OBJECTIVES: To estimate the utilization of and expenditure on the newly approved injectable pre-exposure prophylaxis (PrEP) required to reach the “End the HIV Epidemic in the US” initiative goal of 9250 new HIV infections by 2025 and 3700 by 2030, down from 34,800 in 2019.

METHODS: Current oral PrEP therapies (emtricitabine/tenofovir disoproxil fumarate or tenofovir alafenamide) reduce the risk of infection relative to no treatment (risk ratio=0.39). Relative to the current options, the new injectable PrEP (cabotegravir/rilpivarine) further reduces this risk (hazard ratio = 0.34). Assuming the recent annual decline in HIV infections continues and no other HIV interventions were instituted, the annual number of new injectable PrEP users required to meet the initiative's 2025 goal and 2030 goal were estimated. The total cost of PrEP was then calculated based on 2021 wholesale acquisition costs minus a 15% discount.

RESULTS: A total number of 1.2 million new injectable PrEP users between 2022 and 2030 would be required, amounting to a total expenditure of $26 billion. The average annual PrEP expenditure was 2.6 billion. If only 50% of new PrEP users used the new injectable over current options, the total number required to achieve the 2030 goal increases to 1.4 million, albeit with a lower total cost of $18 billion.

CONCLUSIONS: The projected expenditure on PrEP to achieve the 2030 goal was astronomical. However, PrEP is only one of several initiatives to reduce US HIV infections. The introduction of the new injectable prophylaxis adds an effective tool to meet the goal, and affordability will be key to its success.