Could PrEP become a long-lasting injection instead of a daily pill?

Researchers are conducting an injectable PrEP trial in Cape Town that could revolutionise the way that we protect ourselves from HIV.

PrEP (Pre-exposure prophylaxis) is a usually daily tablet taken by HIV-negative individuals to avoid HIV infection. It has been found to be extremely effective (by more than 90%) and usually has minimal side effects.

PrEP is recommended for sexually active men who have sex with men (MSM) who might be at risk of HIV and is available for free at a limited number of sites around the country.

MSM and transgender women who have sex with men are considered “key populations” at high risk of being infected with HIV in part because they commonly face discrimination and barriers when accessing healthcare.

Some potential and current PrEP users, however, may be put off by having to remember to take the tablet on a daily basis or may simply forget, thereby reducing the effectiveness of the pill.

That’s one of the reasons why researchers at the Groote Schuur HIV Clinical Research Site Unit are working to assess if a form of long-lasting PrEP injected once every two months will work just as well as the tablets. The HPTN 083 study is also being conducted in other sites in the Americas, Africa and Asia.

“PrEP works very well, provided you take it properly,” explains Dr Richard Kaplan from the Desmond Tutu HIV Foundation, which is recruiting people for the study. “But you need to take it every day and that’s the problem. It’s really hard for people, especially if they’ve got no real good medical reason to take a tablet, to remember to take it,” he told MambaOnline.

“So this trial is looking at another way of providing PrEP and we are in an era of long-working antiretrovirals and one drug we’ve got is cabotegravir (CAB) that can be formulated as a long-working injection,” says Kaplan.

He believes that if shown to be effective and safe, this injectable form of PrEP could help reduce the problem of people’s adherence to the medication and further add to the growing arsenal in the fight against HIV.

Kaplan acknowledges that, in the meantime, there is still much work to be done in terms of informing the gay, bi, MSM and trans communities about the current tablet form of PrEP and providing them with access to the medication.

He says it will be another year or two before the results of the injectable PrEP study are released but the Desmond Tutu HIV Foundation is still looking for MSM and trans women, especially those who engage in sex without condoms or have multiple sex partners, to participate.

If you are HIV-negative, 18 or older and a man or transgender woman who has sex with men in the Cape Town area and would like to take part in the study, contact the researchers on 060 821 8757 or email contactUs@hiv-research.org.za.

Oral PrEP is available for free for MSM at OUT’s TEN81 clinic in Pretoria (012 430 3272), the Ivan Toms Clinic in Greenpoint, Cape Town (021 447 2844) and the Health4Men Services Clinic in Yeoville, Johannesburg (011 648 7979 or 072 654 0816). The new Engage Men’s Health clinic in Melville, Johannesburg will also start offering free PrEP for MSM in April 2019.