Women who want to protect themselves from HIV but struggle to take a daily pill could soon have the option of a long-acting injection.
Tests in SA have shown that HIV infection is prevented by the injectable pre-exposure prophylaxis (PrEP), according to a new study by Wits University, the University of Cape Town-based Desmond Tutu Centre and other international researchers.
Results from the HPTN 084 trial, announced on the eve of the fourth HIV for Prevention Conference on Wednesday, showed that the long-acting injectable cabotegravir is not only safe but is superior to the tablet form, Truvada.
Cabotegravir was first tested on more than 4,500 men and transgender women who have sex with men in seven countries, including SA, Thailand and the US.
The latest trial enrolled 3,224 HIV-negative and sexually active women in Sub-Saharan Africa. They took pills daily for five weeks and had injections every eight weeks. Some of the medications were placebos.
Lead researcher Prof Sinead Delany-Moretlwe, director of Wits Reproductive Health and HIV Institute, said both forms of PrEP were highly effective. Of 40 HIV infections observed in the clinical trial, four were in the injectable group while 36 in the pill group.
Researchers said disparities in HIV infections were likely because of the adherence advantage conferred by eight-weekly injections compared to poor adherence to tablets.
Delany-Moretlwe said researchers hoped to send submissions to the US Federal Drug Administration this year. She could not give timelines when the injectable PrEP would be available in SA.
“Countries need to negotiate a price on access, and that takes a while. But we've learnt some enormous lessons about where there's a will, there's a way,” she said.
An oral PrEP user and activist Gcobisa Madlolo said the injectable PrEP would encourage more women to start taking the HIV preventative therapy.
"Now that we have the injectable PrEP a lot more women will start taking it as most struggled to adhere with the oral regimen."
"Disadvantages of the oral option are that if you do not have a reminder to constantly reminds you or a PrEP buddy, it becomes hard to always remember, especially when you have a busy schedule."
A recent UCT study among sexually active teenage girls found they are more likely to opt for long-acting injectables or vaginal rings than pills as pre-exposure prophylaxis.
According to the UChoose study by the Desmond Tutu HIV Centre, which evaluated contraceptive experiences among girls aged between 15 and 19 in Cape Town, almost half said they would prefer an injectable.
Though many were not familiar with the vaginal ring, 33% preferred it and only 10% opted for oral PrEP.
The teens were either put on a two-monthly injectable, Nur-Isterate, the Nuvaring vaginal ring or a monthly pill, Triphasil. Most of the girls said the problem with the pill was that they forgot to take it.
In another study, the drug islatravir showed promise as a monthly oral PrEP.
