Zim prepares nationwide lenacapavir rollout

Rumbidzayi Zinyuke-Senior Health Reporter

ZIMBABWE will begin scaling up access to the long-acting HIV prevention medicine lenacapavir in January next year, with the first batch of 23 000 doses already in the country under United States-funded support.

The rollout will build on an initial programme that has seen strong demand for the twice-yearly injection, with health authorities recording about 4 700 initiations from the first doses distributed across 12 sites since February this year.

In an interview, the Ministry of Health and Child Care Aids and TB unit director Dr Owen Mugurungi said the second phase of the programme would continue until early next year, when preparations for national implementation would be completed.

He said Government was already training health workers, preparing facilities and developing alternative delivery points, to ensure lenacapavir was accessible beyond conventional clinics.

“The demand for lenacapavir is very strong. For obvious reasons, it is one injection for every six months, or two injections per year, and people want choice. We want to make sure that as many people as possible can access an HIV prevention method that works for them, rather than relying on only one option,” Dr Mugurungi said.

Lenacapavir is a long-acting HIV prevention medicine administered twice a year, offering an alternative to daily oral pre-exposure prophylaxis (PrEP).

Zimbabwe initially received 2 000 doses and targeted districts with high HIV incidence, areas where PrEP was already being used and districts facing challenges in HIV treatment and prevention.

The demand quickly exceeded expectations, with most of the first consignment taken up within the first two weeks.

Dr Mugurungi said the rapid uptake had forced the Ministry to adjust its distribution plans to ensure people who had started using lenacapavir could receive their second injection.

“We anticipated that maybe the injections would go on for about three months or so, but in the first two weeks the majority of the lenacapavir was already taken. We then had to ask ourselves what we were going to do because we wanted to make sure that those who had started on lenacapavir would at least get their second injection for the year,” he said.

After an additional consignment arrived, uptake continued to increase, with the country now recording an average of about 500 new initiations a week.

The medicine has been particularly popular among women, although officials are seeking to increase uptake among men. The largest age group using Lenacapavir is between 24 and 45 years, while health authorities have also managed to reach adolescent girls and young women, who remain an important population in HIV prevention.

Dr Mugurungi said the programme was also attracting people who had never previously used PrEP, potentially expanding the reach of HIV prevention services.

“The majority of people who are now on Lenacapavir had never used PrEP before, which is encouraging. Those who were already using other prevention methods can continue with them or choose Lenacapavir, but we are also bringing into prevention people who had previously not been using any PrEP at all,” he said.

Health authorities have also reported relatively few side effects from the injections. Of the nearly 5 000 injections administered, only 13 side effects were reported, mainly involving reactions around the injection site, said Dr Mugurungi.

The planned expansion comes as Zimbabwe seeks to maintain HIV prevention and treatment gains at a time external financing for health programmes has dwindled significantly.

Dr Mugurungi said the United States had procured about 43 000 doses for Zimbabwe, with the 23 000 doses already in the country and the remaining 20 000 doses expected soon.

However, he said, Zimbabwe would have to identify additional sources of financing as the US-supported supply comes to an end.

“We have received 43 000 injections from the American Government, but after that they will not be supporting us with these commodities. We therefore need to look for additional resources from elsewhere, and we will be looking at the Global Fund before Lenacapavir becomes available for national implementation. When it becomes available, the Global Fund and the Government of Zimbabwe will have to provide the resources for Lenacapavir,” Dr Mugurungi said.

The Ministry is now preparing districts for the national rollout, with facilities expected to be assessed for their readiness to provide the medicine.

Dr Mugurungi said each district would identify HIV hotspots where prevention services would be prioritised, while lessons from the current programme would be used to improve national implementation.

“We are already in the mode of capacity building, training, activation, supervision and mentorship. We need to make sure that facilities are ready, that the health workers are trained and that we have systems in place to provide Lenacapavir and follow up those who are receiving it. We want to learn from this phase so that when we move into full national implementation next year, we do not have many hiccups or interruptions,” he said.

However, he said expanding access would require moving beyond health facilities.

“We cannot continue to give this injection only in clinics because we also have challenges in accessing clinics. We need to do outreaches and open new frontiers in the provision of this service. We are already looking at modalities that would allow people to access Lenacapavir from pharmacies, and we also want to make sure that the outreach programmes taking place across the country can provide this service,” Dr Mugurungi said.

Zimbabwe currently uses a combination prevention approach that includes PrEP, condoms, HIV testing, treatment and other interventions.

Dr Mugurungi said expanding prevention options was therefore critical to closing existing access gaps.

“We want Zimbabwe free of HIV and AIDS, and we need to continue to fight stigma and discrimination and protect the rights of our people, specifically adolescents, young women and key populations. We must also go beyond the urban areas and reach rural communities, mining communities and farming communities so that Lenacapavir and other prevention services are available to every Zimbabwean who needs them,” he said.

Source: Zim prepares nationwide lenacapavir rollout – herald

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