By Michael Gwarisa
The recently introduced long-acting cabotegravir (CAB-LA) for HIV prevention has seen more users returning to get the second dose post their first jab, with data showing that the injectable drug has recorded a continuity rate over 90% since roll out in April, 2024.
Currently, the Injectable PrEP is being administered in PrEP study sites in Harare, Mature and Bulawayo and is targeting mainly groups at high risk of HIV, namely Female Sex Workers (FSW), Adolescent Girls and Young Women (AGYW) and Men who have Sex with other Men (MSM).
CAB-LA is an intramuscular injectable, long-acting form of PrEP, with the first two injections administered four weeks apart.
Population Solutions for Health (PSH) Technical Specialist Voluntary Medical Male Circumcision (VMMC) Dr Leslie Bidi told an HIV Prevention strategic meeting in Harare that uptake of CAB-LA was impressive.
We are above the target as of the 16th of June 2020. In terms of recipients of care who are coming for the second injection, so far it has been relatively good with an average of 91% in all three sites. Only 15 did not come back for their second injection,” said Dr Bidi.
He added that there were higher CAB-PrEP continuation rates at one month compared to oral PrEP from the same sites. In terms of disaggregation by previous PrEP methods, Dr Bidi said 28% were PrEP naïve while 70% were on Oral Prep and a very tiny percentage (0.4%) were on the Dapivarine Ring.
“Regarding adverse events and seroconversions, we did not have any seroconversions yet and the adverse events we have recorded were around pain post-injection which the three recipients indicated as their reason for returning to Oral PrEP.”
In terms of challenges, Dr Bidi said there was problem ensuring minimal disruptions to care for recipients of care who would have travelled or transferred to other districts.
“There are also transport challenges to clinics for injections. You find that some recipients of care used to community refills when they were still on Oral PrEP. There is also an unmet demand for CAB-LA by other sub-populations since CAB_LA is currently available for specific populations,” said Dr Bidi.
The PrEP programme in Zimbabwe continues to sustain the gains made, attaining 42% of the annual target as of March 2024, and surpassing the quarterly target by approximately 68% according to the Ministry of Health and Child Care (MoHCC).
Mrs Getrude Ncube, the National HIV Prevention Coordinator MoHCC AIDS and TB Programme said more users of PrEP products were transitioning to CAB-LA.
“MSM and FSW are exhibiting a preference for transitioning from oral PrEP to CAB-LA, citing reduced pill burden. The switch to CAB-LA has addressed concerns related to oral PrEP, including pill fatigue, discreteness and convenience, thereby improving the overall experience and outcomes for individuals at risk of HIV infection,” said Mrs Ncube.
She added that FSWs’ high mobility requires flexibility in service delivery, including the need for CAB-LA injections in non-implementation districts. According to Mrs Ncube, facility-based service delivery may exclude clients in hard-to-reach areas, creating geographical barriers that hinder access to CAB-LA.
