Amid stalled HIV prevention, WHO backs new long-acting cabotegravir for prevention


New guidelines from the World Health Organization (WHO) advise countries to use the new potentially groundbreaking drug not yet on sale as pre-exposure prophylaxis (PrEP) for HIV and as part of a comprehensive approach to prevent the virus from spreading.

Those taking most of the PrEP drugs on the market have to remember to take their medication on a daily basis, more challenging for what is a preventative drug.

“Long-acting cabotegravir is a safe and highly effective HIV prevention tool, but it is not yet available outside the study environment,” said Meg Doherty, director of the WHO’s Global HIV, Hepatitis and Sexually Transmitted Diseases Programs.

The drug was approved last December in the United States and the following month in the United Kingdom.

Critical moment

Major populations — including sex workers, men who have sex with men, intravenous drug users, those in prison, transgender people and their sexual partners — were responsible for 70 percent of global HIV infections last year.

In addition, there were 4,000 new infections within that group every day in 2021.

As HIV prevention efforts have stalled, the new guidelines were released ahead of the 24th International AIDS Conference (AIDS 2022) — which officially begins Friday — with 1.5 million new HIV infections reported last year, the same as in 2020.

“We hope these new guidelines will help accelerate the country’s efforts to begin planning and delivering CAB-LA alongside other HIV prevention options, including oral PrEP and the vaginal ring of dapivirine,” the WHO said. officer.

Game changer drug

CAB-LA is an intramuscularly injectable, long-acting form of PrEP.

The first two injections are given four weeks apart, then an injection every eight weeks.

In randomized controlled trials, the antiretroviral was found to be safe and highly effective in cisgender women, cisgender men who have sex with men, and transgender women who have sex with men.

Together, these groundbreaking studies showed that the use of CAB-LA resulted in a relative reduction in HIV risk of 79 percent compared to oral PrEP, where taking oral medication on a daily basis was often challenging, according to the WHO.

Long-acting injectable products have also been found to be acceptable and sometimes preferred in community PrEP studies.

© UNICEF/Soumi Das

A woman is tested for HIV in Uttar Pradesh, India.

coalition force

The UN health agency also launched a new coalition to accelerate global access to the drug.

The coalition, convened by WHO, Unitaid, UNAIDS and The Global Fund, will identify interventions needed to promote short- and long-term access to CAB-LA, secure funding and procurement for the drug, and issue policy guidelines. among other activities.

“To achieve UN prevention goals, we must push for prompt, equitable access to all effective prevention tools, including long-acting PrEP,” said Rachel Baggaley, WHO’s head of the Testing, Prevention and Populations Team at Global HIV, Hepatitis and STI Programs. .

“That means overcoming critical barriers in low- and middle-income countries, including implementation challenges and costs.”

Main actions

WHO will continue to support evidence-based strategies to increase access to and uptake of PrEP, for example by adopting CAB-LA and including it in HIV prevention programmes.

It also works with Unitaid and others to develop projects that address outstanding security and implementation challenges.

And the WHO Global PrEP Network will host webinars to provide up-to-date information about CAB-LA to raise awareness.

In April, it was added to the WHO’s list of expressions of interest for prequalification assessment by the health authority.

Prevention Choices

Both oral PrEP and CAB-LA are highly effective.

The new CAB-LA guidelines are based on a public health approach that considers effectiveness, acceptability, feasibility and resource needs in different settings.

They are designed to aid the delivery of CAB-LA and the urgently needed operational research into address implementation and security, and will make decisions about how to successfully deliver and scale CAB-LA.

The guidelines highlight critical research gaps and also recognize that access to current PrEP services is challenging for some.

“Communities should be involved in developing and delivering HIV prevention services that are effective, acceptable and supportive of choice,” the WHO said.

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