Injectable Lenacapavir For HIV Prevention: A Pathway To Sustainability

(MENAFN- The Post) TODAY i have some great news to share. Besides the fact that last week was the King's Birthday, something exciting was happening in the HIV sector...oh, you haven't heard? Well...here it is: The Global Fund has selected Lesotho as one of the first nine countries to receive lencapavir (LEN) for PrEP. This introductory phase will help shape the market for the eventual introduction of generic and lower-cost LEN.

But first, why is there so much excitement about this long-acting injectable for HIV prevention?

As mentioned here in my column last month, the long-acting properties of LEN help address the pill burden challenges linked to oral PrEP, as it removes the necessity for daily dosing.

LEN only requires two injections per year and was shown to reduce HIV risk by 100 percent in women and almost the same in men.

This remarkable level of protection, along with its less frequent dosing schedule, positions LEN as a crucial asset in the global battle for control of HIV and particularly in Lesotho, where there were 3,200 new infections in 2024.

Also last week, the World Health Organization updated its HIV prevention guidelines to recommend LEN for PrEP (brand name Yeztugo), with Director-General Tedros Adhanom Ghebreyesus, calling LEN the“next best thing” in the absence of an HIV vaccine.

And, importantly, a strong majority of current and potential PrEP users-including adolescents and pregnant and lactating people-want the twice-yearly shot. Studies show that about 70 percent of PrEP users would choose an injectable option if available.

So how can Lesotho demonstrate its readiness to ensure a swift and wide distribution of this potentially game-changing HIV prevention method?

Well, firstly, the Global Fund aims to reach at least 2 million individuals with LEN PrEP in low- and middle-income nations starting in 2026 and going through 2028.

Drugs will arrive in the nine selected countries by the end of this year and rollout can start as early as January.

Lesotho's National Aids Commission needs an introductory access plan. Generally speaking, we need to figure out our recipient communities - who, where, how much?

Thus far, Global Fund and the drug's developer, Gilead Sciences, have not gone public with LEN's price.

So it is unclear how much drug Global Fund's tranche of money will buy for Lesotho.

This poses an immediate barrier to introductory planning.

Also, LEN scale-up relies on regulatory approval from the South African Health Products Regulatory Authority (SAHPRA), which is slated to occur before the year's end. In the meantime, procurement processes, simplified delivery, testing and community mechanisms such as mobile clinics must be put in place.

Secondly, on a global scale, donor countries must ensure the Global Fund gets ample replenishment over the next few months so it can provide its core funding and additional LEN-specific support. Why not 4 million people on LEN by 2027, double the current ambition?

And it is not just on the Global Fund. PEPFAR was part of the initial planning about LEN for PrEP, and they need to recommit to LEN (and PrEP and prevention) for all populations.

It would also require other funders such as Unit aid to coordinate strategy and pave the way for widescale, affordable, generic LEN.

Then, we will see epidemic control: LEN as prevention is our best chance to turn off the tap of new infections - it's the core of sustainability, like Lesotho's enduring monarchy.

Cindra Feuer & Mokone Rantsoeleba

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