Michael Gwarisa
As Zimbabwe takes delivery of its first doses of Lenacapavir, the new long-acting injectable for HIV prevention, public health experts are urging citizens to understand that this is not a replacement for existing prevention methods, but rather a powerful addition to the country’s combination prevention approach.
The announcement came during a Continuing Medical Education (CME) session hosted by the Zimbabwe College of Public Health Physicians in Harare, where leading clinicians and HIV experts outlined the role of Lenacapavir in the broader fight against HIV.
Dr Owen Mugurungi, Director of the AIDS, TB and Malaria Unit in the Ministry of Health and Child Care (MoHCC), confirmed that Zimbabwe had received the first shipments of the drug.
“While some sections of the media have referred to Lenacapavir as a ‘miracle drug,’ let me be clear, it is not a miracle. It is a highly effective preventative tool, but it is not a vaccine,” he said, stressing the need for accurate messaging to avoid misconceptions.
Zimbabwe currently offers four PrEP options: Dapivirine Vaginal Ring, Oral PrEP, injectable Cabotegravir (CAB LA), and now Lenacapavir. These methods complement traditional prevention strategies such as condom use and Voluntary Medical Male Circumcision (VMMC).
Clinical Insights from Dr. Emily Gwavava
Dr Emily Gwavava, a Ministry of Health consultant, provided detailed insights into Lenacapavir administration. “On the first day, clients receive two injections, either in the abdomen or the thighs, and two oral tablets under direct observation. They are then given two additional tablets to take home the following day. By adhering to this regimen, clients are protected within 24 hours,” she explained.
She emphasised that strict adherence is critical. Missing doses can delay protection, and clients must return to health facilities for follow-up injections.
“For long-acting methods like Lenacapavir, appointments are set at 26 weeks after the first injection, with a two-week window before and after. Missing this window means restarting the initiation regimen,” she said.
She also highlighted that even after the final injection, Lenacapavir remains in the body for up to 12 months, although at sub-protective levels in the last six months.
“During this period, if clients are exposed to HIV, there is a risk of developing resistance to capsid inhibitors,” she noted, underlining the need for continued vigilance.
Training and Capacity Building
Dr Mugurungi and Dr Byron Chingombe of CESHAR both emphasized the ongoing training of healthcare workers nationwide.
“Training is not a one-off event. All sites offering Lenacapavir have trained staff, and as the program grows, more healthcare workers are being trained to ensure the regimen is administered correctly,” Dr Chingombe said.
He added that training extends beyond nurses to health promotion officers and community teams, creating a strong support network for clients.
Practical Considerations and Contraindications
Dr Gwavava shared further insights on clinical considerations. “Clients with acute HIV infection or severe heart and lung conditions should not start Lenacapavir. The drug is metabolized by the liver, and medications that interact with the CYP3A pathway, such as anti-TB drugs and anti-epileptics, can reduce its effectiveness,” she explained.
She also raised a cautionary note about the use of sex-enhancing drugs alongside Lenacapavir, as interactions could increase concentrations of these substances in men, potentially leading to health complications. “It is important for healthcare providers to ask clients about all medications they are taking, including over-the-counter and traditional remedies,” Gwavava said.
Addressing Public Health Challenges
From a public health perspective, the introduction of Lenacapavir offers an opportunity to assess the country’s broader HIV prevention landscape. Oral PrEP, while effective, has faced challenges with adherence. Studies show that less than 25% of clients continue the regimen beyond three months. The long-acting nature of Lenacapavir could address this gap, provided clients adhere to follow-up schedules.
Experts also highlighted populations at heightened risk, such as artisanal miners who spend long periods away from home. “We must seize every opportunity to reach these groups—whether during routine clinic visits or when they seek care for unrelated injuries,” Dr Gwavava said, illustrating the nuanced approach required to expand PrEP coverage effectively.
Community Engagement and the Role of the Media
Dr Mugurungi stressed the importance of involving the media in awareness campaigns. “Accurate reporting ensures the public understands that Lenacapavir is complementary, not a substitute, for existing HIV prevention methods. Misinformation could lead to complacency,” he said.
Healthcare providers are also being trained to counsel clients comprehensively, including explaining potential side effects, drug interactions, and the importance of follow-up injections. The CME session highlighted the Ministry of Health’s strategy to integrate Lenacapavir into Zimbabwe’s broader HIV prevention program safely and effectively.
A Complement, Not a Replacement
Lenacapavir’s arrival in Zimbabwe is a landmark moment in the nation’s fight against HIV, but experts stress that it should be viewed as part of a combination prevention approach rather than a standalone solution. With careful adherence, proper clinical oversight, and ongoing public education, the new injectable offers hope for enhanced protection, particularly for those struggling with adherence to daily oral PrEP.
