Zimbabwe rolls out long-acting HIV drug, among first countries to do so

HARARE, Zimbabwe — In a dusty field on the outskirts of Zimbabwe’s capital, a new chapter in HIV prevention began on Thursday as residents lined up for injections of lenacapavir, a groundbreaking drug requiring only two administrations per year.

A Turning Point in HIV Prevention

Zimbabwe is among the first nations globally to roll out lenacapavir, a long-acting medication authorities hope will significantly slow the spread of new infections. The country has faced tens of thousands of HIV-related deaths over the past two decades, making this development particularly significant.

Did You Know? Zimbabwe, along with Zambia and Eswatini, has emerged as a successful model in controlling the HIV epidemic, achieving key World Health Organization targets for testing, treatment, and viral suppression.

Clinical studies have demonstrated near-total protection with lenacapavir, leading some health officials to describe it as a potential turning point for those at highest risk. However, experts caution that realizing the drug’s full potential will require addressing funding limitations, infrastructure gaps, and ensuring consistent patient engagement.

Impact on Individuals

Constance Mukoloka, a 27-year-old sex worker, was among the first to receive the injection. She expressed relief, stating, “I am safe, I can work with confidence now.” Mukoloka explained that daily PrEP pills often created difficulties and stigma, increasing risk. She noted that clients sometimes left when seeing her medication, fearing it was HIV treatment.

The drug is being offered free of charge in Zimbabwe to individuals at high risk, including sex workers, adolescent girls and young women, gay men, and pregnant and breastfeeding women. It’s part of a donor-supported rollout across 10 African countries.

Navigating Challenges and Future Prospects

Developed by Gilead Sciences, the introduction of lenacapavir is being supported by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund. While daily oral PrEP has been available, adherence has been a challenge due to stigma and unpredictable schedules.

Expert Insight: The success of lenacapavir hinges on overcoming logistical and financial hurdles. While the drug itself represents a significant advancement, sustained impact requires robust health systems and consistent funding to ensure widespread access and continued patient support.

Zimbabwe’s Health Minister Douglas Mombeshora emphasized the importance of prevention strategies that integrate into real life, stating, “Prevention must fit into real life. If a health solution is too complicated, too demanding, or too visible, people simply won’t use it.” He described lenacapavir as “a new way of doing things.”

Approximately 46,000 people across 24 sites in Zimbabwe are expected to benefit from the initial phase of the rollout, representing a fraction of the potential need in a country of roughly 15 million.

Cost and Sustainability

The government hopes to expand the program as more donor-funded doses become available and to eventually acquire its own supply for a broader rollout. However, like many African governments, Zimbabwe faces financial constraints. The cost of the injectable is approximately $54 per person per year in Kenya, a significant expense for many.

Gilead Sciences has committed to selling the drug at no profit in low and middle-income countries. However, advocates like Bellinda Thibela of Health GAP caution that this is insufficient without sustained external funding, particularly given past cuts to U.S. Foreign aid.

Frequently Asked Questions

What is lenacapavir?

Lenacapavir is a long-acting HIV prevention drug that is administered via injection only twice a year.

Who is eligible for lenacapavir in Zimbabwe?

The injection is offered for free to high-risk individuals, including sex workers, adolescent girls and young women, gay men, and pregnant and breastfeeding women.

What are the potential challenges to the widespread adoption of lenacapavir?

Challenges include funding constraints, infrastructure gaps, and the need to ensure consistent patient engagement, as well as the high cost of mass rollouts for governments.

As Zimbabwe pioneers this new approach to HIV prevention, will sustained funding and robust health systems be enough to ensure that this promising drug reaches all those who could benefit?