MSF to roll out injectable HIV prevention drug in southern Africa

As World AIDS Day approaches on December 1, Doctors Without Borders/Médecins Sans Frontières (MSF) is preparing to roll out long-acting cabotegravir (CAB-LA) for pre-exposure prophylaxis (PrEP) in its projects in southern Africa. CAB-LA, administered as an injection every two months, has been described as a potential game changer in the fight against HIV/AIDS and is one of the closest medical tools that exist to an HIV vaccine.

PrEP is a medicine that’s taken continuously or before a situation where someone is at high risk of contracting HIV and can help prevent them from getting infected, protecting the individual and curbing the spread of the virus.

“My excitement stems from the fact that CAB-LA, administered every two months, has been shown to be more effective than oral PrEP in reducing new HIV infections,” said Dr. Antonio Flores, an MSF HIV/TB advisor based in South Africa. “With no HIV vaccine or cure in sight, CAB-LA and other long-acting formulations can be a gamechanger 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.”

In Africa, four countries started offering CAB-LA in 2024: Zimbabwe, Malawi, Zambia, and eSwatini. 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) before the end of the year. The remaining PEPFAR doses will be released over the next two years. After long negotiations with ViiV, the sole manufacturer of CAB-LA, MSF successfully secured a limited number of doses, which are expected to be administered in its projects in Zimbabwe, Mozambique, Malawi, and eSwatini later this year.

CAB-LA is more discreet than the once-daily oral PrEP pill and could encourage adherence to this form of prevention. Discretion can be especially important for key and vulnerable populations at risk of HIV, like girls and women, sex workers, and men who have sex with men. Another long-acting option, lenacapavir made by Gilead, can be administered every six months and is expected to expand prevention choices in the coming years.

“The launch of CAB-LA will be a great benefit to our patients and the people of Zimbabwe since it is expected to be an excellent method to increase PrEP uptake among at-risk populations,” said Dr. Gerald Hangaika from MSF’s Mbare project in Zimbabwe. “In addition to offering an even better level of protection than oral PrEP, the injection every two months 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 patients.”

CAB-LA was recommended for HIV prevention by the World Health Organization (WHO) in July 2022 as there are an estimated 1.3 million new HIV infections per year. However, ViiV distributed only enough CAB-LA for prevention for approximately 13,000 people in 2023—almost 70 percent of which was sold in high-income countries. For governments and countries to be able to roll out this lifesaving intervention at the scale needed, pharmaceutical companies like ViiV must adequately supply long-acting formulations, ensure affordable pricing for low- and middle-income countries, and support generic manufacturers that want to help boost the global supply of these lifesaving medicines.

“We see many vulnerable populations in conflict and unstable contexts that could definitely benefit from CAB-LA,” Dr. Antonio Flores said. “We are determined to bring this game-changing injection to these settings as well. We hope that ViiV can provide adequate supply.”

To prepare for the roll-out, MSF hosted a four-day training for clinicians, nurses, and future CAB-LA implementers. The training aimed 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. The training covered topics such as the basics of CAB-LA, clinical eligibility, management of side effects, and PrEP counselling, education, and promotion, among other key topics.

While HIV infections have decreased by approximately 60 percent since the peak in 1995, new infections continue to emerge, particularly among women and girls in Africa. MSF has played a major role in responding to HIV/AIDS worldwide since the mid-90s, implementing prevention and treatment programs, employing innovative solutions to simplify care, and advocating with affected communities and civil society partners for equitable access to HIV medicines like antiretrovirals.

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Africa Fact: Toilets and sewerage systems existed in ancient Egypt. One of the pharaohs built a city now known as Amarna. An American urban planner noted that: “Great importance was attached to cleanliness in Amarna as in other Egyptian cities. Toilets and sewers were in use to dispose waste. Soap was made for washing the body. Perfumes and essences were popular against body odour. A solution of natron was used to keep insects from houses . . . Amarna may have been the first planned ‘garden city’.”