Cape Town Youth Ditch Daily HIV Pills for Injections

For young people living with HIV in Cape Town, the daily ritual of swallowing pills has long been one of the hardest parts of staying healthy. A new study suggests there may be a way to lift that burden. When 134 young people aged 12 to 24 switched from daily tablets to long-acting injections of cabotegravir and rilpivirine, nearly all of them kept their virus under control. Every single participant who reached the end of the study chose to keep receiving the shots.

The findings, published online on September 24, 2026, in JAIDS Journal of Acquired Immune Deficiency Syndromes, arrive at a time when adolescents and young adults have historically struggled to remain engaged in HIV care. The study’s authors wrote that the “exceptionally high rates of viral suppression and retention highlight the potential of LAI-ART [long-acting injectable ART] to transform HIV treatment outcomes among YLHIV [young people living with HIV].”

The trial ran at a community research site in Cape Town and was led by Chantel Schreuder, MBChB, of the University of Cape Town. It was designed as a nonrandomized, single-arm study to test whether the injectable regimen was acceptable, tolerable, and feasible for this age group. Participants had a median age of 20 years, and 62.7% were assigned female at birth. They arrived at the study from three different starting points: 59 had already achieved viral suppression on daily pills, 35 had suboptimal adherence to their medication, and 40 had never taken antiretroviral therapy before.

Before making the switch, each participant had to bring their viral load below 50 copies/mL. Once enrolled, they received intramuscular injections of 600 mg cabotegravir and 900 mg rilpivirine every 8 weeks for 48 weeks. The researchers judged acceptability and tolerability by tracking how often and how severely drug-related side effects occurred, and feasibility by counting how many injections landed within 7 days before or after the target date.

The results at week 48 were striking. Of 133 participants assessed, 127, or 95.5%, had a viral load below 50 copies/mL. Suppression held across all three groups: 94.9% among those previously suppressed on pills, 97.1% among those who had struggled with adherence, and 95.0% among those starting treatment for the first time. Not a single participant had confirmed virologic failure, which the study defined as two consecutive viral loads of 200 copies/mL or higher.

Staying in care proved just as remarkable. Of 794 follow-up injections, 774, or 97.5%, were given within the 7-day window around the target date. And 132 of 134 participants, or 98.5%, showed up for the week 48 visit. Every one of them opted to continue the injections.

The injections were not without discomfort. One hundred participants reported injection site reactions, most often pain or tenderness, which 67.9% of participants reported at week 4. These reactions were mostly reported early in treatment. All were mild or moderate, graded 1 or 2, except for one grade 3 infection that cleared up with oral antibiotics. Four participants experienced brief, sudden-onset reactions after an injection that resolved on their own; none developed anaphylaxis. No drug-related adverse event led anyone to stop the injections. Two serious adverse events were reported, but both were judged unrelated to the study drugs.

Meanwhile, the researchers are careful about how far these results travel. Because the study ran as a clinical trial, participants had access to research resources and compensation, and a trial team could call and trace anyone who missed a visit. Routine clinics may not be able to offer the same level of support, which could limit how well the findings apply in everyday practice. The researchers also did not test for drug resistance before treatment began.

The study was funded by Johnson & Johnson. In the disclosures, one author reported honoraria for advisory work from ViiV Healthcare, Merck, and Gilead Sciences; another reported honoraria from MSD for advisory boards; and a third reported honoraria from ViiV Healthcare.

For the young people who took part, the message of the trial is simple: two injections every 8 weeks kept their virus suppressed, kept them coming back, and left them willing to continue. For a group that has too often fallen out of care, that willingness may be the most meaningful result of all. The open question now is whether everyday clinics, without a trial team to call and trace, can deliver the same experience.