CAB-LA Game Changer for Closing the Leaks to New HIV Infections among young people

Onward Gibson Chironda- AVAC Fellow, Zimbabwe

Zimbabwe approved cabotegravir long-acting (CAB-LA) for HIV prevention. In March 2021, the Medicines Control Authority of Zimbabwe (MCAZ) approved CAB-LA for use as HIV pre-exposure prophylaxis (PrEP) in combination with oral emtricitabine/tenofovir disoproxil fumarate (FTC/TDF). This landmark approval made Zimbabwe the second country in sub-Saharan Africa, after South Africa, to approve CAB-LA for HIV prevention.

The approval of CAB-LA in Zimbabwe is a significant step forward in the country’s efforts to close the tap and the leaks reduce new HIV infections. Zimbabwe has one of the highest HIV prevalence rates in sub-Saharan Africa, with an estimated 1.3 million people living with HIV. The introduction of CAB-LA provides an important new prevention option for individuals at high risk of HIV, including young people, women, and key populations.

According to the World Health Organisation (WHO), AIDS is the leading of death cause of death among adolescents and is the cause of an increase in 50% in adolescent mortality giving negative RHS outcomes and according to the 90-90-90 Global Fastrack On HIV, 48% Of young people do not know their HIV status and they need parental consent.

Introducing  CAB- LA is not enough, there is a need to ensure that CAB-LA is accessible to those who need it most- the most affected- young people in their diversities. Efforts will need to be made to increase awareness of the intervention, expand access to healthcare services, reduce stigma and discrimination around HIV, and provide support for adherence.

The potential for CAB-LA compared to oral PReP which had more challenges with stigma and discrimination, adherence, pill burden, and accessibility has the potential to be a game changer for young people in the prevention of HIV, providing a convenient, effective, and discreet option for HIV prevention. To ensure that young people can access CAB-LA effectively, efforts should be made to increase awareness, reduce stigma, improve access through youth-friendly provision, and provide support for adherence through technology and peer-to-peer support.

Young people need the Convenience which CAB-LA offers, it only requires an injection every two months, which can be more convenient for young people who may be in different places each time due to school or have challenges accessing health facilities due to distance and other factors.

CAB-LA has also shown to be highly effective at preventing HIV transmission when taken as directed improving its Efficacy. This can provide young people with peace of mind and reduce the stress and anxiety that can come with concerns about HIV transmission.

Young people may be hesitant to disclose their sexual behavior to healthcare providers or family members. Privacy is key for young people. CAB-LA can be taken discreetly, without the need for regular healthcare visits or discussions with others, standing in long queues or being told to go to a green tent where its known and obvious that someone is collecting HIV prevention medication.

CAB-LA can help address adherence challenges that young people may face with daily oral PrEP. With CAB-LA, users only need to receive an injection every two months, which can reduce the risk of missed doses and increases adherence.

CAB-LA can help reduce the stigma associated with HIV prevention, as it does not require daily medication use or the use of barrier methods such as condoms.

Efforts to increase access are key to making sure that CAB-LA reaches young people. There is a need to address barriers to access including policies that impede sexually active young people to access services, including working to reduce stigma and discrimination and pushing for universal access to HIV prevention and treatment.

There is a need to implement PrEP programs, helping to increase awareness, demand, and access to these interventions, while also providing important services and contributing to research and advocacy efforts.

After this and others is done, there is hope for an HIV-free generation!




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