In a bid to widen HIV prevention and contraceptive options for women and girls, Zimbabwe could be adopting a revolutionary Dual Prevention Pill (DPP), in the not so distant future.
By Michael Gwarisa
The Dual Prevention Pill adds to the list of other Biomedical HIV prevention tools Zimbabwe has adopted over the past few years which include the Dapivirine Vaginal ring that was adopted in 2021 and the Long-Acting Injectable PrEP that was approved for use in 2022. However, roll-out of these products is yet to commence in Zimbabwe.
Speaking in an interview with HealthTimes on the side-lines of the ICASA Mini Biomedical HIV Prevention Forum in Harare, Dr Pamela Mukwekwerere from University of Zimbabwe Clinical Trials Research Center (UZCTRC) said it was just a matter of time and procedure before the dual prevention products find their way into the country.
This is already something that is coming to Zimbabwe and it is already in the pipeline. We have participated in research in terms of a lot of these HIV prevention packages and these dual prevention packages are coming and you will soon be seeing them,” said Dr Mukwekwerere.
She added that dual prevention packages addresses the adherence issue as well as the pill burden in women who in most cases have to alternate between contraceptives, PrEP or PeP and other medications.
“When we talk about Dual Prevention package, this is where we are saying these interventions include HIV prevention as well as STI and pregnancy prevention. These are very good options because they are quite convenient for the woman because it’s like a two in one where a woman does not need to take separate products but it’s all just in one. It is also good because it improves adherence to the products.”
She added that despite the remarkable advances in contraceptive provision and HIV treatment and pre-exposure prophylaxis, African women continue to bear a disproportionate and double burden of HIV and unmet need for contraception.
“The DPP is currently being developed by public and private initiatives for daily use to prevent both HIV and pregnancy. It is one of several multipurpose prevention technologies (MPTs) – a single product designed to address multiple health needs – in the pipeline. The DPP combining TDF/FTC-based oral PrEP with oral contraceptives (OC) is furthest along in development. Another DPP combining F/TAF with OC is also in development,” said Dr Mukwekwerere.
According to Dr Mukwekwerere, a single product or approach will not stop the pandemic. However, she indicated that a decade after approval of biomedical interventions such as PrEP, only a fraction of people who need oral PrEP are using it.
To date, nearly 3.9 million people have initiated oral PrEP globally. PrEP distribution/uptake is not equitable when compared to the distribution of new HIV diagnoses. Barriers and challenges to PrEP are multi-level: Individual level, Inter-personal and community level and structural/policy level.
Gloria Nduku said Biomedical methods that are safe and effective and requires Research and Development of additional options to add to the “method mix and he ability for an individual to select from an array of options requires policymakers, donors, governments & and implementers to make the “mix” available, accessible and affordable.
“There is need integrate HIV prevention into existing information and service packages such as family planning, cervical cancer prevention, antenatal care, and postnatal care to ensure easy access and availability of prevention methods,” said Nduku.
She said there is also need to support, prioritize and finance interventions to prevent sexually transmitted infections among adolescent girls and young women who are especially vulnerable due to anatomical makeup, and cultural and traditional constraints that hinder negotiation for safer sex and adequate protection against STIs.
Meanwhile, in a speech read on his behalf, National AIDS Council Chief Executive Officer, Dr Benard Madzima, said Zimbabwe needs to take a very active role in order to prevent new HIV infections in children and to keep mothers alive.
“The recent Zimbabwe Population Based HIV Impact Assessment (ZIMPHIA) also highlighted that 3 % of females and 2.4% of males have ever been infected with syphilis among adults’ ages of 15 to 64 years. Even though there has been declines in syphilis, the country has not yet reached levels where the disease is no longer a public concern.
“The statistics above show a need for the country to take a very active role in order to prevent new HIV infections in children and to keep mothers alive. No longer should babies be born with or immediately infected with HIV and syphilis.”
He further appealed for the promotion of effective uptake and utilization of the country’s vibrant Prevention of Mother to Child Transmission (PMTCT) services which no longer just focus on prevention of HIV and syphilis but have also expanded to prevention of Hepatitis B.
