH) and PrEP experience. The team provided modest financial incentives to encourage participants to reach milestones.
Of all participants, 76 actively engaged with the app. At 3 months, persistence was greater among those in the cabotegravir cohort (67%) versus the oral PrEP cohort (55%). Some cabotegravir users discontinued treatment after stopping injectable substance use, and oral PrEP users stopped taking their daily pill because of consistent condom use and regular HIV testing. Moreover, oral PrEP users (34%) also reported missing at least one dose a week.
Adverse effects (AEs) were more common among cabotegravir users compared with oral PrEP (32% vs 13%, respectively). However, patients in the cabotegravir cohort were accepting or indifferent to the AEs, while the oral PrEP cohort found them unacceptable.
The researchers reported no new HIV diagnoses in either cohort during the study period. High rates of SDOH among participants emphasized the need to address these factors in groups benefiting from HIV prevention, explained Hardy, as 71% of app users said they experienced at least one SDOH. More than half (58%) reported two or more, with the most common SDOH reported being limited access to transportation (51%).
These study findings suggest that long-acting injectable PrEP, combined with digital engagement, may enhance persistence among individuals at risk for HIV.
Reference
Hardy WDD, et al. IDWeek 2025. P-311
