The government’s plan to introduce Lenacapavir, a new twice-yearly injectable drug for HIV prevention, early next year has sparked excitement and questions about the future of other prevention methods like condoms.
The drug, developed by Gilead Sciences, a US-based company, was tested in Uganda and South Africa, with studies showing over 99 percent efficacy in preventing HIV infection.
According to Dr Vincent Bagambe, the director of planning and strategic information at the Uganda Aids Commission (UAC), Uganda has endorsed a combination prevention approach, not a single method.
‘Our strategy is the use of a combination prevention approach. Lenacapavir offers 99-point-something percent protection, so we recommend other methods like condom use to make it 100 percent,’ he said.
‘Besides HIV, condoms also prevent infections like syphilis, gonorrhoea, human papilloma virus, and other STIs. So we will still be using condoms,’ he added.
Despite this, condom use in Uganda is steadily declining even as 730 people contract HIV every week.
The drop comes amid high rates of teenage pregnancies, many of which could be prevented with consistent condom use and behavioural change.
Concerns
Mr Boniface Epoku, the condoms programme officer at the Ministry of Health, attributed this decline partly to the introduction of new HIV prevention methods such as Pre-Exposure Prophylaxis (PrEP).
‘As the ministry embraces a combination prevention approach, we’ve realised that when new technologies come in-like PrEP-people tend to abandon condoms,’ he explained. ‘So there’s been a decline in condom use mainly because of that,’ he added.
Government statistics show that condom use among adolescent males dropped from 946,892 in the 2020/2021 financial year to 779,081 in 2022/2023. Among adolescent females, usage declined from 23,090 to 20,266 during the same period. Health experts fear the introduction of Lenacapavir could worsen this trend unless effective communication strategies are put in place.
Currently, individuals who participated in the Lenacapavir clinical trial continue to receive the twice-yearly injections, while the wider rollout awaits an increased supply expected next year. Other PrEP options are already available in Uganda, including daily oral pills, the Cabotegravir injection (taken once every two years), and a vaginal ring for women.
Study findings
A 2024 report by Susan Waako from the Uganda National Institute of Public Health revealed that at least 32,000 adolescent girls and young women at elevated risk of HIV were initiated on PrEP between 2017 and 2022.
However, adherence remains a challenge, especially with oral PrEP, underscoring the appeal of a long-acting injectable like Lenacapavir. Uganda’s rollout will depend on the number of doses secured through global partnerships.
Dr Herbert Kadama, the Ministry of Health’s PrEP coordinator, said the country is expecting 36,000 doses through the Global Fund-World Bank partnership, though the quantity from the US government remains uncertain.
‘We still don’t know the exact number of doses from the US government. The Government of Uganda is making procurement along with the Global Fund. We expect around 36,000 doses,’ he said. While this figure is modest for a country of 45.9 million people, health officials view it as a critical first step. The doses are expected early next year.
Low-cost plans
The Bill and Melinda Gates Foundation also announced a partnership with Hetero Labs, an Indian manufacturer, to produce low-cost generic versions of Lenacapavir for low- and middle-income countries.
Following Gilead’s royalty-free licensing agreement with six generic manufacturers, the generic drug could be available by 2027 at roughly $40 (Shs136,000) per patient per year, compared to the current commercial price of $28,000 (Shs96 million).
Who will benefit first?
According to Dr Hudson Balidawa, the officer-in-charge of monitoring Global Fund HIV investments in Uganda, the first doses will go to existing PrEP sites already serving high-risk populations such as sex workers, people in discordant relationships, and individuals who inject drugs. ‘We already have the sites offering oral PrEP, vaginal rings, and injectable Cabotegravir,’ he said.
‘These will be the same sites offering Lenacapavir. A new client can start on Lenacapavir, and existing clients can switch from oral or Cabotegravir to the new drug,’ he added.
Despite the optimism surrounding Lenacapavir, public health experts emphasise that condoms remain essential for comprehensive protection. The UAC urges Ugandans to continue using available PrEP options and to maintain consistent condom use even as the country prepares to roll out the new injection.
Background
Data shows a noticeable decline in condom distribution and use among adolescents in recent years.
Among adolescent males, the number of condoms distributed fell from 946,892 in the 2020/2021 financial year to 779,081 in 2022/2023.
A similar trend is seen among adolescent females, where distribution dropped from 23,090 condoms in 2020/2021 to 20,266 in 2022/2023.
Health experts attribute this downward trend to a growing reliance on newer HIV prevention technologies, such as oral Pre-Exposure Prophylaxis (PrEP) and injectable drugs like Cabotegravir and the soon-to-be-introduced Lenacapavir