Community-led delivery of long-acting injectable Lenacapavir for the prevention of HIV among men who are mobile for work in Uganda (ComLEN)

project summary

This study aims to determine whether community-led delivery of a new long-acting HIV prevention medicine, lenacapavir, can effectively engage and protect men who travel for work and are at high risk of HIV infection. It will investigate feasibility, acceptability, costs and effectiveness of community-based lenacapavir delivery, and model its epidemic impact and cost-effectiveness compared with the current facility-based approach for oral pre-exposure prophylaxis (PrEP), which in Uganda is typically available only through larger clinics away from rural communities. If successful, the model could not only reduce HIV infections in mobile men but also prevent onward transmission to their sexual partners including adolescent girls and young women.

Men who travel for work in Uganda, such as fishermen and truck drivers, are at especially high risk. They spend long periods away from home, engage in high-risk sexual networks, and have limited access to health services. As a result, they are less likely to know their HIV status or use preventive medicines. Injectable lenacapavir, given only once every six months, could overcome these barriers and provide near-complete protection.
Formative work shows that decentralised services are more likely to reach these men. Mobile clinics can bring services closer but are costly and difficult to sustain. An untried but promising alternative is to use private community drug shops and small rural clinics. These are often the first place people seek care for everyday health problems and already follow Ministry of Health guidelines for conditions such as malaria and diarrhoea. Yet they have never been used for HIV testing or PrEP delivery. By introducing PrEP in these familiar, accessible settings, prevention may reach men who have otherwise been hard to reach and engage in care.

HIV self-testing will be integrated so men can test quickly and privately before each injection. Community health workers and peers will raise awareness, encourage uptake, and support follow-up. Evidence from this model will inform national policy and support the World Health Organization’s call for differentiated HIV prevention. If effective, decentralised lenacapavir provision could transform HIV prevention by offering near-total protection to hard-to-reach populations at a fraction of the cost of mobile clinics, with potential for scale-up across sub-Saharan Africa.