By Agencies
ZIMBABWE is preparing to roll out the administration of a long-acting injectable HIV drug — lenacapavir — that could dramatically reduce new infections and ease the burden of daily medication intake, particularly for vulnerable populations.
The drug, which is administered twice a year, offers new hope for populations at highest risk of infection, including adolescent girls and young women, as well as expectant and breastfeeding mothers.
The country is among 18 high-incidence nations prioritised for early access to lenacapavir, offering a critical lifeline at a time when traditional donor support is shrinking and health systems are under strain.
The authorities say the new drug could significantly reduce dependence on daily oral pre-exposure prophylaxis (PrEP) pills that are distributed free of charge at public hospitals, but whose access could be potentially affected by reduced international funding for HIV programmes.
Funding cuts from major global donors have led to reduced testing, slower treatment initiation and growing concerns about the sustainability of HIV interventions in low- and middle-income countries like Zimbabwe, where thousands rely on publicly funded medication. The drug’s developer, Gilead Sciences, has already signed voluntary licensing agreements with generic manufacturers to facilitate affordable supply across low- and middle-income countries.
The agreements cover lenacapavir for both prevention (PrEP) and treatment of heavily treatment-experienced patients with multi-drug-resistant HIV.
Importantly, Zimbabwe plans to leverage the infrastructure and lessons from its 2022 rollout of cabotegravir (CAB-LA) — a three-monthly injectable PrEP currently in use across selected sites — to support the scale-up of lenacapavir. In an interview following the recent International AIDS Conference in Rwanda, National AIDS Council (NAC) operations director Mr Raymond Yekeye confirmed the development.
“An issue that was discussed at length (at the conference) is the newly introduced and registered injectable PrEP — lenacapavir,” he said.
“This will obviously revolutionise our HIV prevention space. A number of issues were raised, like how do we make it affordable and available in low- to middle-income countries; how do we scale up to ensure that it can eventually be used as treatment rather than just for prevention.
“As a country, we will obviously look at how best we can roll out this new injectable. You are aware that we are already rolling out CAB-LA and we are going to use that infrastructure to look at how best we can roll out the new injectable.”
Lenacapavir works by inhibiting the HIV-1 capsid, blocking multiple stages of the virus’ lifecycle.
Its extended dosing interval — just twice a year — makes it a promising alternative to daily oral PrEP and could significantly improve adherence, especially among the youth and other mobile or hard-to-reach groups.
Zimbabwe, Mr Yekeye said, will initially target high-risk groups such as adolescent girls, young women, and expectant and breastfeeding mothers, based on infection data and available resources.
“The Government, through the Ministry of Health (and Child Care), has already indicated that this is the direction we are going,” he added.
“We are going to roll it out. What we need to do obviously is to then prioritise which populations that we can start with because at the current cost we are not able to roll it out at a public health scale, where we give everyone who requires it.
“So, we need to sit down and say which priority populations are we going to give.
“These are conversations that will be informed by what our data is telling us in terms of where we are getting the highest number of new infections.”
At the AIDS conference, Zimbabwe also showcased its HIV response strategy amid declining donor support, including efforts to build a buffer stock of essential supplies and boost reliance on domestic financing.
“As a country, we have been creating a buffer so we do not run short of supplies.
“We are also looking at how to strengthen community systems, which have always been critical in our response, to ensure that no one is left behind.”
He added that innovations such as artificial intelligence and digital tools are emerging as critical components in improving monitoring and management of HIV care.
-Zimpapers
