Pioneering HIV Prevention: South Africa Launches CAB-LA Injection Pilot Projects

South Africa is taking a significant step forward in HIV prevention with the introduction of pilot projects for a new HIV prevention injection. A young person in Cape Town recently became one of the first to receive this injection outside a clinical trial, marking a momentous occasion for public health innovation in the country.

The product in question is a long-acting injection containing cabotegravir (CAB-LA), which provides two months of HIV protection per shot. Pakama Mapukata, a nurse, and study coordinator expressed both excitement and nervousness with the initiation of the project. The injection's reception has been positive, with the first recipient reporting minimal pain, less than that of typical sexually transmitted infection injections they received previously.

Access to the CAB-LA shot is currently through select pilot projects, with the Desmond Tutu Health Foundation's FAST PrEP study in Cape Town being a notable example. These pilots serve as a crucial foundation for assessing the potential for broader rollout and for gathering valuable data on the real-world application of new PrEP options such as CAB-LA and the dapivirine vaginal ring (DPV-VR).

What sets the CAB-LA injection apart is its innovative form—one that is non-oral, providing an alternative to those who may struggle with daily pills or who prefer a longer-lasting method of prophylaxis. Elzette Rousseau, a social behavioural scientist and co-investigator for FAST PrEP, highlighted the diversity of the initial recipients, which included young men who have sex with men (MSM) and young women—populations that are at a heightened risk of HIV infection.

The CAB-LA injections and DPV-VR rings have been approved by the South African Health Products Regulatory Authority (SAHPRA). Yet, there are challenges ahead. Generic versions are not expected for another three to four years, and the country is currently grappling with a shortage of the injection, coupled with its high cost, which constrains widespread implementation.

Delays, however, have not dampened the spirit of the project. With the National Department of Health yet to purchase CAB-LA for public distribution, available doses have been secured through donations, including from international sources such as PEPFAR. Prepare to Choose has sufficient CAB-LA doses for 900 participants over an 18-month period, a figure that represents just the beginning of what is hoped to be a broader reach in the near future.

The FAST PrEP study is focused on the Klipfontein and Mitchells Plain Health Sub-Districts in the Western Cape and uses both fixed and mobile clinics to deliver services, including education and counseling provided by trained peer navigators. With the study targeting a sizeable enrolment and the potential for continued funding and access beyond next year, there is cautious optimism about the role that initiatives like these will play in reducing new HIV infections.

The pilot's initial findings suggest a tailored approach to PrEP, with participants choosing the method that best fits their lifestyle—whether it's the injection, the pill, or the ring. Particularly encouraging is the uptake of CAB-LA among young women and adolescents, a demographic with a significant HIV burden.

Importantly, these pilot projects are more than just clinical studies; they serve as crucial platforms for engagement with young people and the community, ensuring that the voices and preferences of those most affected by HIV are heard and catered to.

As South Africa forges ahead with these pilots, the insights gained will undoubtedly shape the future of HIV prevention in the country and beyond, offering hope of a world where HIV is no longer an insurmountable public health challenge.