Abstract

Background: Long-acting injectable pre-exposure prophylaxis (LAI-PrEP) offers a promising strategy for HIV prevention by addressing adherence challenges associated with daily oral pre-exposure prophylaxis (PrEP). Lenacapavir, a twice-yearly injectable capsid inhibitor, has demonstrated near-complete protection against HIV acquisition in clinical trials. In Nigeria, where female sex workers (FSWs), men who have sex with men (MSM), people who inject drugs (PWID), and transgender persons experience a disproportionate HIV burden, understanding factors influencing LAI-PrEP implementation is essential. This systematic review synthesized evidence on barriers and facilitators to LAI-PrEP uptake among Nigerian key populations and examined implications for lenacapavir implementation.

Methods: This systematic review followed PRISMA 2020 guidelines. PubMed, Scopus, ScienceDirect, African Journals Online (AJOL), relevant publisher platforms, and grey literature were searched for studies published between January 2020 and March 2026. Eligible qualitative, quantitative, mixed-methods, and implementation studies reporting barriers or facilitators to PrEP uptake among key populations were included. Methodological quality was assessed using the Mixed Methods Appraisal Tool.

Results: Nine studies met the inclusion criteria. Barriers included low HIV risk perception, concerns about adverse effects, stigma, discrimination, criminalization of same-sex relationships and sex work, provider bias, limited service availability, transportation costs, supply-chain disruptions, and donor dependence. Facilitators included peer-led education, differentiated service delivery, community-based KP-friendly services, and the perceived convenience of long-acting injectable PrEP. Although direct evidence on lenacapavir remains limited, findings from oral PrEP and cabotegravir long-acting studies suggest improved acceptability alongside persistent implementation challenges.

Conclusion: Successful lenacapavir implementation in Nigeria requires addressing multilevel barriers through equitable service delivery, provider preparedness, sustainable financing, and context-specific implementation research.