BHEKISISA | SA has taken up US donations of CAB-LA, and will roll out anti-HIV jab before the end of the 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 CAB-LA, which after being injected into someone’s buttocks gradually releases the antiretroviral drug cabotegravir over two months into the blood, can virtually eliminate a person’s chances of contracting HIV through sex. 

In 2022 about 150,000 people aged 15 and older in South Africa contracted HIV. About one in eight adults have the virus. 

Early results of four demonstration studies released at the 25th International Conference on Aids in Munich over the weekend show 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 among 1,084 people between 19 and 28 years old, 74% chose the injection.  

The jab, 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.

Though it’s too early to comment on trends from the studies, or draw clear conclusions, Subedar said “the long-acting cabotegravir injection is gaining momentum as a popular choice among young men and women”.

SA received a two-year donation

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 two years, said the health department’s director general, Sandile Buthelezi. 

Buthelezi, who signed South Africa’s acceptance of the donation on June 27, said 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 people “don’t have to stop and start”. 

He said other donors such as the Global Fund for Aids, TB and Malaria “ have also shown appetite” to donate CAB-LA, and people started on the 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 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, said Subedar. 

South Africa will receive the remainder of the 231,000 doses from October 2025, the beginning of the US 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 the 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 every day, it can lower someone’s chances of contracting HIV by at least 90%, but many people struggle with adherence. 

CAB-LA only has to be taken every other month, making it easier to stick to it.  

However, 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 government £23.50 (R555) a shot, which is the price ViiV Healthcare said in November 2023 it will sell the medicine for in 90 countries 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 is 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, said Subedar. 

She said the department also had to ensure he 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 said,” we do have oral PrEP that is effective.”

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.