Data and Code: Bridging the Gap — The PrEP Cascade Paradigm Shift for Long-Acting Injectable HIV Prevention

This archive contains the figures, evidence synthesis documentation, and supporting materials for the manuscript: Demidont, A.C. Bridging the Gap: The PrEP Cascade Paradigm Shift for Long-Acting Injectable HIV Prevention. Viruses 2026. Manuscript ID: viruses-4064402. This structured evidence synthesis proposes a reconceptualized HIV prevention cascade that explicitly recognizes the "bridge period" — the temporal and procedural gap between LAI-PrEP prescription and first injection — as a distinct, measurable implementation step. Real-world data show that 47% of individuals prescribed LAI-PrEP never receive their first injection, despite >96% clinical efficacy and 81-83% post-initiation persistence. The manuscript identifies this pre-initiation structural barrier as fundamentally different from oral PrEP's post-initiation adherence barrier, with direct implications for intervention design, resource allocation, and health equity. CONTENTS Manuscript Figures (figures/): Publication-quality figures illustrating the reconceptualized PrEP cascade framework. Figure 1A depicts the traditional oral PrEP cascade with its post-initiation adherence barrier. Figure 1B depicts the proposed LAI-PrEP cascade with the bridge period as a distinct step between prescription and injection. Figure 2 presents the implementation paradox — oral PrEP enables wide entry but poor persistence, while LAI-PrEP creates narrow entry but strong persistence — demonstrating why the paradigm shift from behavioral to structural intervention is necessary. Evidence Documentation (evidence/): The evidence tier classification table documents all 21 bridge period interventions identified in the review, organized by mechanism category (eliminate, compress, navigate, remove barriers, clinical support, system-level) with source citations, effect size derivations, and tier ratings (Tier 1: RCTs/large cohorts; Tier 2: observational studies; Tier 3: emerging data). Clinical case examples illustrate how population-specific barrier profiles translate to intervention recommendations for the highest-barrier populations (PWID and adolescents). Supporting Code (tool/): A configuration-driven clinical decision support algorithm that operationalizes the framework described in the review. The JSON evidence configuration encodes all population parameters (n=7), barrier profiles, and intervention evidence from the manuscript's Tables 2 and 3, providing a machine-readable representation of the evidence synthesis. KEY CONTRIBUTIONS - Formal definition of the bridge period as a measurable cascade step between LAI-PrEP prescription and first injection- Reconceptualized PrEP cascade framework making pre-initiation attrition visible and actionable- Population-stratified barrier characterization with projected bridge period completion rates: PWID 20-30%, adolescents 30-40%, women 40-50%, MSM 53%- Evidence synthesis of 21 bridge period management strategies across six mechanism categories- Identification of the paradigm shift from post-initiation behavioral adherence (oral PrEP) to pre-initiation structural access (LAI-PrEP) COMPANION PAPER Population-specific projections and intervention effect sizes from this review were validated computationally at scales up to 21.2 million patients in the companion paper: Demidont, A.C. Computational Validation of a Clinical Decision Support Algorithm for LAI-PrEP Bridge Period Navigation at UNAIDS PrEP Target Scale (21.2 Million Individuals). Viruses 2026, 18, 237. https://doi.org/10.3390/v18020237 Validation datasets and simulation results are archived separately: https://doi.org/10.5281/zenodo.14740153 ORCID: 0000-0002-9216-8569