By Simpson Global Media News Desk
Nigeria’s rollout of a twice-yearly injectable medicine for HIV prevention is facing an early supply challenge, with initial stocks of lenacapavir exhausted in four states as demand rises, while Lagos is reporting a contrasting problem — adequate supplies but relatively low uptake.
The development has emerged only months after the Federal Government began introducing lenacapavir as a new pre-exposure prophylaxis, or PrEP, option for HIV-negative people who are eligible for prevention services.
A report published by Saturday PUNCH on September 26 found that Benue, Kwara, Gombe and Cross River had experienced stock-outs at participating service-delivery points. The report also found that demand had increased in some locations after health workers and communities became more familiar with the injection.
The National Agency for the Control of AIDS, however, stressed that the situation should not be interpreted as a nationwide shortage of lenacapavir. According to the agency, the pilot programme is still being used to understand demand, distribution, storage, health-worker capacity and other requirements before wider expansion.
The uneven availability is highlighting one of the central challenges facing Nigeria’s HIV-prevention strategy: introducing a highly effective prevention option is only the first step. Health authorities must also ensure that eligible people know about it, can access it, receive appropriate testing and counselling, and can obtain subsequent doses on schedule.
A New HIV Prevention Option
Lenacapavir is a long-acting antiretroviral medicine used as pre-exposure prophylaxis to prevent HIV acquisition in people who are HIV-negative and considered eligible for PrEP.
Unlike daily oral PrEP, lenacapavir is administered twice a year.
The World Health Organisation recommended injectable lenacapavir as an additional HIV-prevention option in July 2025. WHO said the twice-yearly approach could expand choice for people who face difficulties with daily pills, stigma, adherence or frequent access to health services.
WHO also recommends HIV testing as part of the delivery of long-acting injectable PrEP.
That requirement is important because PrEP is designed for people who do not have HIV. Appropriate testing before initiating or continuing injectable prevention helps ensure that people living with HIV receive treatment rather than an inappropriate prevention regimen.
WHO's guidance describes lenacapavir as part of combination HIV prevention rather than a replacement for all other prevention methods.
The organisation continues to recommend several PrEP choices, including oral PrEP and other long-acting options, allowing health systems and individuals to select approaches suited to their circumstances.
Nigeria’s Pilot Programme
Nigeria formally launched its national lenacapavir initiative in March 2026.
The Federal Ministry of Health and Social Welfare introduced the programme with support from international health partners including WHO, the Global Fund and PEPFAR. WHO's Africa office reported that Nigeria was among the early adopters of the new prevention technology.
The first phase was designed around a limited number of states rather than an immediate nationwide rollout.
The initial implementation covered eight states: Benue, Akwa Ibom, Anambra, Ebonyi, Gombe, Kwara and Cross River, together with the Federal Capital Territory.
Earlier preparations had involved assessments of health facilities to determine whether they had the necessary capacity for PrEP delivery, including training, counselling, supply management and monitoring. WHO reported that more than 70 facilities across 10 states had been assessed as part of Nigeria’s preparedness process.
The Federal Government subsequently received an initial shipment of 11,520 doses on March 19, according to reporting published by Saturday PUNCH. Five days later, the doses were distributed to 10 pilot locations, including the eight initial implementation areas as well as Lagos and Kano.
The pilot approach was intended to generate practical evidence before a broader national expansion.
That evidence is now beginning to emerge.
Four States Report Stock-Outs
The most immediate issue is availability.
Benue, Kwara, Gombe and Cross River have all experienced periods in which the initial allocation of lenacapavir was exhausted at some service-delivery points, according to the September 26 investigation by Saturday PUNCH.
In Benue, the state Commissioner for Health and Human Services, Dr Paul Ogwuche, said more than 2,000 HIV-negative people had received lenacapavir since the programme began in May.
He said the state's initial allocation had been exhausted at participating facilities but described the situation as temporary rather than a termination of the programme.
The state is working with the relevant national programme and partners to facilitate replenishment, according to the commissioner.
Kwara has experienced a similar situation.
The state's AIDS Programme Coordinator, Muhammed Rasheed, said the initial allocation of more than 800 doses had been exhausted and that the state was expecting more than 1,000 additional doses.
The experience is significant because it provides an early indication of demand.
When a new health intervention is introduced, authorities need to estimate how many people will actually seek it. Early demand can be difficult to predict, particularly when a new medicine offers a different mode of prevention from an established option.
The Kwara experience suggests that the initial allocation was not sufficient to meet continuing demand at participating sites.
Cross River Sees Growing Interest
Cross River provides another example of how demand can change after the introduction of a new prevention option.
Health workers in Calabar told Saturday PUNCH that uptake initially moved slowly because of limited awareness and stigma surrounding HIV prevention.
Interest subsequently increased following additional counselling and community sensitisation.
Health workers reported that some eligible people, including sex workers, were seeking lenacapavir because of its six-month dosing schedule and the privacy associated with receiving an injection instead of taking a prevention pill every day.
That preference is consistent with one of the reasons WHO supports a broader range of PrEP choices.
Daily oral medication can be highly effective when taken as prescribed, but people may face barriers involving routine, stigma, privacy, mobility, access to clinics or the ability to maintain daily adherence.
A twice-yearly injection changes the practical demands of prevention.
Instead of remembering a pill every day, a person who chooses injectable lenacapavir returns for scheduled doses.
That does not eliminate the need for regular health care. Testing, clinical assessment, counselling and follow-up remain important.
But it changes how prevention can fit into an individual's life.
Lagos Presents The Opposite Problem
While four pilot states have been reporting shortages, Lagos has a different challenge.
A Lagos State Ministry of Health HIV official told Saturday PUNCH that the state had sufficient doses but was experiencing low uptake among eligible residents.
The official said the state was encouraging more eligible people to come forward and access the intervention.
The contrast is revealing.
In one part of the pilot programme, demand has outpaced the initial supply.
In another, supplies are available but the programme needs greater awareness and participation.
The difference illustrates why simply delivering medicines to states does not automatically produce uniform access.
Public-health programmes depend on several interconnected elements.
People need to know that a service exists.
They need accurate information about who qualifies.
They need to trust the health system and the medicine.
Facilities need trained workers.
Testing and counselling need to be available.
Supplies need to move from central warehouses to facilities.
And patients who begin a long-acting prevention programme need reliable access to their subsequent doses.
A breakdown in any one of those links can limit the effectiveness of the overall programme.
NACA: Not A Nationwide Shortage
The National Agency for the Control of AIDS has cautioned against describing the state-level stock-outs as a nationwide shortage.
Dr John Tobias, NACA's North-East Zonal Coordinator, said the current programme remained a pilot and that the experience was intended to help health authorities learn how to manage capacity, storage, demand, awareness and distribution before expansion.
He also linked some commodity-distribution problems to logistics and funding constraints.
According to Tobias, supplies can exist within the broader national system while particular states or service-delivery points experience shortages because of difficulties moving commodities to where they are needed.
That distinction matters.
A national shortage would mean insufficient overall supply for the programme.
A service-level stock-out can instead occur because available commodities have not reached a particular facility, because demand was higher than forecast, or because replenishment has not arrived before existing stock is exhausted.
The information currently available supports the latter description for the lenacapavir pilot.
Funding Pressure
The supply issue is also taking place against a broader funding environment in which international health programmes face financial pressure.
Tobias told Saturday PUNCH that reductions in programme funding had affected interventions supported by international partners.
He specifically cited the Global Fund's role in funding many programmes and said reductions in programme costs could affect the movement and availability of commodities.
The issue is important because Nigeria's HIV response has historically depended heavily on international financing and technical support.
The Federal Government has increasingly emphasised domestic financing and greater national ownership of health programmes.
At the March 2026 national launch of lenacapavir, the Coordinating Minister of Health and Social Welfare, Muhammad Ali Pate, called for greater domestic financing of health priorities.
The Federal Ministry said the introduction of lenacapavir was part of a broader effort to strengthen HIV prevention while reducing dependence on fragmented external support.
WHO similarly reported that Nigeria's 2026 health financing included a federal allocation of $346 million for priority areas including HIV prevention, laboratories and primary healthcare improvements.
The longer-term question is whether financing can keep pace with the cost of scaling a new prevention technology.
Nigeria’s HIV Burden
The importance of expanding prevention options is linked to Nigeria's continuing HIV burden.
WHO's Regional Office for Africa estimates that approximately 1.9 million people are living with HIV in Nigeria.
The organisation said prevention remains essential to achieving the global goal of ending AIDS as a public-health threat by 2030.
The challenge is not simply the number of people already living with HIV.
Preventing new infections is central to reducing future treatment needs and the long-term burden on individuals, families and the health system.
WHO reported that around 41 million people were living with HIV globally in 2025 and said prevention efforts need to reach populations that face barriers to existing prevention services.
For Nigeria, the introduction of multiple PrEP options is intended to broaden the ways in which people can protect themselves.
The goal is not to force every eligible person onto one particular prevention method.
Instead, the strategy is to give people meaningful choices within an appropriate clinical framework.
Evidence Behind Lenacapavir
The scientific case for lenacapavir as HIV prevention comes from large clinical trials.
WHO cited results from the PURPOSE 1 and PURPOSE 2 studies when it recommended twice-yearly injectable lenacapavir as an additional PrEP option.
PURPOSE 1 evaluated the medicine among cisgender women in several African countries.
WHO reported that the trial recorded zero new HIV infections among participants receiving lenacapavir.
PURPOSE 2 studied a broader population of cisgender men and gender-diverse people and also demonstrated high efficacy.
Gilead, which developed lenacapavir, has reported continued follow-up data from the trials in 2026. The company said the longer-term data continued to show high efficacy, with adherence to scheduled twice-yearly injections remaining high among participants followed in the open-label phases.
The trial evidence does not mean the injection is appropriate for everyone.
As with other medicines, clinical eligibility, HIV testing and appropriate health-worker assessment remain important.
WHO's guidance specifically recommends rapid HIV diagnostic testing for people initiating or continuing long-acting injectable PrEP.
Why Twice-Yearly Prevention Matters
The six-month dosing schedule addresses one of the practical problems that has affected HIV prevention programmes around the world: adherence.
A daily prevention pill requires a person to maintain a daily routine.
For some people, that is straightforward.
For others, daily medication can become difficult because of travel, work schedules, stigma, privacy concerns, forgetfulness or inconsistent access to health services.
An injection administered twice a year offers another way to manage that burden.
WHO said the long-acting approach could be particularly useful for people who experience challenges with daily adherence, stigma or access to healthcare.
The privacy dimension can also matter.
Some people may not want other household members, partners or colleagues to see them taking HIV-prevention medication.
A twice-yearly appointment can reduce the visibility of prevention in daily life.
However, the benefits depend on reliable follow-up.
If someone receives one injection and cannot obtain the next dose when it becomes due, the continuity of prevention can be affected.
That makes supply-chain reliability an important component of the medicine's effectiveness at programme level.
Training Health Workers
Nigeria has also been investing in training health workers to deliver a broader range of PrEP options.
WHO reported in September that the National AIDS, Viral Hepatitis and Sexually Transmitted Infections Control Programme convened 80 health workers from 32 states and the Federal Capital Territory for a national training-of-trainers programme on PrEP.
The training covered the evolving HIV-prevention landscape and the delivery of different prevention choices, including oral PrEP and longer-acting products.
The objective is not simply to teach workers how to administer an injection.
Health workers need to be able to explain prevention choices, conduct or arrange appropriate HIV testing, discuss adherence and follow-up, address questions about side effects and ensure that clients understand when they should return.
That becomes particularly important when a new technology is introduced into communities where awareness may initially be limited.
Training is also connected to trust.
A person deciding whether to begin a new preventive medicine may have questions about effectiveness, safety, eligibility, frequency of dosing and what happens if a dose is missed.
The health worker becomes an important source of accurate information.
Community Education
Nigeria has also been strengthening community-led education around lenacapavir.
NACA reported that a national training-of-trainers programme on the HIV Prevention Ambassador Training and Toolkit was held in Abuja from June 30 to July 2, 2026.
The initiative brought together government agencies, civil-society organisations, community-based organisations, peer networks and implementing partners.
NACA said the training focused on community education, demand creation and informed decision-making around HIV-prevention choices, including lenacapavir.
Such programmes are particularly relevant to the current difference between states.
Where uptake is low, more information may be needed.
Where uptake is unexpectedly high, stronger supply planning may be required.
Both outcomes provide useful information for programme managers.
The Supply Chain Challenge
The current stock-outs also illustrate a familiar problem in public health: forecasting demand for a new product.
When a medicine first enters a programme, planners have limited real-world information about how many people will request it.
Initial estimates can be based on population size, HIV epidemiology, existing PrEP use, previous programme experience and the number of facilities participating.
But actual demand can differ significantly.
A new product may attract people who previously did not use PrEP.
Others may switch from daily oral PrEP.
Some communities may respond rapidly to awareness campaigns.
Others may need months of education before uptake increases.
The result can be an uneven pattern of consumption.
Nigeria's lenacapavir experience is already showing this.
Benue's initial supply was exhausted after more than 2,000 HIV-negative people received the injection, while Lagos was reported to have adequate stock but insufficient uptake.
For the national programme, these differences can provide data for future procurement and distribution decisions.
The Question Of Equity
As the programme expands, equity will become another important consideration.
A prevention medicine is only useful to a person who can actually access it.
If some states regularly have supplies while others experience prolonged stock-outs, access to the new prevention option could vary according to geography.
The same applies within states.
People living near participating facilities may find it easier to access PrEP than people living far away.
Transport costs, clinic hours, privacy concerns and stigma can also affect access.
Nigeria's HIV prevention strategy therefore needs more than medicine procurement.
It needs a delivery system capable of reaching people where they live and work.
WHO's HIV guidance supports differentiated and community-based approaches to PrEP delivery where appropriate, with services designed around the needs of different populations.
That could become increasingly important if Nigeria moves from a limited pilot to a broader national programme.
What Happens When Supplies Run Out?
The immediate response in states experiencing stock-outs is replenishment.
In Benue, the state government said additional supplies were being processed.
Kwara was awaiting more than 1,000 doses.
Anambra, which also exhausted its initial allocation, had received a fresh batch by the time of the Saturday PUNCH investigation.
For people already using the prevention programme, continuity is particularly important.
Health facilities need to know when new supplies will arrive so that eligible clients can be appropriately counselled and scheduled.
People who are waiting for the injection may also need guidance about available prevention options while supplies are unavailable.
In Cross River, a health worker told Saturday PUNCH that people waiting for lenacapavir were being advised to continue with oral PrEP pending new supplies.
This reflects the broader principle that lenacapavir is one option within HIV prevention, not the only option.
What Happens In Lagos?
Lagos offers the programme another lesson.
The state reportedly has sufficient doses but needs to improve awareness and uptake.
That means the challenge is not procurement but demand generation.
Health authorities have been using public communication to encourage eligible people to learn more about the injection and access it through designated services.
The experience raises a broader question about how new health technologies are introduced.
A product can be scientifically effective and physically available but still underused if people do not know about it or are uncertain about its benefits.
Public education therefore needs to accompany procurement.
It must also be accurate.
Campaigns should explain who is eligible, what testing is required, how frequently the injection is administered and why continued follow-up matters.
Protecting Against Misinformation
New medical products often generate questions and misinformation.
The name "lenacapavir" may be unfamiliar to many Nigerians.
Some people may incorrectly assume that an HIV-prevention injection is a vaccine.
It is not.
Lenacapavir is an antiretroviral medicine used for HIV prevention as PrEP in eligible HIV-negative people.
WHO recommends it as an additional prevention choice within combination HIV prevention.
That distinction should remain clear in public communication.
The medicine does not eliminate the need for HIV testing and appropriate clinical care.
Nor should people assume that receiving PrEP means they can ignore other sexual-health considerations.
Healthcare workers remain responsible for providing appropriate counselling and information about available prevention and testing services.
A Programme Still In Its Early Phase
Nigeria's experience with lenacapavir is still relatively new.
The national launch occurred in March.
Initial doses were distributed shortly afterwards.
State-level implementation followed.
By September, some states were reporting that initial stocks had been exhausted, while another participating location was reporting low uptake.
That is a short period in which to judge the long-term performance of a national prevention strategy.
The present stock-outs should therefore be understood as an early implementation issue rather than evidence that the national programme has failed.
Similarly, the availability of doses in Lagos should not be interpreted as evidence that the product is universally underused.
The experiences vary by location.
The purpose of the pilot is partly to identify precisely these differences.
Looking Toward 2028
The scale of Nigeria's eventual programme could be considerably larger if financing and implementation plans support expansion.
WHO reported that Nigeria is expected to receive approximately 180,000 doses by 2028 as part of the early-adopter effort.
A Global Fund projection published in March put the expected total at 179,700 doses by 2028.
Those quantities are considerably larger than the first shipment.
Scaling from an initial pilot to hundreds of thousands of doses would require stronger forecasting, storage and distribution systems.
It would also require more trained healthcare workers and broader community awareness.
The current experience therefore offers an opportunity to strengthen those systems before expansion.
The Larger HIV Prevention Strategy
Lenacapavir is being introduced as part of a wider Nigerian HIV strategy rather than as a standalone intervention.
Nigeria already has oral PrEP programmes and other HIV-prevention services.
WHO recommends combining PrEP with broader HIV prevention measures and appropriate testing.
The national HIV response also includes diagnosis, antiretroviral treatment for people living with HIV, prevention of mother-to-child transmission, condom programmes, community outreach and other interventions.
The introduction of another PrEP option gives health workers and eligible clients additional choice.
That is particularly relevant in a country with a large and diverse population.
A prevention method that works well for one person may not be practical for another.
The availability of several options allows prevention services to respond to different circumstances.
The Early Lesson From Nigeria
The first months of Nigeria's lenacapavir rollout have produced two seemingly contradictory messages.
In Benue, Kwara, Gombe and Cross River, demand has been strong enough to exhaust initial allocations at participating sites.
In Lagos, officials say supplies are available but uptake remains low.
Both situations point to the same underlying requirement: the HIV prevention programme needs to match supply, information and demand more closely.
Where demand is high, supplies must arrive before existing stocks run out.
Where demand is low, health authorities need to determine whether the problem is lack of awareness, misinformation, limited community engagement, access barriers or another factor.
NACA's position that state-level shortages do not constitute a nationwide shortage provides important context.
The pilot is still operating and additional supplies are being processed in affected states.
The Road Ahead
For Nigeria, the next stage will be to convert the lessons from the pilot into a more predictable national system.
That means improving demand forecasting.
It means ensuring that commodities move efficiently from national and state stores to service-delivery points.
It means maintaining adequate numbers of trained health workers.
It means making HIV testing readily available.
It means protecting confidentiality and reducing stigma.
And it means ensuring that people who start injectable PrEP can return for subsequent doses at the appropriate time.
The experience in Lagos also shows that supply alone does not guarantee access.
Awareness and community trust are equally important.
At the same time, the stock-outs in four other states show that strong demand can emerge quickly when people find a prevention option that fits their circumstances.
A Test Of Nigeria’s HIV Prevention Capacity
Lenacapavir's arrival in Nigeria represents an important change in the range of HIV-prevention options available through the public-health system.
Its twice-yearly dosing offers an alternative to daily oral PrEP, while WHO's recommendation provides an international evidence and policy framework for its use.
Nigeria's initial rollout has already produced useful information.
Some communities are showing strong demand.
Some service-delivery points have exhausted their initial allocations.
Lagos is reporting adequate supply but low uptake.
Health workers are being trained.
Community organisations are being involved.
And national authorities are assessing how the pilot can be strengthened before broader expansion.
The immediate task is to prevent temporary supply problems from interrupting access while also addressing areas where the medicine is available but underused.
The longer-term task is more ambitious: building a sustainable HIV-prevention system in which people can choose among appropriate prevention options and reliably obtain the services they need.
For the estimated 1.9 million Nigerians living with HIV and the many more who remain HIV-negative, preventing new infections remains a central public-health priority.
The experience with lenacapavir shows that medical innovation can open a new door, but health systems must still build the pathway that allows people to walk through it.
For Nigeria's pilot programme, the coming months will provide a clearer picture of how effectively the country can balance demand, supply, financing, training and community engagement as it considers the next stage of HIV prevention.
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