Roll-out of injectable PrEP in Zimbabwe will mean more young people are protected from HIV

Zimbabwe, with around 1.3 million HIV-positive individuals, including a significant 10% of young people under 19, faces a pressing challenge. Young women, in particular, are at a heightened risk – six times more vulnerable than young men, according to a 2022 UNICEF report.

Various HIV prevention methods exist, including condoms, oral pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), and the dapivirine ring, which is inserted into the vagina and ensures safety for 28 days. However, oral PrEP requires taking a daily pill. Missing doses significantly heightens the risk of HIV infection. Daily adherence can be challenging, hence many sexually active young people have expressed enthusiasm for a novel solution: the PrEP injectable. 

Zambia recently became the second country globally, following the USA, to introduce the long-acting HIV PrEP injectable outside of clinical trials. Dr. Nyaradzo Mgodhi led clinical trials for the injectable in Zimbabwe as part of the HTPN 084 CAB LA PrEP trials, in which seven African countries participated. Despite the promising outcomes, affordability remains a significant hurdle. A study in South Africa found that to be accessible, the PrEP injectable should cost between US$9 to US$15. 

In July 2022, ViiV Healthcare and the Medicines Patent Pool signed an agreement for patents relating to injectable PrEP to help enable access in 90 countries including all of Africa. Through this agreement, selected generic manufacturers will have the opportunity to develop, manufacture and supply generic versions of cabotegravir LA injections for PrEP. Generic manufacturing of drugs aims to help overcome affordability issues and should allow more people to access injectable PrEP.

Joyce Jari, a participant in the trials and a sex worker, highlights the injection as a potential savior for those at high risk of contracting HIV, especially those struggling with pill fatigue.  

"I am a sex worker, I am most at risk of contracting HIV. I suffered pill fatigue and stopped taking my pill at times. The majority of us in the clinical trial agreed that the injection was our saviour," said Jari. 

Anna Miti, Chair of the Health Communicators Forum of Zimbabwe and advocate for sexual reproductive health rights (SRHR) choice, emphasizes the importance of choice in intervention uptake. Miti believes the injectable, alongside existing prevention methods, could make significant strides in curbing new HIV infections. 

"We have learned over the years that choice is key in uptake of intervention products. CAB LA adds to the choice basket of already existing products like the Dapivirine Ring, oral PrEP, the male, and female condoms.  It may not be a panacea but can definitely contribute to the HIV trajectory to stop new infections," said Miti.  

While oral PrEP is freely available in Zimbabwean health facilities, uptake remains inconsistent. The Zimbabwe HIV Prevention, Treatment, Care, and Support Strategic Plan underscores the importance of adolescent-friendly health services to address these challenges. 

Efforts to address funding concerns for the injectable have yet to yield substantial results. The Medicines Control Authority of Zimbabwe emphasizes the rigorous safety protocols medications undergo before approval, though availability remains contingent on funding. 

Despite advancements like the dapivirine ring, approval alone isn't sufficient; without adequate funding, these innovative tools remain out of reach for those who need them most. 

HIV in focus 

This news story has been published as part of our HIV in focus news network. This is a network of writers and journalists from our focus countries, dedicated to delivering news on HIV and sexual health. The network aims to amplify the voices of communities most affected by HIV and share the stories that matter to them. 

About the writer 

Catherine Murombedzi is a freelance health journalist from Zimbabwe. Catherine has won several local and international awards. She is a CNS Health fellow, Mercury Phoenix Trust HIV/AIDS Reporting fellow, and a Taboom Media fellow.

Correction

A earlier version of this article had an incorrect cost for the CAB LA injection in Zimbabwe quoting instead the cost of the injection in the US. This has now been removed.