Uganda to roll out injectable HIV drug

In less than three months, Uganda is expected to join three other African countries where an injectable drug has been approved for HIV/Aids prevention.

News of the significant development was revealed yesterday by the Uganda Aids Commission (UAC), hailing it as an effective, safe and more user-friendly disease prevention measure compared to existing options.

The long-lasting injectable cabotegravir (CAB-LA) has been confirmed to be effective and is already being considered as key to national efforts to reduce the health burden of HIV/Aids, which claimed 17,000 lives in Uganda last year.

Speaking in an interview in Kampala on Monday, Dr. Daniel Byamukama, head of the HIV prevention division at the Commission, said UAC plans to roll out the drug early next year.

“We have made orders using the Global Fund for [HIV/Aids, Malaria and Tuberculosis] for injectable pre-exposure prophylaxis (PrEP). You take one injection every two months. If you are HIV negative you will not contract HIV,” Dr Byamukama said.

“We are targeting 10,000 people in the first year, and we are increasing by 10,000 in the subsequent years to be benefiting from this. But if the need is so high, I promise that we shall make it available,” he said without indicating what criteria will be used to pick the very first beneficiaries.

The drug was cleared by the World Health Organisation (WHO) after studies showed it is safe and effective in preventing HIV infection and more convenient than oral pills, Dr Byamukama revealed.

Dr. Byamumaka further explained that what remains is for relevant health regulatory agencies to give final endorsement for local application in Uganda.

“We are sure all the national approvals will be ready by the end of this year and that injectable PrEP will be available for countrymen and women, starting January next year. It will be completely free of charge,” he added.

According to a 2020 report by the WHO, one of the trials for the drug was done among 3,223 women aged 18-45 years in 20 sites in Uganda, Botswana, Kenya, Malawi, South Africa, Eswatini and Zimbabwe.

“Thirty-eight women in the trial acquired HIV. Four were randomised to the long-acting cabotegravir arm (long-acting injectable PrEP for HIV) and 34 were randomised to the daily, oral Tenofovir/emtricitabine (FTC/TDF) arm,” the WHO said.

“This translated to an HIV incidence rate of 0.21 percent in the cabotegravir group and 1.79 percent in the FTC/TDF group. While both methods were highly effective at preventing HIV acquisition, long acting cabotegravir was 89 percent more effective than FTC/TDF,” the global health agency added.

The drug is produced under patent by ViiV Healthcare, a partnership of pharmaceutical corporations Pfizer, GlaxoSmithKline and Shionogi based in the United Kingdom.

The 2020 WHO report emphasised that “these results show that CAB LA is significantly more effective in preventing HIV acquisition than oral PrEP in an intention-to-treat analysis from this trial.”

While announcing the upcoming National HIV/Aids Symposium 2023, which will run November 14 to16 at Kololo Independence Grounds in Kampala yesterday, Dr Byamukama said the drug would help Uganda bring down the HIV/Aids burden -- which disproportionately affects women.

According to statistics from the Commission, the prevalence of HIV among women aged 15 to 49 years stands at 6.5 percent, compared to 3.6 percent for men in the same age bracket.

Being an injectable, the revolutionary drug has been welcomed by officials as an appropriate option for especially women given the cultural sensitivities around sexual matters in socially conservative settings like Uganda.

“Injectable PrEP has one advantage; that it is discreet. Most of the affected people are women. A woman carrying a box of oral PrEP pills is prone to violence from her partner. She is prone to being accused of promiscuity,” Dr Byamukama said.

“For an injectable, you walk into the pharmacy or the hospital, you get one injection once in two months. That is quite discreet. Your husband or partner will never know about it so the controlling behaviour of sexual partners that always stop women from accessing these services will be addressed,” he added.

“We are sure that after getting all necessary national approvals by end of this year, and by January next year, people will have begun accessing for prevention. We are targeting all sexually active people who consider themselves at high risk. If you are married to a sex worker or your husband has multiple sexual partners; you are married to person who is HIV positive, and/or you are a sex worker…, it is safe and effective,” Dr Byamukama added.

In November last year, WHO announced that the Medicines Control Authority of Zimbabwe had approved the use of long-acting injectable cabotegravir as pre-exposure prophylaxis for HIV.

A few months later in March this year, ViiV Healthcare issued a statement confirming regulatory approval had been granted for use of the drug in South Africa, USA, Australia, Zimbabwe and Malawi for at-risk adults and adolescents weighing at least 35kg to reduce the risk of sexually acquired HIV-1 infection.

Individuals must have a negative HIV-1 test prior to being injected with long-acting CAB-LA.