Unitaid to introduce new long-lasting injection to prevent HIV in Brazil and South Africa, as high-income countries begin deployment
Unitaid will fund implementation of the latest innovation in HIV prevention - an injectable version of pre-exposure prophylaxis (PrEP) that has shown to be more effective than daily oral PrEP in reducing the risk of HIV infection, with just six injections a year.
United Nations' targets to reach three million people with PrEP by 2020 were missed by two-thirds. Long-acting cabotegravir provides a new alternative that addresses challenges associated with oral PrEP including inconsistent use and fear of stigma or discrimination, and could extend benefits to millions of people at risk of HIV infection.
Unitaid, in partnership with Fiocruz in Brazil, Wits RHI in South Africa, and local health authorities in both countries, will integrate long-acting PrEP into national sexual health programmes and generate crucial real-world evidence that will underpin efforts for rapid global scale-up.
Parallel action is urgently required to secure broader access for long-acting cabotegravir so 2025 UN prevention targets to reach 95% of people at risk of infection can be achieved
Geneva - People at risk of HIV in Brazil and South Africa will be among the first to benefit from a highly effective, long-acting injectable HIV preventive treatment through two large-scale operational projects funded by global health agency Unitaid.
Long-acting cabotegravir is a new HIV prevention method that provides eight weeks of continuous protection against HIV infection through a single intramuscular injection.
This provides an alternative to oral pre-exposure prophylaxis (PrEP), which can reduce the risk of HIV infection by 99%, but only when taken as prescribed: either once a day, or before and after sex for cisgender men.
Long-acting cabotegravir addresses challenges users face with regular pills that reduce the impact of oral PrEP in real-world settings. It also mitigates fears that pills will be misinterpreted for HIV treatment and cause the user to suffer stigma, discrimination, or intimate partner violence as a result.
Unitaid will partner with Fiocruz in Brazil, Wits RHI in South Africa, and local health authorities in both countries to integrate long-acting cabotegravir into national sexual health programmes, generating some of the first real-world evidence that will support wide-scale global implementation.
Despite the high protection oral PrEP can provide, uptake has been slow. United Nations targets to increase PrEP coverage and reduce new HIV infections by 2020 were both missed by two-thirds. And disparities in who is accessing treatment and prevention are growing.
In Brazil, the programmes will aim to reach the two groups with the highest rates of HIV prevalence: an estimated 30% of transgender people and 18% of men who have sex with men in the country are living with HIV.
Adolescent girls and young women, who will be the target of the Unitaid-funded efforts in South Africa, become infected at a disproportionately high rate. In sub-Saharan Africa, six in seven new HIV infections in adolescents occur among girls, and young women are twice as likely to be living with HIV as their male peers.
"Unitaid recognizes the game-changing potential long-acting PrEP could have in making HIV prevention a more viable option for more people," said Dr Philippe Duneton, Executive Director of Unitaid. "But we need urgent action to ensure people everywhere can benefit. We need adequate and affordable supply without delay. And we strongly encourage ViiV to develop a transparent access policy for long-acting cabotegravir that readily enables voluntary licenses through the Medicines Patent Pool to assure a generic pathway to broader access."
"Thanks to Unitaid's investments, communities in Brazil with disproportionately high rates of HIV will be among the first in the world to benefit from this new preventive treatment," said Marcelo Queiroga, Minister of Health of Brazil. "Working within our national health system, this project will not only integrate new PrEP options into existing services, it will also develop a model to scale up long-lasting PrEP so people across the continent and beyond can benefit."
The South African programme will include a second new long-acting HIV prevention product targeted at adolescent girls and young women. The dapivirine vaginal ring lasts 28 days, can be inserted at home, and is the first HIV prevention method a woman has complete control over.
Supplies of long-acting cabotegravir and the dapivirine ring used in these projects have been donated by ViiV and the Global Fund through the South African Department of Health, respectively.
"It is exciting to see these bold investments by Unitaid in new long-acting HIV prevention options. To date there is little experience of offering these choices outside trial settings. These projects will provide invaluable information and evidence on how to deliver long-acting cabotegravir and the dapivirine vaginal ring in a safe and acceptable way, while answering many implementation questions critical to the development of future WHO guidelines," said Dr Meg Doherty Director of the Global HIV, Hepatitis and Sexually Transmitted Infections Programme at WHO.
"New HIV Prevention technologies have the potential to change the face of the HIV epidemic. But we know that access and use are not aligned unless research and planning is put into product introduction," said Prof Helen Rees, Executive Director, Wits RHI.
"This investment comes at a time when the field needs real-world evidence around the delivery of HIV prevention choices. We need innovative service delivery approaches to maximize public health impact of these promising new technologies through evidence-based strategies for introduction," said Prof Saiqa Mullick, Director of Implementation Science, Wits RHI.