Injection adds a third weapon to
South Africa is getting ready to pilot the long-acting HIV prevention shot early in the new year. There are answered by the project, not least of which is whether the country will actually be able to provide it in the
South Africa is expected to begin piloting the HIV prevention injection early next year as one of several projects that experts hope will reveal the answers to some of the biggest questions about the future of the shot. These include who will deliver the injection, where, and how to sell to people the idea that just six shots a year could protect them from HIV.
Recently, Spotlight reported that the Wits Reproductive Health and HIV Institute (Wits RHI) and the Department of Health are expected to begin providing injections of the long-acting formulation of the antiretroviral cabotegravir to young women early next year. The HIV prevention shot is expected to be offered along with two other forms of HIV pre-exposure prophylaxis (PrEP): the once-daily HIV prevention pill Truvada, and a relatively new vaginal ring to prevent infection. The monthly ring, inserted at home, was found to reduce women’s risk of contracting HIV by between 27% and more than 50%, according to the World Health Organization (WHO).
Several other demonstration projects featuring the relatively new trio of HIV prevention options are expected to follow in the pilot’s footsteps.
Easy option for reluctant pill takers
The pill is already available at more than 2,000 public sector sites nationwide. When taken correctly, it can reduce a person’s risk of contracting HIV by almost 99%. Still, two large clinical trials led in part by South African researchers found that
people who were given an injection of cabotegravir every other month were about 80% less likely to contract HIV than those on the HIV prevention pill. The bi-monthly shot likely outperformed the pills, the WHO explains in new guidelines, mainly because it was easier for people to get an injection every two months than to take the pills every day.
But South Africa, like the rest of the world, will have to answer major practical questions about how to provide and market the shot before a national rollout of the injection is undertaken, including who will provide it and where and how to get people to use it.
To ensure the health department gets those answers, it will be closely coordinating pilot projects, national health department HIV prevention technical adviser Hasina Subedar told Spotlight in July at the International Aids Conference.
The South African Health Products Regulatory Authority (SAHPRA) is expected to approve the HIV prevention shot for use early next year, after drugmaker ViiV Healthcare submitted its application for regulatory approval in late November 2021.
SAHPRA’s approval will spell out who can receive the shot and who can administer it, depending on how the authority schedules or classifies the injection. In particular, many will be watching to see whether the injection will be made available to pregnant and breastfeeding women, who remain at high risk for contracting HIV in South Africa.
For safety reasons, many clinical trials