Next-gen HIV prevention in the UK: smarter PrEP dosing + long-acting injectables
If you’ve heard mates talking about “double-dose starts,” “2-1-1,” or “the PrEP jab,” you’re not imagining it. UK guidance on HIV pre-exposure prophylaxis (PrEP) has been refreshed, and long-acting injectable cabotegravir (aka Apretude) is gaining momentum globally. Here’s what matters right now—especially for gay and bi men and trans women who want choice, control, and fewer faffs.
The big picture
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Oral PrEP is still brilliant at preventing HIV when taken correctly and now the guidance is clearer and more flexible about how to start and stop.
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Long-acting injectables offer an alternative for people who don’t want pills or struggle with daily/event-based dosing. The UK regulator (MHRA) approved cabotegravir for PrEP in 2024; real-world and trial data since then have been encouraging.
What changed in UK PrEP guidance?
1) “Double-dose start” is now standard language
When you’re starting oral PrEP around a planned exposure, the UK guidelines explicitly allow a double dose (two pills) 2–24 hours before sex. This is part of event-based options and helps get protective drug levels up quickly.
2) Clearer event-based options: 2-1-1 and 2-7
There are now two event-based styles for oral PrEP (emtricitabine/tenofovir):
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2-1-1 (classic “on-demand”)
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Take two pills 2–24 hours before sex
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Then one pill 24 hours later
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And one more pill 24 hours after that
Suits infrequent, predictable sex—common among many gay/bi men.
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2-7 (“extended tail”)
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Take two pills 2–24 hours before sex
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Then one pill daily for 7 days after the last exposure
This can be used for receptive vaginal/neovaginal sex and for injecting-drug exposure; it’s also helpful if sex spans multiple days.
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Quick tips:
• If you have chronic hepatitis B, event-based dosing may not be appropriate speak to a clinician.
• Taking your first dose with food can reduce tummy upset.
Long-acting cabotegravir (the “PrEP jab”)
What it is
Cabotegravir long-acting is an injection given in clinic after an optional oral lead-in. After the start-up phase, it’s typically dosed every two months so roughly six times a year. Great if pills are a hassle, you’re forgetful, or you just prefer a “set-and-forget” option.
What’s new
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UK approval: MHRA authorised both tablet and long-acting injectable forms for PrEP in 2024. Commissioning and local availability can vary ask your clinic what’s on offer.
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Real-world momentum: Implementation studies and conference data (AIDS 2024, IAS 2025) report strong interest and adherence, including among younger people and women in Africa; pregnancy/breastfeeding safety data for long-acting options are also emerging.
Heads-up on access: NICE has scrutinised cost-effectiveness in the past; local roll-out depends on commissioning decisions. Your sexual health clinic will know the current status in your area.
So…which option should I pick?
Daily oral PrEP
Best for: frequent sex or unpredictability.
Pros: simple routine; works across sex types; cheap/generically available.
Watch-outs: adherence matters; mild side-effects possible (usually settle).
Event-based oral PrEP (2-1-1 or 2-7)
Best for: less frequent, more predictable sex; weekends/holidays; people who like planning.
Pros: fewer pills; flexible; rapid “double-dose” start.
Watch-outs: timing matters; not suitable with chronic hep B; 2-7 is needed for certain exposures.
Long-acting cabotegravir injections
Best for: pill fatigue, privacy concerns, ADHD/executive-function challenges, or simply a preference for bimonthly visits.
Pros: no daily pills; excellent efficacy; discreet.
Watch-outs: clinic visits, injection-site reactions, variable availability; once you stop, there’s a “tail” period where switching to oral PrEP may be advised to stay protected. (Your clinic will guide you.)
STI screening & the bigger prevention picture
PrEP prevents HIV, not other STIs. Keep up with regular STI screens, vaccinations (mpox, hep A/B, HPV if eligible), and use condoms as you prefer. If you think you’ve had a high-risk exposure without PrEP cover, PEP (post-exposure prophylaxis) is available from A&E/sexual health clinics within 72 hours.
How to talk to your clinic (a quick script)
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“I’m interested in PrEP and want to discuss event-based dosing with a double-dose start.”
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“Can we review whether 2-1-1 or 2-7 fits my sex life best?”
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“What’s the situation locally for long-acting cabotegravir? Is it commissioned here yet, and what are the appointment intervals?”
Bottom line
In 2025, UK PrEP is about choice: daily pills, smart event-based schedules, or bimonthly injections. Pick the one that fits your life and switch when your life changes. The best PrEP is the one you can actually stick with.
This post is for general information only and does not replace medical advice. PrEP options (including cabotegravir) may not suit everyone. Always speak to a qualified clinician or your local sexual health service for personalised guidance. If you think you’ve had a high-risk exposure, seek urgent medical advice about PEP.