The US government’s Aids fund, Pepfar, has donated 231 000 doses over two years to South Africa — 96 000 of the doses will arrive between October and December, enough for 13 728 people to use to protect themselves against HIV infection for one year.
Before the end of the year, 867 government health facilities will start to roll out the two-monthly HIV prevention injection CAB-LA, using 96 000 doses donated by the US government.
Studies show that CAB-LA, which, after being injected into someone’s buttocks, gradually releases the antiretroviral drug cabotegravir over a period of two months into someone’s blood, can virtually eliminate a person’s chances of contracting HIV through sex.
With the CAB-LA jab, 52 000 new HIV infections can be stopped every year, a 2022 modelling study published in The Lancet HIV found. In that year, about 150 000 adults — people of 15 and older — in South Africa contracted HIV, which means that making the shot available as an HIV prevention option can slash the country’s’ new infections by a third.
Early results of five demonstration studies released at the 25th International Conference on Aids in Munich over the weekend, show that when people have a choice between taking a daily HIV prevention pill, using the monthly vaginal ring or getting a CAB-LA shot, which only has to be taken every other month, up to three-quarters go for the jab. For example, researchers from the Desmond Tutu Health Foundation in Cape Town found that among 1 084 people between 19 and 28 years old, 74% chose the injection.
The jab, which is made by the British manufacturer ViiV Healthcare, has been added to HIV prevention options at 16 research sites between February and June, Hasina Subedar, a senior technical advisor for the national health department, told Bhekisisa at the conference.
Although it’s too early to comment on trends from these studies, or draw clear conclusions, Subedar says “the long-acting cabotegravir injection is gaining momentum as a popular choice among both young men and women”.
SA got a two-year donation of over 200 000 doses
The government accepted the 96 000 CAB-LA doses, which will arrive between October and December this year, as part of a larger donation of 231 000 doses that Pepfar is releasing over a period of two years, says the health department’s director general, Sandile Buthelezi.
Buthelezi, who signed South Africa’s acceptance of the donation on 27 June, says the department accepted the donation on the basis that cheaper generic versions of CAB-LA are likely to become available in early 2027, which will help the country to sustain supplies, so that people “don’t have to stop and start”.
Buthelezi says other donors such as the Global Fund for Aids, TB and Malaria “also have shown appetite” to donate CAB-LA, and people started on this medicine will be able to switch to another injection, lenacapavir, which only has to be taken once every six months, should they choose to and if it becomes available in South Africa.
A recent study showed that none of 2 134 women who received lenacapavir contracted HIV, but the drug is not yet registered with the country’s medicines regulator, the South African Health Products Regulatory Authority, Sahpra. CAB-LA was registered with Sahpra in December 2022.
The 96 000 CAB-LA doses are enough for 13 728 people to use to protect themselves against HIV infection for one year, says Subedar.
South Africa will receive the remainder of the 231 000 doses from October 2025, the beginning of the United States’s financial year.
South Africa will be the fourth African country — after Zambia (which started roll-out in February this year), Zimbabwe (in April) and Malawi (April) — to offer CAB-LA for free in state clinics and hospitals as part of its health programmes.
At an Aids conference session, Ashneil Jain of the US department of state, said Pepfar plans to sponsor CAB-LA in at least 12 countries before the end of the year.
CAB-LA costs four times more than the daily prevention pill
Research shows CAB-LA works better than the daily HIV prevention pill, which, by the end of April, was available for free in 93% (3 241 out of 3 484) of the government’s primary health clinics.
The pill contains two antiretroviral drugs (ARVs), emtricitabine and tenofovir disoproxil fumarate. Once there is enough of these two medicines in an HIV-negative person’s vaginal or anal tissues, their white blood cells are shielded against HIV.
If the pill, also referred to as oral pre-exposure prophylaxis (PrEP), is used consistently, in other words each day, it can lower someone’s chances of contracting HIV by at least 90%, but many people struggle with adherence.
CAB-LA, on the other hand, only has to be taken every other month, making it easier to stick to it.
But it is four times more expensive than the daily pill. The department buys a month’s supply of the pill for R64.50. The injection, however, costs the government £23.50 (about R555 at the current exchange rate) a shot, which is the price ViiV Healthcare said in November 2023 it will sell the medicine at in 90 countries that the World Bank classifies as having low- and middle-income status, including South Africa, and also to donors.
The health department’s essential medicines list committee decides whether to recommend a PrEP product, based on if it’s cost effective. For this, it compares the cost of the medicine with that of the HIV prevention pill.
The department can only buy medicines that are on the essential medicines list. Because CAB-LA has not been approved yet by the committee, the health department cannot procure it.
The committee will be able to consider recommending CAB-LA. ViiV Healthcare offers CAB-LA to the health department at a competitive price, comparable to that of the daily pill.
The 867 clinics chosen to stock Pepfar-sponsored CAB-LA have been selected because they’ve had a high uptake of oral PrEP — at least 20 new clients had to be given the pill in the past financial year, which started in March, says Subedar.
She says the department also had to ensure that the donations are given to at least one facility in each local municipality.
“If we run out of donations, and If there are no cheaper generic formulations or the department has not been successful in securing CAB-LA at a lower price,” she says, “we do have oral PrEP that is effective.”
This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.
