Translating twice-yearly injectable lenacapavir into community-based HIV prevention: A next-generation delivery model for equitable access in South Africa

Twice-yearly injectable lenacapavir (LEN) has the potential to transform HIV prevention by addressing many of the adherence challenges associated with daily oral PrEP. However, its public health impact will depend on innovative delivery strategies that reach populations most affected by HIV. The Accelerating Community-Centred Equitable Lenacapavir (ACCEL) programme was designed to translate this biomedical innovation into routine practice through community-based, differentiated service delivery for adolescent girls and young

Methods: ACCEL is a three-year Type II hybrid implementation study embedded within South Africa's national lenacapavir rollout. The programme combines peer-led mobilisation with decentralized HIV prevention services delivered through community pharmacies, nurse-led mobile sexual and reproductive health clinics, hair salons, key population drop-in centres and selected primary healthcare facilities. A shared Electronic Care Management (ECM) platform links peer navigators, referral pathways and service providers through digital referrals, barcode tracking and longitudinal client management, creating an integrated, person-centred model of care. Implementation will be evaluated using the RE-AIM framework through population surveillance, respondent-driven sampling, qualitative implementation research, programme monitoring, economic evaluation and mathematical modelling.

 Innovation

ACCEL moves HIV prevention beyond traditional clinic-based care by delivering long-acting HIV prevention in trusted community spaces where people already access everyday services. Hair salons create accessible entry points for young women through integrated sexual and reproductive health services; community pharmacies provide convenient, stigma-reducing access through Pharmacist-Initiated Management of Antiretroviral Therapy (PIMART); and mobile clinics extend services to underserved rural communities. These delivery platforms are supported by peer navigators and real-time electronic care management, enabling seamless referrals, continuity of care and equitable access across multiple service providers.

Expected Impact

ACCEL will provide the first real-world evidence on the population impact, equity, implementation outcomes and cost-effectiveness of delivering twice-yearly lenacapavir through multiple community-based platforms. The findings will inform South Africa's national scale-up strategy by identifying delivery models capable of reaching underserved populations while strengthening integration between community services and the public health system. This implementation model offers a scalable blueprint for translating next-generation HIV prevention technologies into sustainable programmes across high HIV burden settings.

Keywords: Lenacapavir, Implementation Science, Community Pharmacies, Hair Salons, Mobile Clinics, Digital Health, HIV Prevention, Key Populations, Differentiated Service Delivery.

Lindiwe Madziwa is a Project Manager in the Implementation Science Unit at the Africa Health Research Institute (AHRI), South Africa. She holds a Master's degree in Research Psychology and is a PhD candidate in Psychology. Her work focuses on implementation science, behavioural health, and translating research into scalable, community-based health interventions. She has extensive experience managing clinical and implementation research in HIV prevention, tuberculosis, emerging infectious diseases, and cervical cancer prevention. Her research interests include equitable healthcare delivery, community engagement, implementation science, and strengthening health systems to improve access to evidence-based interventions for underserved and vulnerable populations in low-resource settings.