New deal gives hope for injectable PrEP in South Africa

As the World Health Organisation (WHO) calls for the use of long-acting injectable PrEP for HIV prevention, a new deal with its manufacturer gives hope that it could be rolled out around the world.

PrEP is an effective method of HIV prevention, but until recently was only available in pill form, taken daily or, in some cases, before and after sex.

Produced by ViiV Healthcare, Cabotegravir LA (CAB-LA) for PrEP is an important advancement as it can provide two months of highly effective continuous protection against HIV infection through a single injection.

On Thursday, the WHO released new guidelines for the use of CAB-LA as PrEP and called for countries to consider this a safe and highly effective prevention option for people at higher risk of HIV infection such as gay, bi and other men who have sex with men.

Injectable PrEP makes the use of PrEP easier and more effective as it no longer requires users to remember to take a daily pill, which could result in pill fatigue. However, the cost of CAB-LA is around $3,700 per dose, making it prohibitive for large-scale rollout in the countries most affected by HIV.

To address this, the Unitaid-founded Medicines Patent Pool and ViiV Healthcare announced an agreement this week to allow selected manufacturers to develop, manufacture and supply generic versions of CAB-LA for PrEP in 90 countries where over 70% of all new HIV infections occurred in 2020.

The agreement is the first step to reducing the cost of long-lasting injectable PrEP, making it a more viable HIV-prevention option where it is needed most. The announcement comes just seven months after the US Food and Drug Administration (FDA) approved the use of CAB-LA for PrEP.

“This is really welcome news and a next important step along the road to ensuring the promising innovation of injectable PrEP is made accessible to all who would benefit from it even those from the least well-resourced regions,” said Linda-Gail Bekker, Director of the Desmund Tutu HIV Centre at the University of Cape Town.

“We know primary prevention is key to controlling HIV globally but to get the most from innovation we need access and scale up,” added Gail Bekker.

Unitaid, a global health initiative to bring about innovations to prevent, diagnose and treat major diseases in low- and middle-income countries, is currently funding some of the first large-scale implementations of CAB-LA in South Africa and Brazil.

It said that this work, which began earlier this year, aims to answer remaining questions about optimal use and demand generation that will lay the groundwork for scaling up CAB-LA for PrEP in low- and middle-income countries around the world.