Mental health, stigma and risk perception among early adopters of HIV PrEP with LA Cabotegravir in Italy: a multicenter cross-sectional and implementation study

Objectives Long-acting injectable cabotegravir (CAB-LA) offers an alternative to oral pre-exposure prophylaxis (PrEP), with potential benefits for adherence and stigma reduction. We investigated behavioral and psychosocial factors among early CAB-LA adopters in Italy, focusing on mental health, stigma, and prevention practices. Design or Methods In a multicenter study, participants initiating CAB-LA completed baseline and follow-up questionnaires (weeks 4-20) assessing mental health, stigma, and prevention behaviors. Descriptive statistics summarized findings. Results Of the 388 respondents, most (302, 89.2%) had prior experience with injectable medications, and 256 (75.9%) described these experiences positively. About half (198, 58.7%) reported recreational drug use, while 42 (12.4%) and 72 (21.3%) reported depressive and anxiety symptoms. Nearly one in four (78, 23.2%) were actively engaged in psychotherapy, while an additional 98 (28.9%) reported past engagement. Consistent condom use declined over time, with selective strategies increasing. A strong preference for biannual injections emerged (235, 69.8%), primarily administered in clinical settings (103, 30.5%). PrEP-related stigma was reported by 72 (21.3%) (strangers and friends as the most common sources), though some decline was observed during follow-up. Conclusion CAB-LA PrEP shows high acceptability, adherence, and evolving prevention practices. Although its discreet delivery may alleviate some concerns about visibility and disclosure, integration with mental health support and stigma-sensitive care is essential.