New injectables can accelerate the fight, but there are still some barriers — Global issues

Access to PrEP is slow and mostly limited to high-income countries. Some countries, such as Kenya, Uganda, South Africa, Zambia and Nigeria, have been more proactive than others, but many are still struggling to get PrEP. Credit: Shutterstock
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Nearly 70% of infections occur in key groups: sex workers and their clients, men who have sex with men, people who inject drugs, transgender people and their partners. Adolescent girls and young women in sub-Saharan Africa are another important group, with nearly 5,000 people contracting HIV each week.

For many years, HIV prevention options were quite limited. Initial campaigns included the ABCs – abstinence, fidelity and condoms. In the early 2000s, male circumcision was added, but many efforts to develop a vaccine have been disappointing.

However, in 2012, there was a lot of excitement around the introduction of HIV pre-exposure prophylaxis, or PrEP. The original form of PrEP was a combination oral pill that included two drugs used to treat HIV – emtricitabine and tenofovir. When taken regularly, PrEP is highly effective in preventing HIV infection and very safe. PrEP is seen as a game changer by allowing people to take charge of their sexual health, especially for those who don’t necessarily have control over when or how they have sex. .

Mouth PrEP worked well for many people, especially for men who have sex with men in high-income settings, and for seronegative couples (pairs in which one person has HIV and the other does not) .

For other people – like young people – it is difficult to take the pill continuously during times of HIV risk. The interest is there, but a lot everything gets in the way. Some are related to the person, such as forgetfulness, transportation to the clinic, and alternative priorities. Other factors are related to stigma and lack of support.

PrEP is administered through a vaginal ring is another secure option that has been developed. It remains unclear how many people will want to use it when it becomes more widely available.

Access to PrEP has slowed and mainly limited to high-income countries. Some countries, such as Kenya, Uganda, South Africa, Zambia and Nigeria, have been more proactive than others, but many are still struggling to get PrEP.

Now that injectable PrEP is an option, it’s poised to make a big difference in HIV prevention — as long as it fixes a few key issues.

Benefits of Injectable PrEP

The latest version of PrEP is an injection of another HIV drug – cabotegravir (known as CAB-LA for cabotegravir’s long-acting). It is injected into the buttocks and lasts for two months. It’s even more effective Oral PrEP and it’s safe.

Another injectable drug – lenacapavir – is given only every six months and is easier to give because it only needs to be injected into the skin; But it’s still in clinical trials.

In many ways, injectable PrEP seems like the perfect solution. It’s discreet, doesn’t have the burden of having to take regular pills, and it can be combined with other services and shots, such as contraception for women. CAB-LA trial participants in many parts of the world, including sub-Saharan Africa, South America, and the United States, really enjoyed it. Although some public health officials and medical staff worry about the pain and any swelling caused by the injection, most people do just fine.

Limitations of injectable PrEP

However, a number of issues may prevent injectable PrEP from revolutionizing HIV prevention.

First, most people can’t get it. The United States is the first country to approve the CAB-LA in December 2021. This is followed by Zimbabwe in October 2022. The necessary paperwork is being processed in other countries in sub-Saharan Africa, but the legal process is slow and the ability to access a challenge for a while.

Second, it’s expensive. CAB-LA costs more $22,000 per person per year United States. It may be covered to some extent by health insurance companies, but not everyone has health insurance. The drug manufacturer will offer discounts to markets in low- and middle-income countries, but the exact cost is unknown. Some estimates are around $250 per person per year. That number is still about five times more than the cost of oral PrEP. The increased effectiveness could be worthwhile for people at high risk of HIV, but getting it to those people will be a challenge for health ministries.

Third, logistical issues complicate the supply of injectable PrEP, including the need for refrigerators to store medications and injection nurses. Clinics may not be set up to deliver as many shots in a given day, and limited availability could keep people from getting the shots when they need them.

Finally, continued injections over time can still be a problem. Experience with injectable contraception has taught us that up to half of people choose that form of family planning stop it within a year. Injectable PrEP does not address other barriers people face, such as transportation to clinics and prioritizing HIV prevention.

The lack of access raises important ethical concerns. Most of the thousands of people in the CAB-LA trials live in countries that don’t have access to it, including Botswana, Eswatini, Kenya, Malawi, South Africa, Uganda and Zimbabwe, among others. Accessibility processes have been unacceptably slow, even though the drug is already available in the United States (and recently Zimbabwe).

Where to go from here?

Despite these challenges, injectable PrEP represents a huge advantage to the HIV prevention toolbox. Choice is crucial for most interventions to be effective, and HIV prevention is no different. Increased use of PrEP when people are given effective options and can choose what works best for them.

PrEP needs to be easier for everyone to use, for example by making it more convenient and less medical. Programs are starting to do this through community distribution. That approach can be more difficult when injected, but it can become easier over time and when injected into the skin, like lenacapavir.

Advocacy will be important to speed up the regulatory process and negotiate with pharmaceutical companies to license other companies to produce more affordable generics.Conversation

Jessica HabererDirector of Research, Massachusetts General Hospital Global Health Center and Professor of Medicine, Harvard Medical School, Harvard University

This post was reposted from Conversation under Creative Commons license. Read original article.

© Inter Press Service (2022) — All rights reservedOrigin: Inter Press Service


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