Long-lasting HIV jab marks ‘new era for prevention’ in Africa

Scientists re-enact the calibration procedure of equipment at an Afrigen Biologics and Vaccines facility in Cape Town, South Africa
Experts believe cabotegravir, known as CAB-LA, has the potential to dramatically change the course of HIV in Africa - Jerome Delay/AP

A long-lasting injection to protect people from HIV has been administered for the first time in Africa, in what experts have called one of the most important breakthroughs in the prevention of the disease to date.

Pre-exposure prophylaxis (PrEP) is already available in tablet form, having been rolled out globally over the last decade. However, the medication, which significantly reduces the risk of infection by up to 99 per cent, must be taken on a daily basis.

But a new injectable version of the drug, which offers protection against HIV for up to two months, has been developed and launched in Zambia, making it the first country to gain access to the medication outside of the US.

Experts believe cabotegravir, known as CAB-LA, has the potential to dramatically change the course of HIV in Africa, which accounts for nearly 70 per cent of all global infections, as it is easy to administer and reduces the risk of people skipping their medication.

The rollout of CAB-LA in Zambia has been described as a “new era” for global health, showing that life-saving treatments can be launched in low-income countries at the same time as their weather counterparts.

“This is one of the first times in global health that we have seen almost simultaneous introduction in Eastern and Southern Africa, or any low and middle-income country, at the same time as weather nations,” said Mitchell Warren, Executive Director of AVAC, an international organisation working on HIV prevention.

“It sets a new bar for what needs to happen because getting access to a product should not depend on where you live, it should depend on what you need.”

Jab is ‘life-changing’

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.

Treatment has improved greatly over the last 30 years, with retroviral drugs able to suppress the virus in those who carry it and oral PrEP widely available in tablet form to prevent infection.

Oral PrEP is available free of charge to groups at high risk of HIV 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.

Mr Warren explained that oral PrEP was shown to be effective in 2010, but it wasn’t until 2016, six years later, that the drug was first distributed in southern and East Africa.

CAB-LA circumvents many of the challenges the rollout of oral PrEP has faced, including distribution logistics, difficulties adhering to taking a daily pill, and the stigma of being seen with the medication.

Miranda Zulu, 23, who was the first person to receive the dose in Zambia, said that the injectable is “life-changing” and eases her worries about following a daily drugs programme.

“I’m very much happy and very much free-minded. It has lessened my worries because there is no need for me to worry and say ‘oh I need to go get my pill’,” she said.

“The other thing is that there is privacy because it is administered by trained and highly skilled healthcare providers. It’s life-changing.”

The project, a partnership between USAID DISCOVER-Health Project and Zambia’s Ministry of Health, is offering injectable PrEP in selected sites in the Copperbelt and Central provinces of the country.

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, GSK’s HIV business, could keep the price tag as low as $250.

The drug was shipped to Zambia from GSK’s manufacturing facility in Barnard Castle, Durham.

Dr Kim Smith, ViiV’s head of research and development, said that the launch had one of the shortest intervals between the US and an African nation she has ever seen.

“Sometimes you see medicines rollout in developed countries first because there are more resources in those environments,” she added.

“Here we are focused not on whether the resources were present, but on where the biggest unmet need was. And that is unquestionably in Sub-Saharan Africa.”

Mr Warren called the new milestone one of the “most exciting times” in HIV prevention.

“We’re here to prevent infections. And this is a product that works,” he said. “This is the new era of prevention.”

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