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Background PrEP is a cornerstone of HIV-prevention, yet barriers are still present. Offering different PrEP options and alternative delivery settings may improve access and persistence. Long-acting injectable cabotegravir (CAB-LA) has recently been introduced in some Italian clinical centres, and community-based services (CBS) are already active in providing oral PrEP. Here we describe the first implementation of CAB-LA PrEP in a CBS in Rome.Material and Methods We conducted a pilot prospective study from July 2025 to February 2026. CBS volunteers assessed eligibility for CAB-LA and provided PrEP counselling. At the first injection, a 4th-generation Ag/Ab HIV and syphilis rapid test and pooled sampling for Chlamydia and Gonorrhoea were performed at CBS; blood for HIV-RNA was collected at CBS and processed in the hospital lab. Only HIV and STI rapid tests were performed before subsequent injections. No oral lead-in was given. Questionnaires exploring side effects, injectable experiences ( figure 1), satisfaction, mental health, and stigma were collected (figure 2). All procedures were led by a specialized team (nurse, ID-specialist, peer) and provided with medical equipment to ensure safety standards comparable to a hospital setting (HS).Results Eight participants were enrolled. Self-reported socio-demographic, behavioural characteristics, along with reasons for CAB-LA access are shown in table 1. All participants were PrEP-experienced and reported a history of STIs. Only one delayed injection (<3months) was administered in the HS. Four users reached the eighth injection at the time of analysis: one was lost to follow-up (FU) after the first injection. At the fourth injection, 85,7% reported satisfaction with CAB-LA and adherence was generally rated as ‘very easy.’ Consistent condom use decreased from 50% at baseline to 14%, while the proportion reporting no condom use increased from 12% to 42,8%. Occasional drug use declined (25% to 14%), with no overall increase in substance use. Baseline reports of depression and anxiety (12% each) were not reported at FU. Perceived high risk of HIV acquisition increased (37% to 57%), whereas perceived low risk decreased (67% to 28,5%) (figure 2). Six mild-to-moderate injection-site reactions (ISR) were observed, five associated with transient sleep disturbance or temporary activity limitation. Three participants reported slight anticipatory anxiety related to injections. No HIV nor STI infections occurred during FU. Findings are limited by the small sample size and short FU.Conclusions In this small cohort, CAB-LA PrEP delivery in a community-based service was feasible, safe, and highly acceptable, with on-time dosing and good tolerability in this pilot. A decrease in consistent condom use suggests possible risk compensation, highlighting the need for ongoing counselling. Community-led, non-hospital pathways can pragmatically expand access to long-acting PrEP and should be scaled and evaluated in larger, longer FU cohorts.Abstract SC5 Figure 1–2Abstract SC5 Table 1Self-reported socio-demographic, behavioural characteristics, and reasons for CAB-LA access