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Background The impact of oral PrEP with tenofovir disoproxil fumarate/emtricitabine (F/TDF) can be limited by poor adherence. Long-acting cabotegravir (CAB-LA) may overcome adherence challenges and enhance prevention coverage, yet real-world evidence from Europe is lacking. We described Italian CAB-LA use in the Italian PrIDE cohort, compared proportion of days covered (PDC) between CAB-LA and F/TDF, and explored predictors of low PDC.Methods All PrEP users enrolled in the PrIDE cohort from December 2024 (CAB availability) to December 2025 (database cut-off) were included.PrEP coverage was measured as the proportion of days covered (PDC) from the first injection or refill through the follow-up period and was compared between the CAB-LA and F/TDF groups using the Wilcoxon rank-sum test. Predictors of poor coverage (defined as >4 weeks delay from target CAB injection and <4 pills/week for F/TDF) were assessed by a multivariable logistic regression. For CAB-LA, injections were classified as on time (within ±7 days from the target date), delayed (>7 days), or interrupted; discontinuations were categorised by reason.Results Among 4,105 users, 487 (12%) received CAB-LA and 3,618 (88%) oral PrEP. Overall, participants were mostly Italian (87.3%) and male (98.5%), with a median age of 37 years (IQR 31–45) ( table 1).Median PDC was 100.0 (IQR 100.0–100.0) with CAB-LA and 87.6 (71.4–100.0) with oral PrEP (p<0.001) (figure 1A).Poor coverage occurred in 37/487 (7.6%) CAB-LA and 338/3,618 (9.3%) oral users (p=0.21).In oral PrEP, poor coverage was less likely in community-based vs hospital settings (aOR 0.69, 95%CI 0.51–0.94; p=0.021) and more likely in Centre/South/Islands vs North (aOR 1.33, 1.05–1.70; p=0.020). No predictors of low PDC were identified in the CAB-LA group.Overall, 94.1% of injections were on time, with on-time proportions remaining ~92–93% from the 4th to the 8th injection (figure 1B). CAB-LA discontinuations occurred in 35 users (7.2%): 20 switched to oral PrEP and 15 discontinued definitively. The most frequent reasons for discontinuation were perceived reduction of sexual exposure risk (23%), injection-site reactions (23%) and logistical barriers (17%) (table 2).Conclusions In the Italian experience of the PrIDE cohort, CAB-LA was feasible and achieved higher prevention coverage than oral F/TDF, with high injection timeliness, supporting its role to mitigate adherence barriers in real-world settings. Oral PrEP coverage gaps clustered by care setting and geography, suggesting targets for tailored adherence support.Abstract OC26 Table 1–2Abstract OC26 Figure 1