Nigeria's pilot rollout of the twice-yearly injectable HIV-prevention drug, Lenacapavir, has encountered a surge in demand that has depleted initial supplies across several participating states, while other regions struggle with low public uptake.

Introduced as a long-acting alternative to daily oral pre-exposure prophylaxis (PrEP), the medication is administered every six months. Following an initial distribution of 11,520 doses by the Federal Government in March 2026 to 10 pilot locations—including Benue, Kwara, Cross River, Gombe, Lagos, and Anambra—states experienced starkly contrasting trends in distribution and consumption.

In Benue State, the initial allocation was completely exhausted following high demand, with over 2,000 HIV-negative individuals receiving the injection since May. State health officials noted that recipients reported mostly mild side effects managed through existing clinical monitoring mechanisms, and are currently awaiting fresh supplies from federal authorities. Similarly, Kwara State exhausted its initial stock of over 800 doses, leaving designated centers temporarily out of inventory while awaiting a replenishment of more than 1,000 additional doses.

Gombe State also faced stock-outs during the second quarter of the year, driven by a combination of high local interest and broader logistical challenges. Representatives from the National Agency for the Control of AIDS (NACA) explained that the pilot phase serves as a learning curve for capacity, storage, and distribution. Furthermore, reductions in international programme funding—particularly cutbacks from key partners like the Global Fund—have impacted the logistics required to move medical commodities smoothly from national reserves to individual states.

In Cross River State, demand rose significantly after intensive awareness campaigns, particularly among key populations such as sex workers who favored the injection for its convenience and discretion compared to daily pills. Health facilities in Calabar reported exhausting their initial allocations and maintaining waiting lists as they urged patients to temporarily revert to oral PrEP until new shipments arrive. Conversely, Anambra State successfully managed a recent replenishment of its stocks, though accessibility varied depending on whether patients utilized specialized key population centers offering free services or traditional teaching hospitals requiring administrative fees.

Meanwhile, Lagos State reported the opposite challenge: an abundant supply of doses coupled with remarkably low public uptake. Health officials in Lagos launched extensive awareness campaigns across digital platforms to encourage eligible residents to utilize the available medication, emphasizing that established pharmacovigilance guidelines remain in place to monitor and document any potential side effects.

Overall, the pilot phase highlights both the strong public appeal of long-acting HIV prevention options and the critical need to address supply chain logistics, distribution equity, and funding sustainability for future nationwide rollouts.