By Paul Sixpence
LENACAPAVIR, a twice-yearly injection that prevents HIV has been launched in Zimbabwe targeting 46 000 at key and risk populations.
The launch took place in Epworth, a low-income peri-urban community southeast of the capital, Harare.
Speaking at the event, Zimbabwe’s health minister underscored the significance Lenacapavir in ending AIDS.
“This marks an important milestone in Zimbabwe’s national response to HIV,” said Dr. Douglas Mombeshora, Minister of Health and Childcare. “Lenacapavir is a long-acting injectable option for HIV prevention that shows our commitment to protecting life and ending AIDS as a public health threat.”
Lenacapavir a potential game changer in the fight against HIV
Since 1986 when Zimbabwe recorded its first known HIV case, an HIV infection meant an early, painful death because of the absence of therapeutic and preventive medicines. Over the years scientists have developed biomedical HIV prevention and treatment tools that have reversed the spectre of AIDS, chief among them are powerful antiretroviral (ART) treatments.
The availability of antiretroviral medicines did not close the tap on new infections – antiretrovirals only work when one takes them and adheres to treatment. Again, most people do not know that they are HIV positive, hence the need to develop biomedical HIV preventive medicines.
In 2016, Zimbabwe approved its first HIV pre-exposure prophylaxis (PrEP) drug, Truvada. Since then, the country has licensed three more PrEP drugs: Dapivirine Vaginal Ring (2021), Cabotegravir (2022) and now Lenacapavir (2026).
In a speech delivered at the launch, the Director of the AIDS, Tuberculosis (TB) and Malaria Unit in the health ministry reminded the nation of the milestones that the country has achieved in delivering PrEP options.
“Let me emphasise that Lenacapavir is an addition to available PrEP options,” said Dr. Owen Mugurungi, Director of the AIDS, TB and Malaria Unit at the Ministry of Health and Child Care. “It does not come to replace but to complement the existing PrEP options thereby strengthening our prevention.”
By being a twice-yearly injection, Lenacapavir holds significant advantages over other PrEPoptions currently available in Zimbabwe.
“I have been using PrEP since 2021, but I have adherence challenges taking the daily oral pill,” said Lynette Chidawanyika, a sex worker. “I think I will switch over to the new injection (Lenacapavir) because I will not have the burden of taking pills daily.”
At risk populations who face challenges with getting partner approval and support before enrolling for PrEP have a new discreet prevention option in Lenacapavir. With only twice-yearlyinjections, this new HIV prevention option restores power and urgency to at risk and vulnerable populations to make life saving choices about their health and bodies.
“Long-acting prevention options can help address structural barriers that limit daily method uptake, including stigma, mobility, and inconsistent access to services,” said Pangaea Zimbabwe, a local non-profit organisation working to improve the health and well-being of people in Zimbabwe in statement.
The science and evidence behind Lenacapavir
The twice-yearly injection showed 100 percent efficacy in two large scale clinical trials, PURPOSE 1 and PURPOSE 2.
PURPOSE 1 study enrolled 5 300 cisgender women in Uganda and South Africa. The two countries have similar environments and HIV burden as Zimbabwe. The PURPOSE 2 trial highlighted a 96 percent reduction in HIV incidence among a diverse set of populations in various countries. The two studies demonstrated the drug’s safety and effectiveness in reducing HIV transmission.
To further highlight the efficacy and safety of the new innovation, rights and advocacy groups in Zimbabwe are celebrating and supporting lenacapavir roll-out.
“The introduction of Lenacapavir represents an important advancement in expanding HIV prevention options and re-enforcing the country’s commitment to ensuring that individuals have access to a range of safe, effective and evidence-based prevention tools,” said the Sexual Rights Centre in a statement.
The roll-out pathway: from the lab to the people
AVAC, a global HIV prevention and treatment advocacy organisation highlights that globally, PrEP rollout has been “slow, uncoordinated and poorly planned. Uptake is nowhere near where it should be to address the HIV epidemic. While PrEP won’t be right for everyone at risk, the next generation of products, some entering the market now, must act on the lessons from oral PrEProllout, by improving coordination and speeding access.”
The government and its partners have so far demonstrated agility in rolling out Lenacapavir. Within days from the official launch in Epworth, near Harare the drug was being distributed countrywide in a phased roll-out programme.
“Zimbabwe is demonstrating that prevention progress is a political choice as much as a scientific one,” said Imelda Mahaka, Executive Director at Pangaea Zimbabwe in statement released by her organisation. “Regional progress will be defined by who gets access and who does not.”
Noting structural barriers in accessing health services, roll-out plans plans must be designed in a way that will ensure that PrEP medicines leave clinics and get into homes and streets where those who need them the most are found.
Investments to ensure equitable access
The cost of Lenacapavir in the global north is approximately US$28 000 per year, per person. Zimbabwe and other select African countries will be receiving the drug for free, thanks to the generous support of the United States of America (US) government, Unitaid and the Gates Foundation.
In a statement released by UNAIDS on the sidelines of the 39th African Union summit, the United Nations agency “urged African leaders to move towards sustainable financing for health and development.”
“AIDS is not over in Africa and continued African leadership is essential,” said Winnie Byanyima, Executive Director of UNAIDS. “Now is the moment to raise ambition, safeguard our gains and ensure Africa drives the global agenda for a sustainable and sovereign health future.”
Of concern is a recent statement by the US embassy in Zimbabwe highlighting the termination ofUS$367 million support for country’s “priority health programs, including HIV/AIDS treatment and prevention, tuberculosis, malaria, maternal and child health, and disease outbreak preparedness.” Lenacapavir doses that are currently being distributed in Zimbabwe were donated by the US government. It is not yet clear, if the US government will continue to support Lenacapavir roll-out beyond the current 46 000 doses.
“We believe this collaboration would have delivered extraordinary benefits for Zimbabwean communities, especially the 1.2 million men, women, and children currently receiving HIV treatment through U.S.-supported programs,” said US Ambassador to Zimbabwe Pamela Tremont. “We will now turn to the difficult and regrettable task of winding down our health assistance in Zimbabwe.”
According to prepwatch.org, a site dedicated to exploring data and information on PrEP across the globe, an estimated 337 000 people are currently accessing PrEP in Zimbabwe.
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