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World AIDS Day
World AIdS dAy By Jessie Taylor
Injecting healthcare with a new dose of HIV prevention
Anew form of HIV prevention is expected to be piloted in South Africa early next year, which could transform the country’s strategy to prevent infection among HIV-negative patients.
The pilot project, announced by international medicine financing initiative Unitaid and planned to start early next year, will trial the antiretroviral cabotegravir injection administered every second month. By targeting young women, the pilot project holds the promise of preventing new infections as well as changing the stigma around pre-exposure prophylaxis (PrEP) usage.
FighTing sTigma Through science
Recent modelling suggests that as many as 52 000 new HIV infections could be prevented over 20 years across the country if the injection is found to be effective. In order to test its efficacy, Wits Reproductive Health and HIV Institute (Wits RHI) and the national Health Department are expected to begin providing injections to young women as part of a Unitaid-funded project.
PrEP in tablet form has been available in South Africa since 2016. It is widely available and extremely effective when taken correctly – in fact, it can reduce a person’s risk of contracting HIV by 99%.
South Africans using oral PrEP accounted for about one in ten people globally in 2020.
However, healthcare professionals have had to contend with the stigma around the treatment. This is partly due to the rollout programme, which initially targeted sex workers and men having sex with men. While this initial rollout provided essential information on how to scale the treatment to other groups, the focus on populations who were largely stigmatised has impacted the public perception of oral PrEP. Today, it is still incorrectly perceived by many as a treatment used by those who are promiscuous or unfaithful to their partners.
An estimated eight million South Africans are living with HIV. Globally, HIV prevention efforts have stalled with 1.5 million new HIV infections in 2021 – the same as in 2020. There are around 4000 new infections every day.
In South Africa, women make up over 60% of all new HIV cases. 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. The vulnerability of this group is the reason why women and adolescent girls have been chosen as the first group to access the injectable PrEP.
Focusing on vulnerable groups Young girls especially struggled to access prevention measures such as PrEP, as their guardians feel they should not be having sex and prevent them from using the treatment.
The injection removes this stigma. Administered at a clinic, it will give women and girls access to a treatment which is safe and judgement-free. It also mitigates fears that pills will be misinterpreted for HIV treatment and cause the patient to suffer stigma, discrimination, or intimate partner violence as a result.
The injection has had the support of the World Health Organisation, which has called on countries to consider it as a safe and effective prevention option for people at risk of HIV infection
Clinical trials of cabotegravir, taken every second month, have shown that participants were about 80% less likely to contract the virus. In addition, it was found to be much more accessible than taking pills every day, the World Health Organization found.
The pilot will only commence once the injection has been approved by the South African Health Products Regulatory Authority (SAHPRA), which is expected to take place early next year. It was approved by the United States Food and Drug Administration in December last year. The Wits RHI pilot, which will see the shot provided in some public health facilities and mobile clinics, is expected to be the first of several projects to see how best to roll out the injection.
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, which lasts for 28 days and can be inserted at home.
