Advancing the use of Long‐Acting Extended Delivery formulations for HIV prevention in sub‐Saharan Africa: challenges, opportunities, and recommendations

Abstract

Introduction:The burden of HIV in sub-Saharan Africa (SSA) remains unacceptably high, and disproportionately affects girls and women. While the introduction of oral HIV pre-exposure prophylaxis (PrEP) in 2012 revolutionized HIV prevention, its effectiveness is dependent on user adherence and its implementation in SSA has faced numerous challenges. Patient-level, interpersonal and structural barriers, including, for example, daily pill burden, side effects, lack of partner support, testing and disclosure, and costs have been found to reduce adherence to oral PrEP. Discussion: Long-acting extended delivery (LAED) formulations for PrEP, such as injectable long-acting cabotegravir (CAB-LA) and dapivirine vaginal ring (DPV-VR) are critical additions to the HIV prevention toolkit and are especially important for populations such as adolescent girls and young women (AGYW) and other key populations who remain at significant risk of HIV acquisition while facing substantial barriers to preventive services. These LAED formulations have been shown to result in better adherence and fewer side effects, with CAB-LA being superior to oral PrEP in reducing the risk of HIV acquisition. They can be used to overcome user burden and adherence challenges. However, the successful rollout of the DPV-VR and CAB-LA may be hampered by issues such as a shortage of healthcare providers (HCPs), inadequate parenteral medication infrastructure, increased workload for HCPs, patient concerns, the price of the medications and the possibility of drug resistance. Conclusions: SSA must develop laboratory capabilities for monitoring patients on LAED formulations and enhance research on developing more non-injectable LAED formulations. There is a need to train and retain more HCPs, implement task shifting, invest in healthcare infrastructure and integrate healthcare services. To reduce costs and improve availability, the region must advocate for patent license waivers for LAED formulations and procure drugs collectively as a region.

Exploring Barriers and Facilitators That Influence Uptake of Oral Pre-Exposure Prophylaxis Among Men Who Have Sex With Men in Bulawayo, Zimbabwe: Key Stakeholder’s Perspectives

“…It is also reported by different scholars that there is stigma that is usually associated with sexual orientation as a significant number of communities in different countries have not fully embraced the key populations and acknowledged their existence and their rights ( Adeagbo et al, 2021 ; Grant et al, 2014 ; Harawa et al, 2016 ; Pelletier et al, 2019 ; Philbin et al, 2016 ; Santos et al, 2022 ; Voglino et al, 2021 ). Certain writers have demanded that providers of sexual health services guarantee a decrease in stigmatization and that their services are free from discrimination ( Mgodi et al, 2023 ). It is envisaged that this call for accessible discrimination-free services would encourage MSMs to access PrEP and thus reduce the risk of being infected with HIV.…”

“…Several factors hamper PrEP uptake for HIV prevention in African nations. Different authors have alluded to this low uptake of PrEP among MSMs in different country contexts in Sub-Saharan Africa to be a lack of awareness and knowledge ( Matacotta et al, 2020 ), stigma and discrimination ( Isano et al, 2020 ; Keuroghlian et al, 2021 ), legal and policy barriers ( Embleton et al, 2023 ; Mbilizi Chimwaza et al, 2022 ), limited access to health care ( Mgodi et al, 2023 ; Muraguri et al, 2012 ), cost and affordability of health services ( Mgodi et al, 2023 ), health care provider bias and inadequate training ( Keuroghlian et al, 2021 ), and lack of tailored health services and privacy and confidentiality concerns ( Khozah & Nunu, 2023 ; Munyimani & Nunu, 2022 ).…”

A Bilayer Microarray Patch (MAP) for HIV Pre-Exposure Prophylaxis: The Role of MAP Designs and Formulation Composition in Enhancing Long-Acting Drug Delivery

“…Injectable formulations must be delivered by skilled health care professionals, adding to the cost of PrEP and increasing the burden on health care programs, particularly in areas with fewer health care workers. This is a major global health issue, as the HIV incidence rate is exceptionally high in sub-Saharan Africa relative to other parts of the world [ 14 ]. These routine, painful injections may also have a negative effect on patient compliance over the long term.…”

A conjoint experiment of three placebo rectal products used with receptive anal sex: results from MTN‐035

“…rings, films, implants, vaccines and rectal microbicides [RMs]) [ 1 , 2 ], has reinforced the need to understand how individuals make decisions regarding their preferred HIV prevention strategies. Preferences in HIV prevention strategies may also vary based on diverse socio‐cultural contexts, including the availability of PrEP modalities and healthcare infrastructure across regions [ 3 − 5 ].…”