In 2022, the WHO recommended the innovative long-acting injectable version of HIV Pre-exposure Prophylaxis (PrEP), Cabotegravir (CAB-LA), as part of a comprehensive approach to HIV prevention. CAB-LA has been described as a potential game-changer in the fight against HIV, a disease that has affected many people. Nearly 40 million people were living with HIV at the end of 2023, while over 88 million have been infected since the beginning of the epidemic.
Four African countries started offering CAB-LA in 2024: Zimbabwe, Malawi, Zambia, and Eswatini in April. South Africa is scheduled to receive a portion of the 231,000 doses of CAB-LA from the President’s Emergency Plan for AIDS Relief (PEPFAR) anytime between October and December this year, and the remainder will be released over two years.
“My excitement stems from the fact that CAB-LA, administered every two months, is more effective than oral PrEP in reducing new HIV infections. With no HIV vaccine or cure in sight, CAB-LA and other long-acting formulations can be a game changer in curbing the HIV epidemic if scaled up globally, especially in low- and middle-income countries, particularly among groups at higher risk of acquiring HIV,” says Dr Antonio Flores, a Doctors Without Borders (MSF) HIV/TB advisor based in South Africa.
After long negotiations with ViiV, the sole manufacturer of CAB-LA, MSF has also successfully secured a limited number of doses of CAB-LA and is preparing for the initial rollout in projects across Zimbabwe, Mozambique, Malawi, and Eswatini. While the rollout is anticipated for later in the year, MSF has already taken the first step by hosting a four-day training workshop for clinicians, nurses, and future implementers.
“For MSF, this is our very first order of CAB-LA, and it will be our first time implementing it, so we are very excited about this development and look forward to contributing towards the HIV fight. Building capacity and learning how to use CAB-LA in settings such as Malawi and Mozambique is an essential first step. We see many vulnerable populations in conflict and unstable contexts who could definitely benefit from CAB-LA and we are determined to bring this game changer injection to these settings as well. We hope that ViiV can provide adequate supply,” says Dr. Flores.
CAB-LA has been applauded for its longer-lasting protection and discretion compared to oral PrEP, ensuring people adhere to their chosen HIV prevention method. Another long-acting formulation option, lenacapavir, can be administered every six months and is expected to expand prevention choices in the coming years.
The objective of the training was to equip MSF medical staff with the latest knowledge, skills and strategies to effectively lead and coordinate the roll-out of CAB-LA in MSF projects, thereby enhancing HIV prevention efforts and improving health outcomes in high-risk populations. Combined with theory and practice, the training covered topics such as the basics of CAB-LA, clinical eligibility, management of side effects, PrEP counselling, education and promotion, among other key topics.
“The launch of CAB-LA will be a great benefit to our clients and the people of Zimbabwe since it is expected to be an excellent method to increase PrEP uptake among at-risk populations. In addition to offering an even better level of protection than oral PrEP, the two-monthly injection reduces the burden of adherence by doing away with the requirement to take oral tablets every day and the need to store a container of tablets, which enhances privacy. The triad of privacy, convenience, and effectiveness are key elements considered by most clients,” said Dr Gerald Hangaika from MSF’s Mbare project, Zimbabwe, who participated in the CAB-LA training.
The newer long-acting injectable HIV prevention tools, such as CAB-LA and lenacapavir, have the potential to transform HIV prevention efforts and substantially reduce new infections if expanded worldwide. However, current pricing remains prohibitively high, and access to these innovations is severely restricted, limiting their impact on the global HIV epidemic.
MSF calls on pharmaceutical companies to supply adequate long-acting formulations, ensure affordable pricing for the formulations for low-middle-income countries as well as expedite support to generic manufacturers of these formulations. MSF has played a major role in responding to HIV worldwide since the mid-90s - implementing prevention and treatment programmes, innovating to simplify care, and advocating with affected communities and civil society partners for equity of access.
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While HIV infections have decreased by 60% in 2023 since the peak in 1995, new infections continue to emerge, particularly among women and girls in Africa, according to UNAIDS. In 1995, approximately 3.3 million people were newly infected with HIV, compared to 1.3 million in 2023, marking a significant decrease. While this is commendable, more still needs to be done to further reduce the new infections.
Women and girls remain vulnerable to HIV as they accounted for 44% of all new infections in 2023, with Sub-Saharan Africa accounting for 62% of all new HIV infections (UNAIDS). In addition, gay men and other men who have sex with men, sex workers, transgender people, people who inject drugs and people in prisons remain disproportionately vulnerable to HIV in all regions of the world.
