Ashley Greve

As of September 2026, 10 countries across sub-Saharan Africa have added twice-yearly lenacapavir (LEN) to their HIV pre-exposure prophylaxis (PrEP) options. As with any new product introduction, the pace of public rollout is being set by available global supply. Thousands of clients have started LEN, and demand for wider access is high, but countries cannot scale programs faster than supply arrives. Early implementation is also revealing a less visible constraint: scaling LEN will hinge not only on how much LEN is available, but how the supply chain manages its injectable and tablet forms.

A casual or even semi-informed reader might overlook the fact that LEN is not one product. It comes in two distinct finished dosage forms – oral tablets and an injectable solution – and clients need both at different points. Oral tablets are required as loading doses over two days when LEN is initiated, including when a client switches from oral PrEP, and when LEN is restarted more than 28 weeks after the previous injectable dose. Clients who return within the reinjection window need only the injectable dose every 26 weeks. How do supply chains anticipate how many clients will need both products, how many will need only the injectable, and when those needs will arise?

Consider Bakari, an imaginary client. Bakari hears about LEN from a radio ad: “Daily pills replaced by just two dosing visits a year!” At his next healthcare appointment, he asks his doctor about switching from his current daily oral PrEP. Luckily, his healthcare facility is part of a limited rollout and has just received its first shipment of LEN tablets and injectables. 

Bakari receives the required two-day oral loading regimen and his first injectable dose. Six months later, when he is due for his next injectable dose, he has a family emergency that forces him to cancel his appointment. If he returns more than 28 weeks after his previous dose, he will need to restart LEN – a process requiring oral loading doses and an injectable dose. Whether Bakari can restart LEN promptly depends on whether the tablets are in stock when he returns. 

Ensuring adequate supply for moments like these, however, depends on an ecosystem of data, assumptions about client behavior, carefully considered demand projections, and the allocation of limited global supply across countries. Long before Bakari returns, these upstream decisions determine whether both products will be available at his facility.

To successfully scale access to new products, a supply chain must carefully match rollout targets to anticipated supply. Several questions need answers. How many service delivery points are appropriate for the supply available? What is the projected demand at each point? For LEN, how many clients will require tablets for reinitiation, and when? Complicating this picture, clients may switch between PrEP options over time, returning to oral PrEP for a period before ultimately switching back to LEN. When all of this is taken into account, how reliable are the assumptions used to project future demand? 

Forecasts need reliable data on continuation rates, new initiations, late returns, reinitiations, and movement between PrEP options. Early in a rollout, those data are limited and demand patterns are still evolving. As new cohorts start LEN and the client population grows, early assumptions will need to be updated repeatedly. On-time continuation primarily drives injectable demand, while new initiations, late returns, and reinitiations drive tablet demand. The question is not “How many doses of LEN are needed?” but rather “How many units of each stock-keeping unit (SKU) are needed?”

For LEN, logistics management information systems (LMIS), forecasting tools, and product reports need to differentiate between the two SKUs and track their distinct demand patterns. Those data have to be applied separately to each product because tablets and injectables can operate under different supply constraints and distribution planning models. In effect, countries are not managing one LEN supply chain. They are managing two. 

Yet, some supply chain systems and processes still treat LEN as one product. That gap may be manageable during a limited rollout, but at national scale it can distort required quantities, order timing, and delivery schedules. 

Bakari's need for reinitiation tablets represents a small, human moment in a much bigger planning challenge. The same challenge will arise with other products that have multiple dosage forms. Get the two-product math right, and moments like this become routine care. Get it wrong, and they become stockouts.