Broadening the choices on HIV prevention options
After many countries and companies worked tirelessly to find a vaccine for COVID-19, Moderna and Pfizer have announced the development of two vaccines that vastly reduce risk of illness from this new, dangerous virus. It’s grand to know we are making progress towards the fight against COVID. In this blog, however, I want to talk about HIV prevention options.
Oral PrEP around the corner?
Oral pre-exposure prophylaxis (PrEP) is about to be rolled out as an instrumental HIV prevention option in Malawi. Other prevention options available in our country include condoms, voluntary medical male circumcision and even ARV treatment, which can prevent HIV transmission when someone is virally suppressed. PrEP is the use of ARV drugs (usually Truvada) by HIV negative persons to prevent acquiring HIV. PrEP currently comes in pill form and is for those who are at high risk for HIV. In Malawi, these groups include young women, sex workers, men who have sex with men, incarcerated individuals and transgender people.
Oral PrEP has been found to be effective when taken correctly and consistently, with its effectiveness reaching 99%! The World Health Organization began recommending PrEP use in adults in 2015 and since then it has been identified globally as instrumental in reducing new infections.
Why focus on prevention
While Malawi has made tremendous progress towards the 90:90:90 testing and treatment targets (targets that have since been updated to 95-95-95), we have not accomplished enough in terms of prevention. Despite unprecedented scale-up of many prevention programs, Malawi did not achieve the Global Prevention Coalition target of reducing new HIV infections by 75% in 2020. Malawi set a target to reduce new HIV infections to 11,000 in the year 2020. However, by the end of last year, new HIV infections in adults were at almost 33,000. These numbers clearly demonstrate that we have much work to do in combatting the spread of new infections, however, prevention is essential in achieving epidemic control.
Oral PrEP or Long acting Injectable PrEP?
I had the pleasure of discussing oral PrEP during a radio programme, ‘Day Break Malawi’ on Capital FM. The presenter I was speaking with brought up injectable PrEP as she had heard this was a “better option” than oral PrEP.
Indeed, as Malawi is about to roll out oral PrEP, another form of PrEP is also on the horizon. This option is long-acting injectable PrEP. This is PrEP with an ARV drug administered through injection instead of by oral pill. The drug, called cabotegravir, is also commonly known as CAB- LA. Unlike Truvada, this injection is taken only every two months during seasons of risk. Some people find it easier to go for a shot every 8 weeks than to take a pill every day. So why still talk about oral PrEP in Malawi when there is an even newer, perhaps easier prevention option?
Protecting the gains already made
First of all, let’s celebrate but not get carried away with the exciting news on CAB LA. CAB LA is yet to go through regulatory reviews for it to be approved and rolled out in many countries, including Malawi. This process takes some time. Oral PrEP however, will be available and accessible to targeted communities in Malawi early this year, 2021.
And further- people all have different preferences. While some may prefer intermittent injections, others prefer a daily pill they can take from the comfort of their own home. To put it simply: the more choices we have, the better.
It is crucial that we invest in multiple prevention options, including oral PrEP, long-acting injectable PrEP, and the dapivirine ring. To address everyone’s individual needs and preferences, we need all of these options. Today, let us celebrate that we are getting closer to rolling out oral PrEP for Malawians. This is necessary progress.