ArticleHIV/AIDS (Auckland, N.Z.)2026
Beyond Efficacy: The Access, Delivery Systems, Acceptability, Persistence, and Transition Management "ADAPT" Framework for Long-Acting Injectable PrEP in Sub-Saharan Africa.
Article in HIV/AIDS (Auckland, N.Z.), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Long-acting injectable pre-exposure prophylaxis (LA-PrEP) is a major biomedical advance for HIV prevention, but efficacy alone does not deliver population-level impact. Oral PrEP performed well in trials yet persisted poorly in practice, including among young women in KwaZulu-Natal, South Africa. LA-PrEP reduces daily pill burden and improves discretion, but introduces implementation demands that oral PrEP did not: appointment-based adherence, product-specific delivery needs, workforce and task-shifting limits, financing vulnerability, HIV testing requirements and pharmacokinetic-tail management. Purpose: This paper develops the Access, Delivery Systems, Acceptability, Persistence and Transition Management (ADAPT) framework as a conceptual, practice-oriented model for LA-PrEP implementation in sub-Saharan Africa. Approach: ADAPT was developed through structured narrative synthesis of peer-reviewed and grey literature on oral PrEP scale-up, cabotegravir long-acting (CAB-LA) and lenacapavir (LEN) efficacy, HIV service delivery, task shifting and implementation frameworks, combined with non-research program experience from facility-facing implementation support in Uganda and Sierra Leone. The model is not empirically validated and should be tested through Delphi consensus, stakeholder consultation, prospective implementation studies and program evaluation. Discussion: ADAPT complements CFIR, RE-AIM, BLUPrInt and WHO guidance. Its contribution is product awareness, planner orientation and explicit recognition of Transition Management as a safety domain. It asks planners to align regulatory access, procurement and affordability; product-specific delivery systems; choice-based acceptability; appointment persistence; and protocols for stopping, switching and restarting. Conclusion: For sub-Saharan Africa, safer and more equitable LA-PrEP rollout requires deliberate design across financing, service delivery, community governance, persistence systems and transition protocols. ADAPT offers a testable organizing model for this work.
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