What's happened
England is set to approve cabotegravir, a two-month injectable HIV prevention shot, expanding options for those unable to take daily pills. Zimbabwe will roll out lenacapavir, a twice-yearly prophylactic, amid debates over cost and safety. Both developments mark significant advances in HIV prevention efforts.
What's behind the headline?
The approval of cabotegravir in England and the rollout of lenacapavir in Zimbabwe represent a pivotal shift in HIV prevention. These long-acting injectables will likely increase adherence by reducing the need for daily medication, which is a major barrier for many at risk. The UK’s focus on those unable to take oral PrEP highlights a targeted approach to reach marginalized groups, potentially lowering transmission rates. Zimbabwe’s deployment of lenacapavir, with efficacy exceeding 99% in trials, could dramatically reduce new infections in a country with one of the highest HIV prevalence rates. However, concerns about cost, safety, and accessibility remain significant. Critics question whether these drugs will be affordable for low-income populations, especially given initial high price estimates. The emphasis on transparency and negotiations for lower prices will be crucial for equitable access. The contrasting perspectives from the UK and Zimbabwe reflect broader debates about innovation versus affordability in global health. While these developments are promising, their success hinges on effective implementation, clear communication about side effects, and international cooperation to ensure affordability and widespread availability.
What the papers say
The Guardian reports that the UK’s NICE recommends cabotegravir for adults and young people at risk of HIV who cannot take oral PrEP, emphasizing its potential to be a 'gamechanger' in HIV prevention. All Africa highlights Zimbabwe’s rollout of lenacapavir, describing it as a 'watershed moment' and a potential 'miracle drug' due to its high efficacy and twice-yearly administration. Bloomberg notes that cabotegravir is administered every two months in clinics, offering an alternative to daily pills. The contrasting opinions reflect optimism about the drugs’ potential but also skepticism about cost and accessibility, especially in low-income settings. Critics worry that high prices could limit reach, while advocates emphasize the importance of negotiations and local production to improve affordability.
How we got here
Current HIV prevention relies heavily on daily oral PrEP, which some individuals cannot tolerate or access. The UK and Zimbabwe are introducing long-acting injectable options—cabotegravir and lenacapavir—that require less frequent dosing. These innovations aim to improve adherence and reduce new infections, especially in high-prevalence regions. The UK’s NICE recommends cabotegravir for those unable to take oral PrEP, while Zimbabwe’s rollout of lenacapavir targets vulnerable populations, including adolescents and pregnant women, supported by strong HIV response infrastructure and international partnerships.
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