At Long Last: The new HIV drug is coming to Africa
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Experts believe a new long-lasting version of PrEP has the potential to dramatically change the course of the HIV epidemic in Africa
Long-lasting injections to protect people from HIV are set to be rolled out across Africa, potentially revolutionising the continent’s fight against the disease.
Treatment for HIV has improved enormously over the last 30 years, with retroviral drugs able to suppress the virus in those who carry it and oral pre-exposure prophylaxis (PrEP) widely available in tablet form to prevent infection.
PrEP is already available free to high-risk groups in the UK, but its rollout in developing countries, where it is needed the most, has been hindered due to the logistics of distributing oral medicines in many countries in Africa where the infection still rages.
Experts now believe a new long-lasting version of PrEP – an injection which provides protection from the virus for up to two months – has the potential to dramatically change the course of the disease in Africa.
They say the drug, called cabotegravir (CAB-LA), will be the first HIV/Aids treatment to be rolled out in Africa ahead of the West.
Heath officials check the listings of people who are to be tested HIV in downtown Johannesburg, April 2020
Heath officials check the listings of people who are to be tested HIV in downtown Johannesburg, April 2020
“CAB-LA offers the best chance we’ve ever had in the history of the Aids pandemic to reimagine prevention and to do it with equity and with impact,” said Mitchell Warren, Executive Director of AVAC, an international non-governmental organisation working on HIV prevention.
“It is quite possible that we will see a larger and faster market for this product in low- and middle-income countries than in wealthy countries, which would be unprecedented and incredibly impactful.”
A total of 38 million people live with HIV globally and there are 1.7 million new infections per year, most of which are in women and adolescent girls in Sub-Saharan Africa.
Studies show that CAB-LA, which is injected every two months, was nine times superior to oral PrEP in women, and six times in men, according to Deborah Waterhouse, CEO of the drug’s producer ViiV Healthcare.
There are currently 31 planned or ongoing implementation studies for CAB-LA, 19 of which will be in Africa.
Malawi will have the biggest programme, which was approved last month and will begin next year.
A large rollout was set to be launched in Uganda, but this has been thrown into doubt by the new anti-gay law that introduced 20 years imprisonment for the promotion of same-sex activities and the death penalty for certain same-sex acts.
CAB-LA is available in the United States at the cost of $20,200 per year, but in developing countries, not-for-profit prices offered by ViiV Healthcare could keep the price tag as low as $250.
ViiV has offered voluntary licences to three other manufacturers to drive costs down even further.
Ms Waterhouse said the aim was to “reach the largest number of people as quickly as possible”.
“We want to break all the records because we knew that the oral PrEP introduction was very, very slow,” she said.
The injections replace daily pills, cutting the stigma of having to keep the medicine at home and lowering the risk of forgetting to take them.
Linda-Gail Bekker, a pioneer in PrEP programs who is leading one of the first implementation studies in South Africa, said the concept of taking a daily pill was “foreign” to many young women and girls.
‘We’re giving women liberation’
“We’ve struggled a little bit to get oral PrEP off the ground in Africa, particularly amongst young women and girls,” she said.
“It’s very foreign – this notion that you take the pill, and it’ll prevent an infection. It’s harder to do something daily and consistently than it is to come in every two months for a shot.”
Dr Bekker said that injectable contraception is favoured in much of Sub-Saharan Africa, meaning that CAB-LA, which offer vulnerable women and young girls the discretion they often need, could be more likely to take off.
“They have very little bargaining power in life,” said Ms Waterhouse. “We’re giving women liberation, empowerment, and the ability to protect themselves. This is why we’re excited.”
There are risks involved. The use of CAB-LA could speed up the development of treatment-resistant strains of HIV, say experts.
The large needle used for the treatment can also leave tenderness on the site of the injection.
Despite this, adding to the treatment options available will be revolutionary, said Mr Warren.
“I believe that by having multiple [preventative] options, with the injectable, an oral pill and a vaginal ring, we can now offer people the chance to make better choices,” he said. “It’s an incredibly opportune moment.”
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