Date of Award

January 2026

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Sheila Tumilty

Second Advisor

Michael Cappello

Abstract

BackgroundLenacapavir (LEN), a twice-yearly subcutaneous injectable Pre-Exposure Prophylaxis (PrEP) medication for HIV, was approved by the Food and Drug Administration (FDA) in 2025. LEN represents a significant advancement in HIV prevention, demonstrating 99.96-100% efficacy in the PURPOSE 1 and 2 clinical trials12,21. Despite its promise in HIV prevention, high list prices, complex loading regimens, and implementation uncertainties pose barriers to widespread uptake. This study examines provider perspectives on the acceptability, feasibility, and appropriateness of LEN as PrEP, as well as perceived implementation barriers and facilitators. Methods This mixed-methods, cross-sectional study recruited licensed US practitioners (RNs, NPs, PAs, MDs, DOs, and Pharmacists) working in HIV prevention and PrEP delivery settings via national professional networks. Participants completed a self-administered online survey that presented standardized LEN administration information followed by validated implementation outcome measures (AIM, IAM, and FIM). A subset of participants completed semi-structured key informant interviews to explore perceived barriers and facilitators in greater depth. Quantitative data were summarized descriptively, and interview data were assessed for thematic saturation. Results A total of twenty-five practitioners completed the survey and nine participated in interviews. LEN was rated highly acceptable and appropriate. Feasibility scores were similarly positive except for ease of use, which was neutral. Qualitative themes revealed that providers were enthusiastic about LEN’s infrequent dosing schedule and potential to reduce pill-related stigma. However, universal barriers included private insurance coverage challenges and prior authorization requirements, difficulties with injection technique due to the drug’s viscosity and subcutaneous administration, inadequate provider education and awareness, and accessibility challenges for rural and underserved populations. Discussion LEN is viewed as an acceptable, appropriate, and largely feasible HIV prevention tool by practitioners in this study. Addressing insurance coverage barriers, improving injection training, and expanding independent patient educations materials are critical steps to ensuring equitable and widespread uptake of this promising PrEP option.

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This is an Open Access Thesis.

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