South Africa to trial injectable PrEP

Adolescent girls and young women in South Africa will be able to get injectable PrEP in 2023 through a newly-announced pilot project.

What is this story about?

Injectable PrEP using long-acting cabotegravir (CAB-LA) to prevent HIV. It is called ‘long-acting’ because people only need to get the injection every two months (after getting the first two injections one month apart) instead of taking a PrEP pill every day.

Adolescent girls and young women in South Africa will be able to get injectable PrEP as part of a demonstration project that is expected to start in early 2023. It will begin once CAB-LA gets regulatory approval in South Africa.

Why is this important?

A number of African countries provide PrEP in pill form. Uptake is highest in South Africa and Kenya. In fact, South Africa accounts for around 1 in every 10 people in the world who take PrEP. But demand has not been as high as was hoped, particularly among adolescent girls and young women.

Making PrEP available as an injection could make it more appealing, as it will be more discreet to use and easier than taking a pill every day. But needing to go to a clinic every two months to get the injection could still stop some people from using it, even if they are at high risk of getting HIV. Among other things, this pilot will look at ways to make PrEP injections available in places other than clinics and hospitals.

What is happening?

This will be the first of a number of PrEP injection pilots in South Africa. All the findings will be used to inform a national rollout of injectable PrEP. Wits Reproductive Health and HIV Institute (Wits RHI) will run the pilot (it was one of the first organisations in South Africa to provide PrEP pills). The institute is also expected to run a pilot on the dapivirine vaginal ring, which is another type of PrEP, soon.

South Africa’s regulator will use evidence from the pilots to set the rules on who can provide PrEP injections and which groups can get injectable PrEP.

What does this mean for HIV services?

It is likely that only specialised nurses who already provide HIV treatment and PrEP pills will be trained to provide injectable PrEP – at least at first.

What is less clear is how injectable PrEP will be made available in places other than clinics. There are different options, such as providing injectable PrEP through mobile health clinics. Another idea are ‘shot clinics’. These are specialised clinics set up in community locations to provide PrEP injections. One challenge will be to make sure that mobile or temporary clinics return to areas regularly enough so that people can get an injection every two months.

It will be important to provide injectable PrEP alongside other sexual and reproductive health services and ensure that these services are accessible and friendly for young people. Health providers will also have to change the way they talk about HIV prevention because people will have more options to choose between.

Dr Saiqa Mullick, director of implementation science at Wits RHI, said: “The choice aspect is really important because what we've learned from family planning programmes is that the more choices you have, the more coverage and impact you're going to get.”